This inspection took place on 12 March 2018 and was unannounced.254 Hagley Road is 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.
254 Hagley Road accommodates seven people who may have learning disabilities and /or may live with autism.
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.” The service did not consistently comply with the Registering the Right Support and the registered manager was not aware of the policy.
There was a registered manager in post 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.
The provider and staff practices of managing people’s medicines, was not safe. We found medicines that were out of date, failure to book in medicines correctly meant it was difficult to check exactly how stock was available and so be able to audit. Some medicines were stored in boxes where the instructions had faded so it made it difficult to read. Staff medication administration competencies had not been checked annually. People’s PRN protocols were not sufficiently detailed, to direct staff when they should be given. Medication audits had failed to identify the shortfalls.
The provider had not taken steps to ensure the systems used to monitor and check the quality and safety of services provided were consistently effective and supported improvements.
Although the provider had notified the Local authority of safeguarding incidents, they had failed to report the events to the Care Quality Commission in the form of notifications.
People felt safe living at the home and staff treated them well. Staff knew how to recognise abuse and were clear about their responsibilities to report safety concerns to the registered manager. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible; they were safe to work with the people who lived there.
People were supported by staff who had received training and the skills necessary to support them. Staff had received training in MAPA, [Management of Actual or Potential Aggression] techniques, but had kept this intervention to the minimum. Incidents were recorded and monitored.
People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible. Staff respected people's right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, although the provider systems were in place to support the ethos of people’s decisions being made in their best interests. Not all best interest decisions taken had been recorded.
People were assisted to access health and social care professionals as required to maintain their health and wellbeing.
Staff had built positive relationships with people, showing acts of kindness when providing people with support to meet their particular needs. People were supported with personal care which met their preferences and supported their dignity and privacy. People were encouraged to maintain relationships important to them.
People were provided with meal choices and received assistance to eat their food to support their levels of independence. Staff provided hot and cold drinks so they could remain hydrated. Menus were in a pictorial format to help people understand the choices of offer.
People’s particular needs were responded to so people’s care experiences were enhanced by staff practices. Staff had the information they required within people’s care plans to support them in providing and delivering responsive care. Staff were given verbal feedback known as ‘handovers’ at shift changeovers to learn about changes in people’s needs.
Although some people living at the home used Makaton as a form of communication, not all staff had been trained. However the registered manager had requested further training for staff from the provider.
People were offered choices of activities and had opportunities to have holidays.
Staff felt supported by the registered manager and we heard how teamwork was valued. The registered manager valued their staff team and had a vision to improve the service delivered to people.
People believed the registered manager was approachable and were comfortable in raising any concerns they had.
The provider had to displayed their current inspection ratings which is a legal requirement to show people had access to the ratings to inform their judgments about services