We carried out this unannounced inspection on 1 & 4 April 2016. Finn Farm lodge is a Prader Willi Service. It provides accommodation for up to six people. At the time of inspection there were three people living at the service. People had their own bedrooms. Some bedrooms were located downstairs but the service was not accessible for people who needed to use a wheelchair. This service was last inspected on 2 September 2014 when we found the provider was meeting all the requirements of the legislation.
At this inspection there was a new manager in post who was not yet 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.
For a period of time leading up to this inspection the service had had an extended period of unsettled management and this had led to shortfalls in the quality of service people received through an absence of consistent management support. A new experienced manager had been appointed. The inspection found there were strengths within the service and that staff now felt better supported, the manager and senior managers in the organisation understood and had identified many of the shortfalls present within the service and were taking action to address these. The atmosphere of the service was relaxed, people told us they felt safe now that changes had been made to who lived in the house with them. People were comfortable in the presence of staff and actively sought their attention if they wanted something. People received individual support from staff that interacted well with them and showed that they understood their individual needs.
This inspection however, found that people were not always safe because the checks made on new staff were not robust in order to meet the requirements of the legislation. The induction of new staff was poor. Some important details about how people’s health needs or behaviour should be supported were not in place to inform staff. Improvements were needed in the management of medicines to ensure boxed and bottles medicines were dated upon opening and staff competency to administer medicines was updated in accordance with the expectations of the organisation. Informal concerns raised by people in the service although listened to were not routinely recorded to ensure that action was taken to address them.
Fire drills were held but improvements were needed to how these were scheduled to ensure all staff participated in fire drills each year, Improvements were needed to the way in which people were provided with activity and stimulation to meet their needs.
The new manager had taken steps to improve communication between staff and with relatives and other stakeholders. Assessments of risk people might be subject to from their environment, or from activities or risks associated with their assessed support needs had been developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated.
Appropriate systems were in place to ensure staff received training to support the needs of people in the service such as Prader Willi Syndrome, and diabetes. Staffing levels were appropriate to ensure there was enough flexibility to meet people’s demands and needs.
Staff felt supported and listened to and opportunities for more frequent one to one meetings with the manager, and more regular staff meetings was an area both the manager and provider representatives had identified for improvement, and plans were in hand for this. Annual staff appraisals were scheduled.
A range of quality audits were in place to help the manager and provider monitor the service, and these were mostly effective in identifying many but not all shortfalls highlighted from this inspection; the provider was therefore able to assure their selves that a safe standard of care was being maintained. Improvements to the premises had been made to provide a comfortable environment for people to live in, systems were in place for the routine testing and servicing of electrical, gas and fire alarm installations to ensure people were kept safe.
There was a low level of accident and incidents, and staff showed an understanding of safeguarding, they were able to identify abuse and were confident of reporting concerns appropriately. Staff understood the action they needed to take in the event of an emergency that could stop the service.
Staff had received training in Mental Capacity Act 2005, they sought people’s consent on an everyday basis and understood when other people might need to be involved in making more complex decisions on a person’ s behalf. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made; appropriate steps had been taken to ensure those living at the service who met the requirements for a DoLS authorisation had been appropriately referred. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
Staff showed a good understanding of people’s needs and people were relaxed and comfortable in the presence of staff. Relatives thought the arrival of the new manager and recent changes to the people supported in the house were positive steps towards provided a better service to the people now living there. Professionals commented the service was providing good management of the Prader Willi Syndrome needs of people living in the service.
Staff monitored people’s health and wellbeing and mostly supported them to access routine and specialist health when this was needed. People liked the food they ate which was designed specifically in relation to their condition.
We have made one recommendation:
We recommend that the provider and manager review their responsibilities to provide individual staff with fire drill training and the recommended frequencies for this in accordance with the Regulatory Reform (Fire Safety) Order 2005.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.