Archived: Andrew Cohen House

Andrew Cohen House is a care home with nursing and can accommodate up to 59 people in one adapted building. The home specialises in providing care to people living with dementia in small separate units within the building. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

People were protected from potential abuse by staff that were trained and understood how to safeguard them. People had risks to their safety assessed and there were plans in place to reduce the risks, which staff understood and followed. There were sufficient staff that had been recruited safely to support people when they needed it. People received support to have their medicines as prescribed. There were systems in place to learn from incidents, or when things went wrong to avoid this happening again.

People had their needs assessed and were supported to meet them by trained well-supported staff. People had their nutrition and hydration needs met and had enjoyable mealtime experiences with lots of choice. The building was purpose built and designed to meet people's needs. People were supported to access health professionals to maintain their health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

People had good relationships with staff and were supported in a kind, caring and compassionate manner. People made choices about their care and support and were involved in decision making. People were supported in a way, which maintained their dignity, and staff were respectful.

People had their preferences met and staff understood people's needs.

There were opportunities for people to follow their interests and take part in a wide range of activities. People's communication needs were considered and they had support to follow their religious beliefs and cultural practices. People understood how to complain and complaints were responded to in line with the provider's policy. People had the opportunity to take part in discussions about their preferences for care and support at the end of their life.

A registered manager was in post and people, relatives and staff found they were accessible. People and their relatives had an opportunity to have say in how the home was run. The registered manager had checks in place to assess the quality of the service people received and ensure the management of the service was effective. The registered manager had a vision for the service and plans in place to make continual improvements.

We carried out an unannounced comprehensive inspection of this service in November 2016 and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to failures to manage risks to health and safety of people arising from the poor management of prescribed skin creams and the lack of an effective auditing system to assess, monitor and improve the service to keep people safe and well.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. Since our last inspection concerns about people’s safety had been raised with us and we used this information to inform our planning. This report only covers our findings in relation to requirements and the information we have received. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Andrew Cohen House on our website at www.cqc.org.uk

At this focussed inspection we found that improvements had been made in the two key areas of Safe and Well Led and the home were no longer in breach of the regulations. However further improvements were still required.

The manager was at the service during the inspection and has applied to become the registered manager 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.

People told us their care was safe and that there were enough members of staff on duty to support them well. We saw that staff moved people safely and met their needs in a timely manner. At this inspection we found that people had care plans and records of their changing needs that were person centred and up to date. These improvements helped to ensure people were kept safe.

People’s risks had been reviewed and actions had been taken as required to ensure people remained safe and well. During this inspection people and staff told us that people received their medication as prescribed but we saw that recording of when skin creams had been administered was not robust.

The new manager came into post on June 2016, shortly after the previous registered manager had left. Before this inspection had completed , the manager became registered with the Care Quality Commission. A 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 and associated Regulations about how the service is run.

At our previous inspection on 7 and 8 April 2016 we asked the provider to take action in relation to two areas. The provider met with us to discuss these areas and submitted an action plan and monthly updates telling us of their progress. The first area was to make improvements to the respect and dignity staff showed towards people. This action has been completed. The second required action was to improve the systems and processes to make sure the service provided was monitored and audited to improve the quality of life for people living within the home. This action has been progressed but had not been fully completed.

Since the inspection of April 2016 we received concerns in respect of the care and support provided to people, the competency and attitude of staff and concerns about the management of medication. We considered the information we had received and used it to inform our inspection plans.

People and their relatives told us that they felt safe with the staff who supported them. Staff were aware of the need to keep people safe and understood their responsibilities to report allegations or suspicions of any poor practice. Assessments had been undertaken to identify any potential risks to people, but records of these were not all up to date or accessed and used by staff to manage the risks. Moving and handling transfers were carried out in a safe manner.

People were supported by suitable staff who had been properly recruited.

People who needed support with medication could be assured that medicines were being given as prescribed and were stored safely; although improvements were needed in respect of management of peoples prescribed creams.

People were being supported by staff who had been provided with training to keep their knowledge and skills current. Staff told us that they had received a planned induction when they commenced working at the home. Staff’s knowledge and understanding of The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been supported by training, but some staff were not sure how it applied to protect the rights of people living in the home.

People were provided with choices of food and drink and were supported to access relevant healthcare professionals when needed. Staff demonstrated that they knew people well and we saw that people were supported in a kind and caring manner.

We saw that people were cared for by staff who knew them well and who they described as kind and compassionate. People expressed how they wanted their care to be delivered, but this was not well recorded. People’s decisions and choices were respected by staff. People told us, and we saw that they were treated with dignity and had their privacy respected.

People were supported to participate in many social activities of their choice. Improvements in the home had enhanced the daily lives on some of the people in the home with the provision of opportunities to engage in a broader range of things to do.

People told us that they felt enabled to raise concerns and complaints and were confident that these would be investigated and acted upon. People, their relatives and staff described the home as well-led and felt confident in the manager, and were pleased with the improvements that were taking place within their home.

The manager had been active in driving forward improvements within the home and plans were in place to ensure the service provided improved in a number of areas. Systems used by the provider to monitor all aspects of the home had been improved since the April 2016 inspection but were not fully effective.

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

There was no registered manager at the service. 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. A manager had been appointed and was managing the home, but they were in the process of becoming formally registered as the manager of the home.

Staff knew how to recognise potential signs of abuse and how to raise concerns should they need to. Risks to people had been assessed and measures had been put in place to reduce the risk to each person. Staff had received training to enable them to provide safe care to meet the needs of the people they were supporting. Staff did not have adequate support or supervision to make sure that people’s needs were consistently well met or that the support people received was respectful and dignified. You can what action we told the provider to take at the back of the full version of the report.

Changes in people's needs were identified and their care packages were amended when necessary to meet these needs. The information contained in the care records was individualised and clearly identified people's needs and preferences. However staff did not consistently make sure that people’s needs were well met in the way that had been agreed. Risks people might experience with their care and environment had been identified and recorded in their care plans.

We saw that medicines were managed safely. Staff had access to information about the specific support people needed with their medicines and new systems were being introduced to monitor medication administration practice.

We saw that safe recruitment and induction processes were in place to ensure there were enough suitable staff employed to support the people who used the service.

The manager was knowledgeable of, and acted in line with, the requirements of the Mental Capacity Act (2005). Staff did not always seek peoples consent before supporting them.

There was a complaints procedure in place that was known about and used by people who used the service and their relatives. Where concerns were raised we saw that the manager had acted promptly and taken action.

People had a range of activities that they could choose to engage in every day. Staff had begun to use aids and equipment designed to enrich the lives of people living with dementia. Management had plans in place to expand on this work and offer a service that would improve the quality of people’s lives. There were systems in place for monitoring the quality and safety of the service, but these were not always effective. You can what action we told the provider to take at the back of the full version of the report.

We set out to answer one of our five questions, Is the service safe? Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

We found that some improvements had taken place but there were not appropriate arrangements in place to ensure staff managed the risks associated with the use and management of medicines. Shortly after the inspection we also met with the provider representative, provider area manager and the home manager to discuss the issues and action that had been taken. We were told of further improvement actions that had been taken between the inspection and the meeting as well as other actions that were planned.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found there were not appropriate arrangements in place to ensure staff managed the risks associated with the use and management of medicines. We were informed by the manager and the director that all issues identified by the inspection would be investigated and action taken.

People were sometimes cared for by an insufficient number of staff. The staff turnover was also high. The service had some people who had dementia and so were at risk of becoming disorientated by having an inconsistent staff team.

People told us they felt safe. One person told us, 'I'm not frightened of anyone here.' The staff we spoke had a basic understanding of safeguard procedures as they had not all received training in this. However, staff said that if they witnessed poor practice they would report their concerns.

The provider had notified the local authority as required of some incidents that had occurred in the home under safeguard procedures. However we had been made aware of other incidents that had not been reported. This places people at risk of allegations not being properly investigated.

There were no people having restrictions placed on them through the Deprivation of Liberty Safeguards (DOLS). These safeguards apply where it is thought that it is in someone's best interests to be placed in a care home but they lack the capacity to make a decision about what is being proposed for them. In these circumstances the provider must apply for authorisation to deprive the person of their liberty. We found that the manager was not aware of a recent Supreme Court ruling that impacts on the circumstances when an application should be made.

Risks to people's health, safety and welfare had not always been assessed and remedial action had therefore not been taken. We were not provided with evidence during our visit that the provider had taken full account of published guidance from the health and safety executive regarding risk of falls from windows or balconies in health and social care settings. Some action to reduce risk was taken during our visit.

Is the service effective?

People we spoke with indicated that they were generally happy living at the home. One person told us, 'I feel alright here, I don't see anything bad.' Another person told us, 'Its' nice here.' The majority of relatives we spoke with were positive about the care provided at the home. One relative told us, 'We are so grateful to this home for the high quality of care.'

We checked people's care plans and found most of them to be detailed, relevant and up to date. However, in some instances we found that information to support staff in managing people's behaviour was not sufficient. This meant that some people were at risk of receiving inadequate or inappropriate care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People were generally positive about the staff who supported them. One person told us, 'The staff are all very nice and helpful.' Another person told us, 'We have very nice staff.'

The home employed two activity co-ordinators. We found that people were given the opportunity to participate in a number of activities and organised events at the care home.

We spoke to staff who had recently started working in the home. Staff confirmed that they had an opportunity to complete 'shadow' shifts when they first started and had worked alongside experienced staff. Some staff who had worked at the home for some time told us that that they felt the training and support for new staff needed to be improved.

Is the service responsive?

During this inspection we identified a number of issues about which the provider took immediate action to rectify or improve the situation. At our last inspection in January 2014 we had identified that the home was not meeting the regulation in regards to the management of medication. At this inspection we found that this regulation was still not being met.

There was evidence that some learning from incidents took place and appropriate changes were implemented. We followed up on two incidents and found that actions had been put in place to help reduce the risk of future similar incidents occurring.

We found that records were kept of accidents, the number of falls and admissions to hospital. There was no central log of all incidents and medication errors. We were told that this information would usually be kept within people's individual records. This meant it would be difficult to track the number of incidents occurring and actions taken in response. It also did not enable the provider to complete a full analysis in order to identify any reoccurring patterns or trends.

People's views about the care they received were sought through meetings and questionnaires and relatives and visitors were asked to comment about the service. We saw that completed questionnaires showed that people using the service and relatives were mostly positive about the care they received and these results were available for people to view in the reception area. Where a minority of negative comments had been received there was no information included about the home's response. This meant that people may be unsure if their comments would be acted on.

Is the service well led?

The service has a quality assurance system, but this had not always ensured that areas that needed improvement had been identified and appropriate action taken.

Systems were in place to assess and monitor the quality of the care provided but some of the concerns we identified during our inspection had not been recognised by the provider.

Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People told us they were happy with the service they were receiving and how their needs were being met. One person told us, 'I can't think of anywhere better to be. The staff are all very nice.'

Care was planned and designed to meet the individual health and welfare needs of the people who used the service.

We found that people were not always protected from the risks associated with the unsafe use and management of medicines. . We found that internal audit processes had failed to identify that improvements were needed in respect of cold storage of some medicines and routine recordings of medication administration.

The provider had satisfactory recruitment procedures in place to ensure that people employed at the service were of good character and had the necessary skills to meet the needs of the people who used the service.

People told us they felt able to complain if they were not happy about their care, although the information provided to people using the service was incomplete.

During our visit we spoke with relatives of three people who lived at the home. They told us they were satisfied with the care provided. One relative told us, 'I have nothing but praise for the home.'

Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People living at the home confirmed their privacy was respected. Not all people spoken with could remember planning their care but we found evidence of consultation, wishes and preferences in records.

Staff told us that they were well trained and felt they had been provided with the appropriate support in order to do their job effectively.

People living at the home told us they felt safe and were able to raise any concerns they had.

There were systems in place to monitor the quality of the service. Complaints and comments from people were used to assess if they were happy with the service.