Background to this inspection
Updated
18 September 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 18 and 24 July 2018. Our visit on 18 July was unannounced. We needed to return to the home to complete the inspection and advised the registered manager when this was likely to take place. The inspection was carried out by one inspector.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some information about the service. What the service does well and the improvements they plan to make. We reviewed the PIR and other information we held about the service, which included notifications they had sent us. A notification is information about important events which the provider is required to send us by law.
We met the four people living at the home. Three people had significant communication impairments and were unable to communicate with us verbally. Another person could speak with us but chose to make this communication brief. During our inspection we observed staff engagement with people in the communal areas of the home.
As part of the inspection process we looked at four care records and checked four staff recruitment files. We checked stocks of medicines against medicine administration records (MAR) for two people and looked at documentation relating to the management of finances for two people. We also looked at records relating to accidents and incidents, training records for the team and quality assurance documents and policies related to the service.
We spoke with two care staff, the registered manager and deputy manager. Following the inspection we spoke with one health and social care professional and one person's relative.
Updated
18 September 2018
This inspection took place on 18 and 24 July 2018. This was a comprehensive inspection and was unannounced.
Choice Support – 18 Vartry Road 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 home provides accommodation and care to four people who have a learning disability, some of whom also have an autistic spectrum condition and additional support needs including communication impairments. At the time of this inspection there were four people living in the home. People shared a lounge, kitchen and two bathrooms.
The home had a registered manager. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”
Following our last comprehensive inspection of the home on 7 February 2017 we rated the home as ‘Requires Improvement.’ The provider had failed to ensure that actions identified during quality assurance checks of the home had been addressed in a timely manner. Food was not always stored in a safe and hygienic way.
During this inspection we found that the provider had acted to address the failures identified at our previous inspection. Food items were stored safely and in accordance with current food hygiene regulations and guidance. The provider had taken to address issues identified during their internal quality assurance monitoring of the home.
Regular quality assurance monitoring of the care and support provided at the home had taken place. We saw that weekly and monthly checks in relation to records and safety had been carried out by the registered manager and deputy manager. Monthly quality assurance visits from the provider’s area manager had also taken place.
We found that actions identified during the quality assurance processes had, in most cases, been addressed promptly. However, we identified concerns in relation to the maintenance of the property which was owned by a housing association responsible for redecoration and maintenance. The provider had liaised with the housing association during the past year to seek an outcome to their requests for essential works to be completed but this had not taken place. During our inspection we noted that the provider had sought support from a partnership organisation which was now taking on responsibility for outstanding improvement works. Although we saw that these had commenced we found that there remained the potential of risk to people until the works are completed.
People’s risk assessments and care plans were person centred and included guidance for staff members on how to support people effectively and safely. We looked at the daily care records for people living at the home. We saw that these were completed in detail and information about specific care and support needs were recorded.
The home was meeting the requirements of the Mental Capacity Act 2005 (MCA). Assessments of people’s capacity to make decisions had been carried out. People had up to date Deprivation of Liberties Safeguards (DoLS) authorisations and meetings had taken place to ensure that any actions or restrictions were in people’s best interests.
Medicines were safely administered and recorded. Staff members had received training in medicines administration and annual competency checks had taken place. Regular medicines audits had taken place. However, we found that medicines were stored in a locked filing cabinet. Although the cabinet was contained in a locked office, The Royal Pharmaceutical Society’s guidance on the management of medicines in care homes advises against the storage of medicines in filing cabinets.
The home had acted to reduce the risk of infection to people. The home environment was clean and free from clutter and we saw that staff members used disposable aprons and gloves for appropriate tasks.
People were protected from harm. Staff members had received training in safeguarding adults from abuse. They understood their roles and responsibilities in ensuring that any incidents or concerns were immediately reported.
People were supported to participate in a wide range of activities. During our inspection we saw that individual activities such as cooking and gardening were taking place. People also went out from the home to attend day centres, visit local parks and shops and go for a drive to visit relatives.
People were supported to maintain a healthy diet based on their individual preferences and cultural and health needs. We saw that they were supported to make choices in relation to food drinks and snacks. Although one person ate a limited diet, we saw that the home had liaised with health professionals and developed plans to encourage them to try other food items.
People living at the home were unable to communicate verbally. We saw that staff members engaged them in decision making and activities using words, signs and pictures that they understood.
Checks of staff members’ suitability for the work they were undertaking had taken place prior to their employment. An on-going programme of training was provided to ensure that staff had the skills and knowledge to support people effectively.