Seven Springs - Care Home Physical Disabilities provides personal care and accommodation for up to 32 people who have physical disabilities. People were accommodated in the large main house and in bungalows on the site. There was a hydrotherapy pool and a day centre where people took part in a range of activities. In the main house there were two passenger lift between floors and all areas of the accommodation were accessible to people who used wheelchairs.
The service had a registered manager who was present during 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.
This inspection took place on 27 October 2014 and was unannounced. An inspection was carried out in August 2013 when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action to make improvements in the management of medicines. We did an inspection in November 2013 to follow this up and found this action has been completed.
During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. Individual risks to people’s safety and welfare were not always identified to make sure people were safe. Some essential training for staff had not been completed or was not kept up to date. There were not always sufficient numbers of staff and safe recruitment procedures were not always followed. Quality assurance systems were not effective in recognising shortfalls in the service. Action and improvements plans were not developed to make sure people received a quality service. Records relating to people’s care and the management of the service were not well organised or adequately updated.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, we found that the registered manager understood when an application should be made and how to submit one and was aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
People told us they felt safe. The provider had taken steps to make sure that people were protected from abuse. Some improvement was needed to make sure that staff training in safeguarding was up to date. Although staff had information about reporting abuse, staff did not know how to contact any external agencies.
Each person’s care plan contained risk assessments, some of these had been personalised to make sure staff knew how to protect the person from harm. The majority of risk assessments were identical to one another, which meant that individual risks to people’s safety and welfare had not been identified.
There were not always enough staff deployed in the home to meet people’s needs. People told us drivers were not always available to drive the minibuses so they could go out and they were “Frustrated when we’re desperate for the loo, if the staff are on breaks”. The provider did not always follow safe recruitment procedures because suitable references and photographic identification were not always obtained. There were plans in place to make sure that people were safe in the event of an emergency. Medicines were safely stored. Safe administration procedures were followed so that people got their medicines when they needed them.
Staff training records were not up to date so it was not possible to see if staff had the essential training or the updates required. Staff told us they had not received safeguarding training ‘recently’. Records showed that 24 out of 49 staff had attended training on the Mental Capacity Act 2005 (MCA). People had capacity to make decisions. Where people were not able to sign consent forms due to physical disabilities and non verbal communication, these were not signed by an appropriate person. Staff were regularly supervised and given opportunities to discuss any concerns they might have. Records showed that staff met regularly with their manager and these meetings were documented.
People’s weights were not monitored and recorded regularly to make sure they were getting the right amount to eat and drink. There were no risk assessments about nutrition or hydration. People told us they enjoyed the food and there was always enough. Staff made sure that people’s choices and special dietary needs were catered for. People who needed support to eat were helped discreetly.
People were supported to manage their health care needs. A chiropodist and a district nurse who visited the service regularly told us staff were quick to refer people when there were any concerns and followed advice about their on-going care. A physiotherapist employed at the service had developed personalised plans with each person to promote their health and improve their physical wellbeing.
People were involved in planning how they wanted their care to be delivered. Those who were able to had signed their care plans to show their agreement. People were supported to be as independent as possible. People said, “The staff are brilliant we have a laugh”. Staff were kind, caring and patient in their approach and had a good rapport with people. Staff supported people in a calm and relaxed manner. Staff initiated conversations with people in a friendly, sociable manner and not just in relation to what they had to do for them.
Staff showed respect for people’s dignity and were careful to protect people’s privacy. People told us they were treated with dignity and respect. Staff made sure that any personal care people needed were carried out in private. People’s information was treated confidentially.
Some people told us that complaints they had made had not been addressed. People knew who to talk to if they had a complaint. Some people told us they were listened to and action was taken to address their concerns. The registered manager told us that there were no recent complaints. We have made a recommendation about this.
Care records did not contain sufficient detail or up to date information to enable staff, particularly new or agency staff, to provide personalised care to each person. Staff knew people well including what they wanted to eat and drink and what they would like to do. Staff knew how to communicate with people who had communication difficulties. People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time.
There was a day centre on site where people could take part in a range of activities. The registered manager told us that there were strong links between the home and the local community. For example, students from a local school were involved with events and often visited the home. People from the home had been involved with initiatives to improve disabled access at a local hospital.
Most people spoke positively about the service and told us they found the management team helpful. One person said, “I love it here, I wouldn’t move”. A few people raised concerns about the leadership of the service and told us the manager was not visible around the home.
Quality assurance systems were not effective in recognising shortfalls in the service. Action and improvements plans were not developed to make sure issues were addressed in a timely manner.
There were no regular staff meetings where staff could express their views or raise any concerns about the service. There were no recent minutes of ‘residents’ meetings available or customer satisfaction surveys to show that people were consulted and their views taken into account in the way the service was delivered. Records relating to people’s care and the management of the service were not well organised or adequately recorded.
You can see what action we told the provider to take at the back of the full version of this report.