Archived: Care Assist in Harrow (Park Drive)

At the last inspection the service was rated Good with no breaches of regulation.

At this inspection we found the service remained Good.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 we spoke with told us they had been treated with dignity and respect in the home. They said they felt safe in the home and in the presence of care support staff. On the day of the inspection, we observed there was a calm and homely atmosphere in the home.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults. Comprehensive risk assessments were in place which clearly detailed potential risks to people and how to protect people from potential harm.

Systems were in place to ensure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. People told us they received their medicines on time and raised no concerns in respect of this.

People who lived in the home and staff told us there were sufficient numbers of staff to safely meet people’s needs.

Fire and emergency procedures were in place and there was evidence to confirm that necessary checks were carried out regularly.

On the day of the inspection, the home was clean and there were no unpleasant odours. A cleaning schedule was in place which allocated cleaning responsibilities to staff to ensure that the home was kept clean and regularly monitored.

People had an initial assessment of their needs with their families' involvement before moving into the home and care documentation demonstrated this. People's healthcare needs were closely monitored by care support staff and contained important information regarding medical conditions, behaviour and allergies.

Care support staff were provided with a range of role specific training and management provided regular support through supervisions and appraisals.

People were supported to have maximum choice and control of their lives and care support staff supported them in the least restrictive way possible. People were involved and encouraged to be responsible for the preparation of their meals.

People’s capacity to make decisions and communication preferences were clearly documented in their care support plans. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The registered manager confirmed that no one in the home was subject to any restriction of their liberty. On the day of the inspection we observed people went out when they wished to do so without any restrictions.

Care records were person-centred, detailed and specific to each person and their needs. Care preferences and cultural requirements were also noted.

Each person in the home had an individual varied activities programme which was devised with their input. People told us there were sufficient activities available for them and spoke positively about the activities they participated in. On the day of the inspection we noted that one person went out for the morning to a jewellery making course. Another person went out to get a haircut.

The home had a complaints policy in place and there were procedures for receiving, handling and responding to comments and complaints. A formal satisfaction survey was carried out in April 2017 and feedback received was positive and no concerns were raised.

People who lived in the home told us that management were approachable and they were satisfied with the management of the home. They said they had confidence in the registered manager. The home had a clear management structure in place. Staff were supported by management and were able to have open and transparent discussions. The quality of the service was regularly and consistently monitored and we saw evidence that regular audits and checks had been carried out by management.

The provider met all the standards we inspected against at our last inspection on 25 April 2014.

There was a registered manager in post at the time of our inspection. 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.

During the inspection we observed people were treated with kindness and compassion. It was evident that positive caring relationships had developed between people who used the service and staff. People who used the service spoke positively about staff and the care provided at the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm. Staff were knowledgeable about people’s individual care needs and were aware of the triggers and warning signs which indicated when people were upset and how to support people appropriately.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. People who used the service told us that staff always had time to speak with them. The registered manager explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

There were arrangements for the recording of medicines received into the home and for their storage, administration and disposal. People told us that they received the medicines on time and had no concerns regarding this.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people’s likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people’s needs changed. The registered manager explained to us that they encouraged people to be independent as much as possible but provided support where necessary.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). People in the home all had capacity to make their own decisions and care plans demonstrated that they were involved in making decisions about their care.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The registered manager informed us that none of the people who lived in the home were subject to any orders depriving them of their liberty. We noted that people could freely go out when they wanted to.

People spoke positively about the food arrangements in the home. They explained that they prepared their own food and that there wasn’t a set menu as people ate what they liked and when they liked. People’s weights were recorded regularly. This enabled the service to monitor people’s nutrition so that staff were alerted to any significant changes that could indicate a health concern related to nutrition.

People spoke positively about the atmosphere in the home and we observed that the home had a homely atmosphere. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

People told us that there were sufficient activities available. Each person had their own activities timetable which was devised based on their interests. Activities included attending the local leisure centre, going shopping and attending college.

We found the home had a management structure in place with a team of care staff, team leader and the registered manager. The home had an open and transparent culture. Staff told us they were encouraged to have their say and were supported to improve their practice. Staff told us that the morale within the home was good and that staff worked well with one another. They spoke positively about working at the home. They told us management was approachable and there was an open and transparent culture within the home and they did not hesitate about bringing any concerns to management.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred monthly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

We spoke with four of the five people who were currently using the service, and three members of staff, including the Registered Manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Individual risk assessments were incorporated into the full support plans, and included, for example, self-neglect, isolation, accessing the community and absconding.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

We checked a sample of records to show that the premises were maintained safely. Fire evacuation drills took place regularly so that staff and people using the service had practice in leaving the premises safely in case of fire. Staff carried out a weekly check of the premises to ensure that people using the service, staff and visitors were safe.

Is the service effective?

Sufficient staff were on duty at all times to meet the needs of the people who used the service. The daily rotas recorded any support that people needed, for example to attend recreational activities or medical appointments in the community, and allocated a specific member of staff to provide that support.

The care plans provided clear information on each person's physical and mental health care needs. Guidance on each person's mental health needs included the support they needed if their behaviour changed and contacts with psychiatrists and the community mental health team. One person told us that they were due to have a Community Psychiatric Assessment (CPA) meeting the following week and they looked forward to discussing a change of medicine with their consultant psychiatrist. They said, “I need less (specific medicine) here because I feel better about myself.” Another person said, “A happy environment affects your mental health.”

People were provided with a choice of suitable and nutritious food and drink. The provider allocated a weekly budget to each person who used the service to buy their own food. People chose the food that they wanted to eat, and their support workers assisted them to prepare it according to their abilities. One person told us that they were able to go to the nearby shops by themselves to buy food for their meals. They said, “Because we live right by the shop I can eat more healthy.”

Is the service caring?

One person said, “The carers are nice, there is always someone to talk to.”

Assessments and support plans were written and reviewed by each person together with their key worker. Each person completed “All About Me”, which gave their views of their care and treatment and their likes and dislikes. One person wrote, “I like to be in control of my life. I like my voice to be heard and my opinions to be respected as I know myself better than anyone else.” All About Me for another person included their desired outcomes for their stay at the service, and the support that they wished from the staff.

Is the service responsive?

People who used the service were asked for their views about their care and treatment and they were acted on. Each person who used the service had regular meetings with their key worker when they reviewed their support plan and goals, and made suggestions for any changes they thought were needed. There were monthly house meetings where people using the service met with staff to discuss management of the house and activities, and to comment on what the service was doing well and what they could do better.

Is the service well-led?

The Registered Manager supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. The Registered Manager was also manager for two other Care Assist services in the locality. Staff we spoke with said that she provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. They carried out quarterly quality audits of all the home's records and procedures and six monthly satisfaction surveys of people using their services and their families. The report of the last survey in January 2014 showed that 97% of people using Care Assist services were very positive.

People using the service told us they were happy living in the home. They made comments such as “We get good care here”, “The manager is very good” and “They treat me like an adult.” People told us that staff treated them with dignity and respect.

People’s needs were assessed before care and support was delivered. This involved speaking to them about their wishes before moving in.

The provider operated an effective system which managed the risks of infection. We saw evidence that a quarterly audit was carried out by the manager and concerns would be sent for the attention of the company management.

We found the provider had effective recruitment procedures in place. The required checks were made before staff commenced their employment, thus protecting people from being supported by individuals who were not of good character or adequately qualified.

The provider had a complaints policy in place. One person told us if they had a complaint they would speak to staff and if they were still not happy they would request to speak to the manager.

We found that the staff providing the service were knowledgeable, competent and skilled in their roles. We observed them supporting people in ways that respected them as individuals, maintained their dignity and enabled them to reach their potential.

We found that there was good communication with external services, including social workers and mental health professionals. Individual needs, wishes and preferences were central to the care provided.