The inspection took place on 9 and 16 March 2015. The visit was unannounced and the second visit was announced. We last inspected the service on 2 July 2014 and found the provider had breached one regulation. This was because there were ineffective systems of medicines audits in place to ensure medicines records were completed accurately.
Clasper Court provides an on-site domiciliary care and support service to people who are tenants within Clasper Court Housing Plus scheme. The scheme can accommodate up to 24 people, at the time of our inspection there were 19 people using the service.
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.
We found the provider had breached Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18(2)(a) (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not completed updated training relating to moving and handling and food hygiene.
You can see what action we told the provider to take at the back of the full version of the report.
The provider had made progress with their action plan and was now meeting the requirements of the regulation they were breaching following our last inspection in July 2014. We found there were audit systems in place now to support the safe management of medicines.
People using the service told us they felt safe and they received good support. People commented, “Yes safe, oh yes they look after you. They are my guardian angels”, “I like living here. I feel safe”, and, “Safe, yes I do [feel safe].” They also said, “Yes I get well looked after”, “The care is fantastic”, and, “Good care as far as I am concerned. I get on alright with the staff. It seems to be ok to me. I am quite happy.” People also gave positive feedback about their living environment. People commented, “Excellent, really nice. Just been all done”, and, “[Building] marvellous, gorgeous.”
Staff knew how to report safeguarding and whistle blowing concerns. They said they would report their concerns to the registered manager straightaway. They said their concerns had been dealt with properly. Staff told us they did not have any concerns about people’s safety.
The provider’s approach to managing risk was inconsistent. Some risk assessments were specific to the person being supported whilst others were generic. There were three different formats in use for undertaking medicines risk assessments. We have made a recommendation about risk management.
People using the service and staff told us there were enough staff. People said, “If I need help, staff come as quickly as they can”, “If I call staff, I don’t wait too long”, “Staff come quickly, I am never left for long”, and, “If I need help staff are quick.” The service followed recruitment and selection processes to ensure new staff were suitable to work with vulnerable people.
Incidents and accidents were logged, investigated and action was taken to keep people safe. Regular health and safety checks were undertaken and these were up to date at the time of this inspection. There were emergency evacuation plans and processes in place to support people in an emergency.
Staff told us they were well supported in their role and had regular supervision and an annual Personal Development Plan (PDP) meeting.
Staff had a good understanding of the Mental Capacity Act (2005). People had support plans in place which detailed the support they needed with making day to day decisions.
People told us staff asked for permission before providing support. They also confirmed they were supported to make their own decisions and choices. Staff also confirmed they always asked people for permission before providing support.
People could either purchase a meal at lunch-time or receive support from staff to make their own meals. Staff supported people with eating and drinking in line with each person’s individual needs. People told us staff supported them with meeting their health care needs. People said, “If I need medical assistance, staff do all that. They are lovely”, and, “When I am bad they are there.”
People said they were treated with dignity and respect. They also said staff were patient and gave them the time they needed. One person said, “Excellent care, staff have time for you and don’t rush you”, and, “They [staff] listen to everything you have to say.”
People were given information both in writing and verbally about how to access independent advocacy. Staff were aware of their responsibilities relating to confidentiality.
Some people did not have up to date care plans that met their current needs. Staff were in the process of updating people’s support plans into a more person centred format. However, a clear timescale had not been set to complete this piece of work. Support plans that had been updated into the new format were personalised to meet people’s individual needs. Support plans were reviewed regularly. However, review records were usually brief and did not provide a meaningful update as to how the person was.
Staff supported people to be as independent as possible. One person said, “I do as much as I can and staff do everything else.” Staff knew the people they supported well. One person commented staff, “Know more about me than I do.”
People knew how to complain if they were unhappy. One person said they would, “Tell Linda [registered manager] if I am unhappy.” Another person said, “If I was not happy I would speak to Linda [registered manager] or [senior support worker’s name].” None of the people we spoke with raised any concerns about the support they received. We saw previous complaints received had been investigated. People had opportunities to give their views about the service through regular ‘tenants’ meetings.’
The home had a registered manager. We found the provider had not made all of the required statutory notifications to the Care Quality Commission. This matter is being dealt with outside of the inspection process.
People and staff said the registered manager was approachable. One person said, “She’s great, she sees to things”, and, “Lovely, top of the pops.” Another person said, “She is fantastic, she is a good girl.” Another person said, “Definitely approachable, She will sit and talk to you.”
There were regular staff meetings where staff were able to give their views about the service.
The provider had made progress with their action plan they sent us following our last inspection. Monthly medicines audit had been implemented which had been successful in identifying issues relating to the quality of medicines management.
The registered manager undertook other quality checks and audits. However, these checks were ad hoc and had not been consolidated into a structured quality assurance programme. We have made a recommendation about quality assurance.
The local authority’s commissioning team was undertaking regular visits to check on the quality of the service. We saw 14 out of 18 people had given positive feedback about the service through completing questionnaires. They had also suggested activities they would like to take part in including a tea dance, a pamper session and a darts and dominoes evening.