The inspection took place on 12 and 13 December 2017 and the first day was unannounced. At the previous inspection in September 2016, we asked the provider to take action to make improvements in seeking people’s consent to receive care and staff training in mental capacity. These actions had been partially been completed.Handsworth 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. The care home is registered for up to 43 people and is located in a residential area of Bowdon in Greater Manchester. Accommodation is across three floors. There is an accessible garden to the rear of the premises and parking for several cars is available at the front of the home. All rooms have their own toilet and some rooms have ensuite shower rooms. At the time of our inspection there were 39 people living at the service.
There was a manager in post who had been registered with CQC since October 2010. 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.
We found two breaches of the Health and Social Care Act regulations in relation to adequate recording and communication of risks. You can see what action we told the provider to take at the back of the full version of the report.
We made two recommendations about enhancing the current emergency evacuation system and strengthening how the Mental Capacity Act was applied with the service.
The service was not consistently safe as risk assessments did not contain sufficient details to ensure staff supported people safely. Recruitment processes helped to ensure suitable staff including volunteers were employed and staffing levels were sufficient to support people appropriately. There were systems in place to protect people from risk of abuse, accidents and incidents.
Appropriate maintenance and checks took place to ensure equipment and the environment were safe for people living at the care home and staff supporting them. The building was in need of refurbishment. However the registered manager could not tell us when this work would start.
Staff’s knowledge and awareness of mental capacity and deprivation of liberty safeguards was satisfactory. People’s care records contained capacity assessments and appropriate applications for deprivation of liberty had been made. However, requirements of the mental capacity act were not always applied effectively. For example, consent to care was not always consistently recorded in people’s care records.
People told us the food was of acceptable quality and meals took into consideration people’s preferences. This helped to maintain people’s good health and wellbeing. We identified concerns regarding how information about special dietary needs such as fork-mashable foods was communicated to staff. We asked the registered manager to address these concerns.
The provider ensured new staff completed an induction and received mandatory and on-going training. Staff had regular supervision and yearly appraisals. This helped to ensure staff were equipped and supported to carry out their role.
The provider had proactive systems in place to ensure people’s healthcare needs were met as and when required. The local GP operated a weekly surgery from the care home and people were supported by staff to attend hospital appointments.
The service was caring and compassionate. People’s dignity and privacy were treated respectfully. We saw that there was good rapport and friendly interactions between people and staff. Staff demonstrated that they knew people well and were able to describe people’s personalities, their preferences and their interests.
Relatives gave us examples of how they were involved in making decisions about the care provided. Care records we looked at confirmed that relatives, where applicable, had been consulted in the care planning process.
We saw examples of how people were encouraged to develop and maintain their independence. This helped to ensure people maintained a good quality of life and wellbeing.
The service was responsive to people’s needs. Support plans contained personal histories, equality and diversity information and people’s interests and hobbies. The service had assessed all relevant needs such as physical and emotional needs. An activities coordinator with the support of volunteers arranged a wide range of activities and outings to help ensure people’s mental health and physical wellbeing was catered for.
People’s end of life needs were reviewed and updated as required and family members, where appropriate, were involved in this process.
Complaints and concerns raised were well managed and in line with the legal requirements.
The provider had systems in place to help ensure people’s communication needs and impairments were recorded and staff were aware of these. Appropriate consents were in place to share this information with the relevant health authorities.
The service was not consistently well led. Quality assurance processes in place did not effectively identify concerns identified at this inspection such as gaps in risk assessments, mental capacity requirements and consent, and clear communication to staff about people’s dietary needs.
The registered manager was well-liked and respected. People and their relatives told us the registered manager and staff were helpful. There was an open and transparent culture at the service. The registered manager valued the contribution of their staff and there was good communication amongst the staff team. This helped to ensure people were supported effectively.
Staff were adequately supported in their caring roles. This support included regular staff meetings and policies and procedures.