Archived: Choice Support - 18 Varty Road

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.

Choice Support – 18 Vartry Road provides accommodation and care to four people who have a learning disability, some of whom also have an autistic spectrum condition. At the time of this inspection there were four people living in the home in single bedrooms. People shared a lounge and two bathrooms.

At the time of the inspection there was no registered manager in place, although the manager, who had been in post since July 2016, had applied to be registered with the Care Quality Commission. 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.

At this inspection we found some improvements had been made since the inspection in July 2016. Although there remained a breach of the regulations in relation to safe care and treatment, people were no longer at risk from breaches relating to poor maintenance of the premises or safeguarding adults from abuse and improper treatment.

Staff were caring and kind and understood the needs and preferences of the people who lived at the service. We were not able to get verbal feedback to our questions due to people’s communication needs but we spent time observing staff with people living at the service and there was a warm caring atmosphere at the service.

On the day of the inspection the cupboard where medicines were stored was not secure due to a broken lock, but medicines were moved following the inspection to a secure cupboard.

The service had experienced upheaval in the preceding weeks due to planned maintenance works so staff explained not all systems were up and running at the time of the inspection. For example, we found meat that had been defrosted to cook that day partially covered and not labelled in the fridge. Staff told us the labels were in a box yet to be unpacked. We also found an out of date cooked meat product in the fridge.

Staff supervision took place on a regular basis and staff told us they were well supported in their role.

Care support plans were detailed and described people’s needs, preferences and methods of communication extensively, but not all had been updated in the last year. Where one person’s needs had changed dramatically in the last few months, their care records were up to date and provided detailed guidance regarding the best way to support them currently.

Risk assessments were in place for the majority of risks identified in the support plans, and there were appropriate documents in place for people who were not safe to leave the property unaccompanied.

People were supported to attend activities such as shopping, visiting local parks, eating out and going on holiday.

Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

There were enough staff to meet people's needs. Changes in day care provision locally meant there would be additional requirements made of the service in coming months, and this would impact on staffing levels required.

Staff recruitment was safely managed. References and checks took place so the provider satisfied themselves that staff were safe to work with vulnerable people.

Whilst the kitchens, bathrooms and bedrooms were clean the building décor was dated and in some areas the carpet was threadbare. In this way the service was not homely.

We could see that team meetings took place regularly. Whilst there were quality assurance processes in place we noted that actions were not always carried through from action plans in a timely way. The manager told us he was aware of this and he and the area manager were keen to embed more effective systems going forward, to improve the quality of the service.

There was a breach of the regulations in relation to the governance of the service and of safe care and treatment.

We have made recommendations in relation to risk assessments, guidelines regarding people’s financial contribution to essential items and activities and obtaining nutritional advice for the service.

You can see what action we told the provider to take at the back of the report.

During our last inspection in September 2012 we judged that people were not fully protected from risk of abuse because the provider had not taken reasonable steps to identify the possibility of financial abuse and prevent this from happening. We stated this had this had a minor impact on people using the service and asked the provider to put an action in place in order to ensure that people were fully protected from the risk of financial abuse. We noted at this inspection that the provider had put action in place to ensure that people's finances were properly managed. We saw that people's care plans were reviewed regularly and staff had training and support to meet their needs.

Appropriate systems were in place for receiving, storing and administration medication.