Archived: 177-179 Spring Grove Road

The inspection took place on 8 November 2016 and was unannounced.

The last inspection took place on 1 February 2016 when we found breaches of five Regulations relating to dignity and respect, person centred care, safe care and treatment, good governance and notifications of incidents. At the inspection of 8 November 2016 we found that improvements had been made. In particular people were receiving better support with their health and the care was safer. In addition the registered manager had introduced systems to monitor and manage the service which had improved the way in which people were cared for. However, we found that further improvements were still needed. In particular care was not always provided in a person centred way.

177-179 Spring Grove Road is a care home for up to eight adults with a learning disability. At the time of the inspection six people were living at the home. Some people also had physical disabilities, a range of complex health needs and were not able to communicate their needs verbally. Voyage 1 Limited is an organisation providing care and support to people with learning disabilities, autism and brain injury throughout the United Kingdom in residential, outreach and day services.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People living at the service did not always have care which reflected their individual needs and preferences.

There had been improvements to the way in which the service was managed and run. This had impacted on the lives of people who lived there. In particular there had been improvements to the way in which their health needs were monitored and met. There had also been improvements to their safety and the way in which they were supported to eat and drink.

People living at the service could not tell us about their experiences, but their relatives told us they thought they were happy living there. Relatives and professionals told us they recognised the improvements at the service and felt that these were positive. They expressed some concerns that further improvements were needed. In particular they felt that not all the staff working at the service had embraced the changes and this meant that people's needs would not always be met.

The staff were well supported and trained. There was clear information about their roles and responsibilities and the registered manager was accessible and supportive. There were enough staff employed to meet people's needs.

There had been improvements to record keeping and the way in which the service was monitored. The registered manager had introduced systems to make sure care was delivered safely and appropriately and these systems were followed.

People received their medicines in a safe way although further improvements were needed to some of the records and auditing of medicine supplies. People were safe and there were procedures to protect them from abuse and to safely recruit the staff.

The last inspection of the service was on 14 November 2014 when we found there were no breaches of Regulation.

177-179 Spring Grove Road is a care home for up to eight adults with a learning disability. At the time of the inspection seven people were living at the home. Some people also had physical disabilities, a range of complex health needs and were not able to communicate their needs verbally. Voyage 1 Limited is an organisation providing care and support to people with learning disabilities, autism and brain injury throughout the United Kingdom in residential, outreach and day services.

There was not a registered manager in post. The registered manager had left the service in 2015. The organisation had employed a new manager who had started work at the service one week before the inspection. They had applied to be 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 and associated Regulations about how the service is run.

The staff did not always support people in a safe way to eat and drink and this put them at risk of choking.

People received their medicines as prescribed and in a safe way. However some of the protocols for administering medicines to individuals and records of stock medicine were not up to date or accurate.

People’s health needs and how these had been treated were not always recorded. Some health needs had not been met. Improvements in this area were being made and the provider was taking action to make sure people’s needs were met and properly recorded.

People received a varied and nutritious diet but the staff did not always keep accurate and contemporaneous records of the drinks they had given people who were at risk of dehydration. The staff had not always responded to changes in people’s weight.

Some staff did not treat people with dignity and respect. They did not always consider people’s feelings or offer them opportunities to make decisions.

Some of the staff tended to focus on the task they were performing rather than the person they were caring for.

People were not always supported to take part in varied social activities which reflected their needs and preferences.

Records about people’s planned care and the care they received were not always accurately maintained.

Incidents and accidents had not always been investigated and the provider had not mitigated risks to people because of this. The provider had not always notified the Care Quality Commission about these accidents and incidents.

The provider had investigated and taken action to improve the service following complaints they had received.

The provider had responded to the concerns about the service and had created an action plan. They had started to change systems and make improvements at the service.

You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager appears who was not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service responsive?

' Is the service caring?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was not always safe because people could not be confident that their medicines were safely managed or administered. There were enough staff and they were suitably appropriately trained and supported. The provider undertook checks on the environment to ensure the health and safety of people, staff and visitors. Where people were at risk this had been assessed and there was information for staff on how to minimise the risks..

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that they had contacted the appropriate authorities so that people's capacity to make decisions could be assessed. The manager had conducted an assessment of people's capacity and this had been considered when creating support plans.

Is the service responsive?

The service was responsive. Where concerns had been identified through accidents, incidents and safeguarding alerts the provider had acted upon these and put in place changes to improve the service people received. In general people's needs were recorded in support plans. These had been reviewed and changes made where a need had been identified.

Is the service caring?

The service was not always caring. The staff did not always treat people with respect or allow them to make informed choices. People's physical and health care needs were usually met but they did not always get support to meet their social and leisure needs.

Is the service effective?

The service was not always effective. The staff did not always meet people's needs or follow their support plans.

Is the service well led?

The registered manager left the service shortly before the inspection. A registered manager from another home and the deputy manager were overseeing the management of the service until a new manager was appointed. There were systems for monitoring the quality of the service however these had not always identified where there were problems.

We found that people were involved in identifying their preferences and needs. This was reflected in the individualised support plans that detailed how people liked to live their life and how they were supported with this. The person we spoke with told us they were happy living at the home and liked the staff. We saw staff being respectful towards people by adapting their communication style to enable people to communicate what they wanted.

We found that improvements were being made to the environment to make it safer and pleasant for the people who use the service. Improvements had also been made to ensure that checks were carried out on staff to ensure they were suitable for working with vulnerable people.