This inspection took place on 16 March 2016 and was unannounced.This was the first inspection of this service since it’s registration with the Care Quality Commission in August 2015.
The service is registered as a care home providing nursing care for up to eight people with a learning disability and /or associated mental health need. Each person has their own self-contained flat and receives one to one support depending on their assessed need. At the time of our inspection there were three people living at the home.
There was a registered manager in post at the time of this 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.
Since opening in August 2015, the home had received referrals for people with complex care needs and associated behavioural issues. As a result we had been made aware of a number of incidents occurring between the people who live at Cheshire House. We therefore carried out observations and reviewed records to look at how the home managed incidents and kept people safe.
Staff we spoke with were confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They knew what action to take to safeguard people from harm.
Records of medicine administered were complete and there were clear instructions to guide staff in the safe administration of ‘as needed’ (PRN) medicine.
A system was in place to identify and assess the risks associated with providing safe care and support. We found more work was needed to ensure there were risk assessments in place to enable people to achieve their current goals as well as to support them with associated risks through behaviours. We saw risks had been discussed with the people who used the service and action agreed to keep people safe from harm.
We saw that the philosophy of the care and support delivered at the home were based on best practice guidance, such as person centred care planning and positive intervention. However we found not all of the care plans were up to date and improvements were needed to ensure people’s current needs were met.
Staff we spoke with understood the needs of the people they supported. We observed that people were supported to carry out household tasks and supported to access the local community which prevented social isolation and promoted their independence.
New staff received a comprehensive induction along with a regular support and mentoring from more senior staff following their appointment. Staff fully understood their caring responsibilities and they demonstrated respect for the rights of the people they supported. We observed positive interactions between people being supported and staff although due to the nature and layout of the service our observations were limited. Because the service was a new service, supporting only three people at the time of inspection, it was difficult for us to ascertain how caring the staff were towards the people they supported. We will check this again at the next inspection.
Records showed that other healthcare professionals such as general practitioners (GPs), dentists, opticians, psychologists and psychiatrists were involved in people’s care.
Staff told us they felt supported, management were approachable and they felt like a valued part of the team. We were unable to ascertain how much people using the service and their relatives or advocates were consulted and involved in assessments, care planning and the development of the service because the service was relatively new and this information was not reflected in care plans. We will check this again at the next inspection.
We found staff received mandatory induction training, however staff had not completed specialist training about positive intervention and positive behaviour support in line with company policy .
We asked the registered manager how people were involved in making choices about their care and support. The registered manager told us that prior to moving in to the home, people (and when appropriate their family members and associated health professionals), were invited to visit the home and spend time there. The manager told us people could visit as many times as they wanted, spend a day, have a meal or stay overnight. They said an assessment would be carried out to determine the suitability and compatibility of each person living there. We saw one assessment contained conflicting information about the suitability of one person living at the home and another did not contain enough information to ensure staff managed risk safely.
We found that the provider had not clearly assessed the risks to the health and safety of service users of receiving the care or treatment in order to ensure staff had the information they needed to mitigate such risks. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
We found information in relation to restrictions placed on people and why particular decisions had been reached were not always clear and was a breach of Regulation 11 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found there were not enough suitably qualified or trained staff to meet the needs of the people who used the service. This was a breach of Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We also found the provider had not notified us of all incidents which was a breach of Regulation 18 Care Quality Commission (Registration) Regulations 2009.
You can see the action we asked the provider to take at the end of this report.