St Aiden's Cottage

St Aiden’s Cottage provides personal and nursing care for up to 41 younger and older adults living with a range of conditions including mental health issues, dementia, learning disabilities and autism. At the time of inspection 31 people were using the service.

People’s experience of using this service and what we found

Medicines were managed safely and effectively. Risks were identified and managed appropriately. There were effective processes to ensure lessons were learnt. Improvements had been made to the premises which were clean and tidy. Recruitment procedures were robust. There were enough staff to meet people's needs and people were protected from the risk of abuse.

Staff were responsive to people's needs, but we did find one person’s specific needs were not always consistently met, possibly due to care records not always being accurate. People’s care plans and individual risk assessments reflected their current needs, but it was not always clear from electronic records whether these had all been reviewed regularly. The provider had identified these issues and was taking steps to address them.

Quality monitoring systems had improved. Staff said the management team had made improvements and things had improved significantly. The service did not have a manager registered with the Care Quality Commission (CQC) at the time of this inspection, although an application had been submitted.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture. Staff ensured they continually maximised people's choice, control and independence in a safe and inclusive environment, whilst also following national infection prevention and control (IPC) guidance. Each person had their own individual person-centred care plan and risk assessments which promoted their rights, privacy and dignity

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 December 2019) and there were three breaches of regulation. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve person-centred care, safe care and treatment and good governance.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements regarding person-centred care, safe care and treatment and good governance. This report only covers our findings in relation to the key questions safe, responsive and well-led which contained those requirements. The inspection was also prompted in part due to concerns about the safe management of medicines at this service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of the full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Aiden’s Cottage on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

St Aiden's Cottage is a care home. It provides personal and nursing care for up to 41 people living with mental health conditions, learning disabilities and acquired brain injury. There were 30 people using the service at the time of inspection.

The service was larger than current best practice guidance. However, the size and design of the building did not have a negative impact on people. The building layout had four units each with its own kitchen and lounge area.

The service was working towards consistently applying the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People’s experience of using this service and what we found

Individual risks had not always been identified and appropriately managed to ensure people remained safe. Medicines were not managed safely. Some care plans contained conflicting and inaccurate information. Quality assurance systems were not effective in identifying the issues we found during the inspection.

Relatives and people we spoke with told us they were happy with the service. Staffing levels were determined by people’s care and support needs. We observed agency staff were not confident with the service’s IT systems which led to issues in the administration of medicines.

The provider had a robust recruitment process in place with pre-employment checks carried out to make sure staff were suitable to work in the service.

People were supported to engage in activities and access the local community. The provider had a therapeutic team to support people emotionally and physically. The therapeutic team had started developing Positive Behaviour Support (PBS) plans to support people achieve positive outcomes.

A complaints procedure was in place. People and relatives told us they had no complaints about the service. Staff told us they were happy working at the service and were supported by the management team and the provider.

The registered manager had notified the Care Quality Commission of all significant events which had occurred in line with their legal responsibilities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 06 September 2017).

Why we inspected

We received concerns in relation to the management of safeguarding concerns, staffing levels, medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the Key Questions of Safe, Responsive and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 including safe care and treatment, person-centred care and good governance.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Aiden’s Cottage on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Aiden’s Cottage is a care home that provides accommodation for people who require personal or nursing care. The home is based in Bearpark, County Durham and provides care for older people with learning disabilities, people living with acquired brain injury or dementia. The home is registered to provide accommodation for up to 41 people. On the day of our inspection there were 32 people using the service.

The home had a registered manager in place. 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 our last visit to the service in November 2016, we found the service in breach of a number of regulations of the Health and Social Care Act 2014 and we rated the service as “Requires Improvement.” On this visit we found the provider had fully met the regulations and the service is now rated as “Good.”

Staffing levels had much improved and staff told us this now felt safe. We observed staff taking people out in the community and spending time chatting with people. Staff training in relation to supporting people who displayed behaviour that may challenge had been implemented and had a very positive impact. Staff told us they now understood better the reasons why people may become distressed and that systems were in place to support people and staff more effectively in these circumstances.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show the service verified the conduct of prospective staff members.

On our last visit some staff and people had told us they did not always feel safe, but now everyone we spoke with said they felt safe. Staff and people were aware of procedures to follow if they observed or were aware of any concerns.

Appropriate systems were in place for the management of medicines so that people received their medicines as prescribed. Medicines were stored in a safe manner. People were also encouraged where possible to manage their medicines themselves with support from staff. The home was clean, spacious and suitable for the people who used the service. People were enabled to access the garden area. Improvements had been made since our last inspection in relation to putting in ensuite bathrooms, décor and furnishings. Appropriate health and safety checks had been carried out on the building.

Staff were suitably trained and training was maintained so staff skills remained up to date. Staff now received regular supervisions and appraisals and told us they felt supported and were working as a team.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external healthcare specialists to ensure people’s physical health was supported.

Staff supported people who used the service with their social and emotional needs. We observed that all staff were very caring in their interactions with people at the service. People looked very comfortable with staff members. There was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and people told us that staff were kind and professional.

People who used the service and the family member we spoke with told us they were aware of how to make a complaint.

The service regularly used community services and facilities and had links with other local organisations. Staff told us they felt very supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. Staff and people told us the management were approachable, supportive and understanding.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at St Aiden’s Cottage. Actions plans and lessons learnt were part of their on-going quality review of the service.

St Aiden’s Cottage is a care home that provides accommodation and nursing care for people who require nursing care. The home is based in Bearpark, County Durham and provides care for older people with learning disabilities and people living with acquired brain injury or dementia. The home is registered to provide accommodation and nursing care for up to 41 people. On the day of our inspection there were 30 people using the service.

The home does not currently have 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.

Although there was no registered manager in post at the home we met the manager who was intending to register with CQC. They had been at the service for seven weeks.

At the previous inspection on 15, 16 November and 1 December 2016 we found that supervisions and appraisals had not been completed or adequately planned. During this inspection we found the new manager had ensured a significant majority of staff had received supervision and, where required, appraisal meetings. They had also planned all supervision and appraisal meetings for the forthcoming year.

All staff we spoke with commented on the noticeable impact of feeling more supported in the workplace and confirmed supervision and appraisal meetings were meaningful two-way discussions about any concerns they might have, and what further training may be beneficial.

We saw where further training had been identified at these meetings, it had been booked by the manager.

At the previous inspection we found staff training had not been renewed in line with the provider’s policy, particularly with regard to MAPA training (Management of Actual or Potential Aggression). At this inspection we found all but four staff were yet to receive MAPA refresher training, and these staff had the training booked. The new manager had worked with the administration assistant to ensure the training matrix was up to date.

To address the concerns we raised regarding the timeliness of care planning the new manager had ensured senior care staff were accountable for the regular review of five people’s care files. Staff we spoke with demonstrated a good understanding of this new approach.

The new manager had ensured staff awareness and understanding of the importance of maintaining people’s privacy and dignity had been improved, through individual supervision, staff and senior meetings.

St Aiden’s Cottage is a care home that provides accommodation for people who require personal or nursing care. The home is based in Bear Park, County Durham and provides care for older people with learning disabilities, people living with acquired brain injury or dementia. The home is registered to provide accommodation for up to 41 people. On the day of our inspection there were 30 people using the service.

The home did not have a registered manager in place managing 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.

At the time of our inspection visit there was a care manager acting as a deputy manager and a covering manager from another service but no registered manager in place at the service.

We spoke with a range of different team members; the care manager, the covering manager, care staff, kitchen staff, domestics and maintenance staff who gave us mixed reviews about the management of the service.

From looking at people’s care plans we saw they held some personal history and described individuals’ care, treatment, wellbeing and support needs. They detailed the care required and were written in plain English but not always in a ‘person-centred way’. Person centred care is an approach that aims to see the person as an individual, rather than focusing on their illness or disability.

Individual care plans contained personalised risk assessments. These risk assessments identified risks and were in place to enable people to take risks safely.

On the day of our inspection people who used the service were not supported by sufficient numbers of staff to meet their needs. We could see in the staffing rotas that there had been recent staffing issues and people who used the service were not supported by enough people to enable them to take part in leisure activities.

When we looked at the staff training records they showed us that staff were not always supported to maintain and develop their skills through training and development opportunities. We found that some training had expired and staff needed to attend refresher training imminently.

When we looked at supervision and appraisal records we saw that these had not been carried out with all staff.

Staff recruitment records that we looked at showed us that staff were recruited safely.

We observed how the service stored and administered medicines. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication and we found that medicines were administered safely.

During the inspection we witnessed the staff rapport with the people who used the service and saw some positive, caring and warm interactions took place.

We observed some practices that at times didn’t respect people’s dignity or maintain their privacy.

Activities for people to take part in were not provided. We saw some evidence that plans were made for people to be supported to go out but this was not regular or consistent.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We saw people enjoying their meals. The daily menu was not developed with the people who used the service to incorporate their likes and preferences but was adapted to suit the people who used the service.

We saw a complaints and compliments procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. We saw evidence that the complaints procedure was adhered to. People who used the service were aware of how to complain and were supported to do so.

We found a quality assurance survey had taken place previously with the people who used the service and we looked at the results. There were actions identified to make improvements to the service as a result of people’s suggestions however these were not all implemented.

A programme of audits was carried out by the care manager and some were ineffective and some were not carried out recently.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We found the service had a policy in place that was working within the principles of the MCA.

During the inspection 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 the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

Is the service safe?

People we spoke with told us they enjoyed living at the service and they felt well cared for. People made comments such as "this is the best place I have ever lived and I have been in a few", "I am happy here the staff are good" and "I am involved in my care and asked about how I want to move on".

We asked people using the service if they knew how to report abuse and how to access other professionals if necessary. People told us what they would do if they were being abused or suspected abuse. One person said "I could tell the manager or my social worker". We spoke with staff who also were able to tell us how they would report incidents of abuse. Staff also told us they had received training in safeguarding people from abuse. Training records looked at confirmed this.

Was the service caring?

People were cared for by staff that spoke to them appropriately. We observed a number of interactions and found staff respected people's privacy when they chose to spend time in their room. We also found staff engaged people in their care by having individual one to one conversations to ensure they were happy with their care, and also had group meetings to ensure people were involved in decisions about how the service operated.

Was people's care effective?

We looked at the care records of three people and found improvements were required. Staff did have knowledge of people's health conditions but did not understand how those conditions impacted on their health and well-being.

The service did not have a system in place for analysing incidents and ensuring people's care was delivered in line with published research and guidance. We found examples where people had known risks and there was an absence of strategies and interventions to ensure people received care which was safe and effective.

Was the service responsive to people's needs?

We did find that the service had made arrangements to ensure people received appropriate medical care where required. For example we saw evidence where people had involvement from GP's and nurses when they had specific health conditions. However we did also find where people's mental health had deteriorated or people required input from other professionals this was not always recognised by the service, which meant people did not always receive the care they required.

Was the service well led?

We looked at the leadership in the service and did find staff were supported with professional development but the services quality assurance system did not identify where staff required specific training to ensure people using the service received care which was safe and effective. Where concerns had been identified through the providers quality assurance system these had not been addressed in a timely manner. For example we found issues regarding the administration of medication which had been highlighted in February 2014 during the providers visit to the service which still remained unrectified.

We found people were asked for their consent to care and treatment. For example, when administering medication a member of staff asked 'Can I give you your medication please?'

People told us they were happy with the care provided. Comments included 'The staff are fine, it's a lovely place', '(Relative's name) is well looked after and the care is personalised', 'Everything is good, it's alright here' and 'The staff are very good.'

We found staff were aware of their duties in relation to safeguarding. People told us they felt safe living at the home.

We saw staff attended training courses relative to their role. We spoke with three members of staff who all told us they received regular feedback and support.

We found the provider requested feedback from people who used its services, relatives and staff, and took action to address any concerns.

We saw all staff knocked on doors before entering, ensuring people's privacy was respected. People we spoke with said they were happy with the staff, comments included; 'This is the best home' and 'Staff are alright.'

We saw people being involved in day to day decisions about their care; we also saw that care needs assessments were written in discussion with people using the service or their families.

We spoke with several people who lived at St Aiden's Cottage, they were all positive about the care they received. Comments included 'It's good, I am happy living here' and 'The staff understand my needs, I am happy here.'

During our inspection we looked around the home. We saw the building was generally kept clean and tidy.

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I had one complaint, I told the staff and they sorted it out", another said 'I would just tell the staff, haven't had to complain yet though.'