The inspection took place on the 23 and 25 November 2016. We gave 48 hours’ notice in line with our methodology for domiciliary care services. This is to give people notice that we wish to visit them in their own home. The service was last inspected on the 8 January 2014 and the service was meeting all the required standards. Since then there has been a recent change in the management of the service and a new manager and deputy manager have come into post.The service provides Housing with care. People have their own tenancies with Broadland Housing and Norse care provides care according to people’s individual needs. There is a dedicated extra care unit for people living with dementia and a separate unit for older people.
The manager is registered 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.’
During our inspection we received mostly positive feedback from people using the service. The service supports and enables people to live independently and have their own tenancies whilst also providing variable support around their individually assessed needs.
Staffing levels were based on the assessed level of support people required with higher staffing ratios on the Extra Care Unit. Some people using the service and a number of staff told us that at times the levels of staffing were not sufficient to meet people’s needs. They gave us examples of when people’s needs had rapidly declined and they had needed additional support. Staff said the service was sometimes stretched really thinly. However within the staffing structure the team leaders, deputy manager and manager were not directly rostered on shift to provide care which meant they were able to help staff at busier times. Reassessments of people’s needs meant gaps in provision and funding could be identified and decisions made if this was the right service to continue to meet a person’s needs or if additional funding could be made available to continue to support the person.
We have made a recommendation about staffing.
Risks to people’s safety were managed as far as possible and risk assessments identified what actions staff should take to mitigate risk. Joint meetings between care and housing providers meant environmental and risks associated with care were discussed and addressed by the right service, (housing or care) with clear lines of accountability and responsibility.
People received support as required with their medicines by staff who were trained to administer medicines. Audits were in place to ensure people got their medicines as required and mistakes could be quickly rectified.
We have made a recommendation about medicines.
Staff received sufficient training to help them support people with their care needs and to assess risks to people’s health and safety. Additional training in specific health care conditions could be accessed as required and more training would benefit some of the less experienced staff.
Staff spoken with knew how to safeguard people in their care and felt comfortable in raising concerns through their internal procedures or through external agencies when this might be necessary. Staff had received training in protecting adults from abuse and said they had policies they could follow.
Robust staff recruitment processes helped to ensure that only suitable staff were employed. Once staff were employed they were supported through an adequate, induction and training programme to ensure they had the necessary skills and competencies. Supervisions had recently taken place and there were direct observations of practice linked to staff supervision and annual appraisal of staff performance.
People were supported to remain healthy. Staff monitored people’s health and reported any changes to family and relevant health care professionals. Staff supported people in staying active and provided activities to keep people stimulated. People were supported around meal times if required and if people were not eating enough for their needs staff would monitor their food and fluid intake and refer appropriately to the GP
Staff were familiar with people’s needs and had care plans to refer to which told them what support people needed. These plans were kept under review to ensure the support provided remained appropriate to need.
Staff supported people lawfully and took into account people’s wishes and where they lacked capacity engaged other professionals and family to ensure decisions reached were in the persons best interest. The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. People were supported to make decisions and any restriction on people with carried out lawfully.
The service was well managed and ran in consultation with people that used it. There were systems in place to assess and monitor the quality of the service so improvements could be identified as and when required. The service learnt from incidents, safeguarding concerns and adverse events.