Archived: Royal Mencap Society - Fryers Walk Also known as Fryers Walk

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the service in relation to the improvements and identified breach of regulation. This was provided when requested.

Fryers Walk provided two separate services. It was registered as a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were fifteen people living in three bungalows called Poppy, Daisy and Foxglove. All bungalows were staffed separately around people’s individually assessed needs. In addition to the bungalows, there were offices on site for staff to use.

Fryers walk also provided care and support to fourteen people living in supported living settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection, they were supporting eleven people with personal care. Some people lived by themselves and some lived with others who may or may not receive a regulated care service. The accommodation was owned and managed by a housing association.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy.

The service had a registered manager 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.

However, the registered manager was in the process of leaving to take over the responsibility of another Mencap service. The service had appointed new managers who were not yet registered with CQC. They were sufficiently experienced and working alongside the existing registered manager. They were going to oversee the residential service with one manager overseeing two residential bungalows and the other manager the third bungalow. There was also a deputy manager for the residential service but they were off sick at the time of this inspection. In addition to the residential managers, another manager was employed and had applied for registration for the supported living service and had a date with the CQC for their interview. An experienced deputy manager supported them. The managers were well supported by the regional manager who was at the service each week.

The service was mostly well led and improvements had been made since the last inspection. The service was in the process of registering new managers with CQC. The managers had received a good induction into their role. We found that the services were managed separately and there was not clear communication across each site. We found some parts of the service ran more effectively than others and this made it difficult to assess if everyone using the service were getting good outcomes. For example, some people had regular opportunities to go out, others less so. Some people’s records clearly demonstrated people’s wishes and aspirations, other people’s records did not. Some people living independently did not have sufficient opportunities to influence the service they received such as what staff would support them with and having access to their own medication and bank account.

However, we found overall the service was working hard to support its staff and were quick to identify any concerns about staff practice and ensure staff were supported to improve. Staff spoke with were motivated and passionate about what they did. The use of agency staff did not detract away from the level of service provided and agency staff sometimes took permanent contracts.

Risks were mitigated as far as possible and there were appropriate quality assurance systems, which took into account people’s experiences and learnt lessons from incidents, accidents and any potential risk. Records were not always complete showing actions taken and this was an area for improvement

Staffing levels were adequate and vacant posts were being recruited into. The service had robust recruitment processes in place to ensure they recruited the right staff. There were good processes in place to support existing staff and help improve staff retention. The use of agency staff was kept to a minimum but still necessary to ensure the service was not understaffed.

Risks to people’s safety were mitigated as far as possible and records recorded the actions staff should take to keep people safe. Regular health and safety checks helped to ensure the environments were free from risk as far as possible. We looked at people’s environments in relation to the residential service but our regulations do not require us to do this in the supported living service. However, individual risk assessments were in place for both and covered peoples individual’s behaviours and needs and their environments. Accommodation was suitable for people’s individual needs and was on one level with appropriate equipment to support people’s manual handling needs and sensory needs.

Staff knew how to and felt confident that they could recognise abuse and knew what actions to take to report it. The records in the service were inconsistent with regards to safeguarding concerns and incidents. For example, records we had asked for had been archived and there was not clear documentary evidence of actions taken. However, the provider was able to provide this information and has changed their practice to ensure information is more clearly documented in future.

Staff were trained to administer medication and there were clear protocols around this. Any errors had been identified and acted upon because there was robust auditing and staff were supported to improve their practice. However, in the supported living service audits did not help us to identify which medication records had been looked at and we thought it would be clearer to carry out separate audits for each dwelling.

The service supported its staff to develop their professionalism and work in line with best practice. Staff new to the service completed a recognised foundation course and mandatory training suitable to their role. Staff were well supported and their performance monitored to help ensure high standards were maintained.

People were supported to eat and drink enough for their needs. There had been some improvements in this area after a number of concerns were identified. Staff had received training in nutrition and the service had established better links with the dietician and speech and language team.

Links with health care professionals were well established for the benefit of people and to ensure their needs were met as holistically as possible.

Staff understood and effectively applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards as applicable depending on the type of support they provided. People can be deprived of their liberty if lawful and only after approvals from the Local Authority. However, this only applies to residential care and not supported living services. People were involved in decisions about their care so their human and legal rights upheld. People had maximum choice and control of their lives and staff assisted them in the least restrictive way possible.

Staff were caring. They supported people according to their needs and wishes and where possible promoted people’s independence.

People were supported to achieve their goals although it was not clear from each person’s record if these had been identified.

People were consulted about their care needs and communication plans told us how staff communicated with people and took into account any sensory needs they might have.

The service was responsive and people’s support plans were detailed. However, more work was needed to be done to ensure people’s records showed what progress people were making towards an agreed goal or wishes.

There was an established complaints procedure and the service took account of any feedback it received about the service.

The service that is provided has changed since our last inspection on 15 and 24 September 2015. At that time the regulated activity accommodation for people who require nursing and personal care was provided to up to 31 people. The regulated activity personal care was not provided to anyone.

As a result of our findings at our last inspection we asked the provider to make improvements to staff knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We received an action plan detailing how and when the required improvements would be made by and these actions have been completed.

This unannounced inspection took place on 19 December 2016 and 5 January 2017. There were 15 people receiving care in the care home and seven people receiving care in their own homes.

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.

Although two managers were registered to manage the services, one of these had left in August 2016. The manager of the supported living service registered with the CQC in November 2016. She was also registered to manage another service in South Lincolnshire and divided her time between the two services. Two managers, who were not registered with the CQC were responsible for the care home. One of these managers had responsibility for Foxgloves, and the other for Poppy and Daisy.

Although improvements had been made to the service provided, there was a lack of day to day management oversight. People and their relatives were encouraged to provide feedback on the service. However, this feedback had not always acted on.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were trained, and well supported, by their managers. There were sufficient staff to meet people’s assessed needs. Systems were in place to ensure people’s safety was effectively managed. However, these were not always followed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People’s medicines were stored safely. However, people did not always receive their medicines as prescribed. People’s health and care were effectively met and monitored. People were provided with a balanced diet and staff were aware of people’s dietary preferences and needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process. People’s rights to make decisions about their care were respected in the care home. However, this was not always the case where people received the supported living service.

People received care and support from staff who were caring. Staff in the care home treated people with respect but this was not always the case in the supported living service. Staff knew people well and understood their needs. People’s care records provided staff with sufficient guidance to ensure consistent care to each person. People were supported to develop hobbies and interests. However, some people’s access to the community was restricted by their funding arrangements.

People had access to information on how to make a complaint and were confident their concerns would be acted on.

We found one breach of the Health and Social Care Act (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.

We spoke with people who lived at the home and relatives who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that staff members were responsive to the needs of people and that they were given the support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted and protected.

People spoken with and their relatives told us that people were provided with the care and support they needed and that the staff were kind.

Medication was administered, recorded and stored accurately and safely.

Staffing levels were adequate when all staff absence was covered. However, relatives told us that people using the service had to sometimes wait to receive the one to one support they required for them to go on individual outings.

People told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making.

The updated plans of care contained the information staff members needed to ensure that the safety of people was promoted. We had received information of concern and the area manager showed us that the provider had taken the appropriate action to ensure that improvements were being made and that people were protected.

Regular checks and audits of medication records had been recently carried out and all staff members had completed updated training in medication administration.

Relatives told us that people received the care and support they needed but that there seemed fewer staff around at times, often in the afternoon and at the weekend.

There was evidence that learning from incidents/investigations took place and appropriate changes were implemented. The provider took account of complaints and comments to improve the service.