14 March 2016
During a routine inspection
The Huntercombe Neurodisability Centre is located in central Crewe. The centre provides care and treatment for people with long term neurological conditions and people with neurological conditions acquired through illness or injury. There is also a one bedded flat for people preparing to leave. The home is registered to provide a service for up to 40 people. On the day of our inspection there were 30 people living in the home.
At the time of the inspection the home did not 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. However a manager was in place and had made an application to become registered with CQC, which was near completion.
We identified two breaches of the relevant legislation in respect of nutritional needs and good governance. You can see what action we told the provider to take at the back of the full version of the report.
We found that there had been a period a time when the home had depended upon agency staff to ensure that there were sufficient staff and this meant that there was less consistency of care. There had been a recent focus on the recruitment of new staff and the manager told us that the home was now fully staffed. However during the inspection we found that staffing on the first day had been affected by staff sickness which impacted on the care provision. There has been some re-organisation within the home and a new allocation system implemented to support staff and enable them to meet people's care needs in a timely manner.
People received their medication in a way that protected them from harm. The staff were working with people's GPs, to ensure that appropriate protocols were in place for medication which was taken "as and when required". People had good support from health professionals based within the home such as psychology and speech therapy. The manager was also recruiting for an occupational therapist.
We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. However we found that not all staff knew where they could report safeguarding concerns to outside of their organisation. Risk assessments were completed to guide staff in how to minimise risks and potential harm.
People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained. However we found that not all areas of the home were visibly clean and some areas appeared cluttered and untidy.
Arrangements for eating and drinking did not always take account of individual needs and requirements. We found that the dining experience was not a particular cheerful or sociable experience. People's views on the quality of the food were mixed. The manager had already acted upon feedback received about the food to make improvements.
Staff had completed a thorough induction before commencing their employment at the home and staff received on-going training. There had been a recent focus on staff training needs.
Staff had received training in legislation such as the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to care or treatment. Where a person was being restricted or deprived of their liberty, applications had been made to the supervisory body under the Deprivation of Liberty Safeguards.
People told us that staff were kind and treated them in a caring manner. However, we observed that staff did not always maintain people's privacy and dignity. Confidentiality was not always maintained with regards to the storage of records and where people's personal information was on display.
Care records were personalised and up to date, they reflected the support that people needed so that staff could understand how to care for the person appropriately. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required.
We found that in some care records and daily charts there were gaps in the information recorded and they had not always been completed at the time that the care had been provided.
People had access to activities both within the home and local community. People were encouraged to maintain their independence.
People and staff told us that the home was well led and that the management team were approachable and supportive. We found that the manager had taken steps to improve the quality of the care provided. We saw that regular team meetings and supervision with staff were held. People's feedback was sought and there had been four resident/relative meetings since the manager had come into post.
Quality assurance systems were in place and audits were carried out to highlight areas where improvements were needed. We asked for information about any quality assurance or monitoring visits carried out by the provider, but there were none available and we were unable to evidence that the organisation provided support to the management team to monitor the quality of the service provision.