Palmer Crescent is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Palmer Crescent accommodates up to 24 people in four bungalows on one site, each of which has separate adapted facilities. The registered provider of the service is Welmede Housing Association Limited, part of the Avenues Group, which specialises in providing care to people with learning disabilities or autism.
There was no registered manager in place at the time of our inspection. The previous registered manager had left their post at the beginning of February 2018. A new manager had been appointed and was due to take up their post the week after our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider’s cluster manager told us the new manager would apply for registration with CQC.
We found there was an over-reliance on agency staff which affected people’s experience of care. There was a high number of vacancies on the permanent staff across the four bungalows. The provider had maintained the staffing levels needed to keep people safe but the high use of agency staff meant people were often supported by staff who did not know them well. Relatives told us that it was important for their family members’ well-being to be supported by familiar staff who knew their needs well. They said the high use of agency staff was discomfiting for their family members. The high number of vacancies also placed pressure on the remaining permanent staff. They were working hard to ensure people received the care they needed but some staff were working excessive hours.
Shortages of permanent staff also affected people’s opportunities to take part in activities. There were not enough authorised drivers employed to take people to some of their planned activities and staff had to prioritise taking people to medical appointments. This meant that some people’s identified needs were not being met.
Following our inspection the provider’s regional manager acted promptly to develop an action plan to address the concerns we had identified. This plan set out how the consistency of care people received would be improved and how permanent staff would be supported. Actions included allocating experienced staff from elsewhere in the organisation to support the service until new permanent staff could be recruited and block-booking agency staff to ensure that regular agency staff were employed.
Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. Health and safety and fire safety checks were carried out regularly to ensure the home was safe and well maintained. The provider had developed a contingency plan to ensure that people’s care would continue in the event of an emergency. The bungalows were suitably adapted and designed to meet people’s needs. Adaptations and equipment had been installed where necessary to ensure people were able to mobilise safely.
Staff were recruited safely. The provider obtained evidence from agencies that the temporary staff supplied had undergone appropriate pre-employment checks. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. People received their medicines safely and as prescribed. Staff maintained appropriate standards of hygiene and cleanliness and followed safe infection control procedures.
People’s needs had been assessed before they moved into the home to ensure staff could provide the support they required. Staff had the training and support they needed to carry out their roles effectively. Staff attended an induction when they started work and had access to ongoing training. Specific training was provided if people developed needs that required it. The provider checked that agency staff had attended training relevant to the roles they performed.
People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. People who lacked capacity received appropriate support when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe,
People were able to make choices about the food they ate and were supported to maintain a healthy diet. Staff ensured that individual support guidelines around diet and nutrition were followed. People were supported to maintain good health and to obtain treatment when they needed it. Each person had a health action plan which detailed their health needs and the support they needed.
Staff treated people with respect and maintained their dignity. They respected people’s individual rights and promoted their independence. People were supported to make choices about their care and to maintain relationships with their friends and families.
Care plans had been developed where needs had been identified during assessment. These were personalised and provided guidance for staff about how care should be delivered. They also outlined what people could do for themselves and how staff could support them to be independent. The provider had established people’s preferences about their end of life care to ensure their wishes would be respected should they become seriously ill.
There were appropriate procedures for managing complaints. Relatives told us that any concerns they had raised had been listened to and acted upon by the provider. Checks on the management of were included in The provider’s quality monitoring audits checked that any complaints received an appropriate response.
Relatives told us the provider communicated openly with them. They said the previous registered manager had always been available if they wished to discuss their family member’s care with them. Relatives told us the regional manager had listened to their concerns about the high use of agency staff and how this affected their family members. They said the regional manager had made them aware of the plans in place to address this issue.
People who lived at the home, their relatives and other stakeholders had opportunities to give their views about the service. The provider’s quality monitoring systems included auditing important areas of the service regularly and action plans were developed when shortfalls were identified.
We identified two breaches of the Health and Social Care Act 2008. Further information is in the detailed findings below.