27 Stratton Road is a care home service, registered to provide personal care for up to 4 people who have a learning disability. The home, a semi-detached house situated in a quiet residential are, is part of Innovations Wiltshire Limited: a provider of several other care home services in the area. The staff who worked at 27 Stratton Road also worked across several of the provider’s other services. We were informed by some staff that there may be a gap of four weeks between their shifts at 27 Stratton Road. Other staff members said they worked more regularly at 27 Stratton Road.
The first day of the inspection was unannounced and took place over the 11 and 12 August 2015.
The service had a registered manager who was responsible for the day to day running of the home. 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 registered manager said they neither worked at nor managed the service because the service was managed by a trainee manager.
We found that the service was not always well led; effective systems to monitor and improve the quality and safety of the service, and to evaluate and improve practice were not in place.
The service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to living and receiving care at the home.
The MCA sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require care home providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so.
We found that the service had not made necessary applications to the local authority for DoLS authorisations to protect people from being deprived of their liberty without lawful authority.
Most of the risks to people receiving care were assessed by the service, and for the great majority of the time all reasonable steps were taken to keep risks as low as possible. However, we noted there were some areas where all reasonable actions to reduce risks had not taken place. We found that people received the correct medication in a timely way, but that some aspects of medication management needed to be improved.
People said they felt safe living at the home. Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing. We have made a recommendation in relation to making safeguarding alerts that can be found in the full version of the report.
The premises were safe, clean, homely and well maintained. The home had been redecorated recently and the service had plans to fit a new kitchen in September this year. Each person had their own room, decorated and furnished according to their choices, and the use of shared bathroom and toilet facilities. These included a level access wet room downstairs.
Checks of records indicated that reporting and recording of incidents and accidents took place.
There was a complaints procedure in place but the service could not provide us with a record of the concerns it had received. We have made a recommendation about the handling of concerns and complaints which can be found in the ‘effective’ section of the full version of the report.
Staff acted in a caring manner; we observed they treated people with warmth and humour; they spoke to people with respect, and asked before carrying out care. People who use the service were helped to make choices and decisions about how their care was provided. People told us that the staff were “good” and kind. One family member said, “To me, they are exceptional” another commented, “I trust [the provider] implicitly.”
We observed that people were given choices and consulted about their care. Family informed us they felt confident to raise any issues or concerns because they were listened to.
Each person who uses the service had their own personalised care plan which promoted their individual choices and preferences. People were assisted to go out into the community to enjoy leisure time and also to attend health appointments.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.