The inspection was carried out on 17 and 23 July 2018. The first day of the inspection was unannounced.
7-9 Park Road South 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. It is registered to provide support for up to 21 people. At the time of our inspection 17 people were living there.
7-9 Park Road South provides support to people who have a learning disability, some of whom also require support with their mental health. Situated close to Birkenhead town centre the home appears externally as a domestic property on a residential street. Originally a pair of semi-detached houses the building has been converted to make one larger house.
The home has a registered manager. 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 registered manager has been in post since 2015.
The last inspection of the service was carried out in April 2016 and the service was rated good in all areas. During this inspection we found breaches in relation to Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014.
This was because the provider had not ensured care and treatment was provided with the consent of the relevant person. It was not clear from records whether people’s capacity to make important decisions had been assessed and what if any support they had received to make the decision and review it afterwards.
Although systems were in place for monitoring the effectiveness and quality of the service provided these were not always effective. For example, medication audits highlighted a concern with recording of medication and records showed that this did not improve following the audit process. Systems had also failed to note that not all care plan information was up to date or reviewed. In addition, audit systems had failed to identify that the home was not operating in line with current best practice guidance for supporting people with a learning disability. This includes Registering the Right Support.
You can see what action we told the provider to take at the back of the full version of the report.
In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection we assessed the service in line with this guidance.
7-9 Park Road South did not meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size, layout, staffing arrangements at 7-9 Park Road South meant that it does not feel or operate as people’s home. Certain physical aspects to the building and staff practices felt institutional and detracted from a homely atmosphere. This included staff wearing disposable gloves for no identifiable reason and wearing bunches of keys around their neck. We also saw that the office was a hub within the home with staff and people living there spending a significant part of their time in or near to it. People who required support to learn or retain everyday living skills were not routinely provided with this support.
The registered manager had a good understanding of Deprivation of Liberty Safeguards and had applied for these were an assessment indicated it was in the person’s best interests.
Polices were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. People felt safe living there and staff knew what action to take if they felt people were at risk of abuse. A system was in place for raising concerns or complaints and people living at the home felt confident their concerns would be listened to and acted upon.
People received the support they needed to manage their physical and mental health needs. People’s medication was generally safely managed and they received it on time and as prescribed. However, records of medication given to people were not always accurate, although the provider was aware of this record keeping in this area had not improved. In depth risk assessments to support people to manage their own medication had not been undertaken to establish if with support people could become more independent in this area.
Individual care plans were in place for everyone living at the home. The contents of these were varied. Some people had plans that provided clear guidance for staff to follow. Other care plans lacked clear guidance or where not available in all areas the person needed support. It was not always clear if people had understood and agreed to the contents of their plan and if this had been regularly reviewed with them.
Equipment and the building were monitored regularly to ensure they were safe. Where repairs or maintenance had been identified plans were in place for this. The registered manager was pro-active in acting on infection control issue identified during the inspection.
There was enough staff working at the home to meet people’s assessed care needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.
Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us that they felt supported and we saw that they had regular supervisions with senior staff.
People told us that they generally enjoyed the meals provided at the home. Where people required a special diet or support with their meal staff were aware of and provided this.
People who were fully independent had facilities for making snacks or a meal. Support was not routinely available for people who required staff support to learn or retain household skills including cooking and laundry skills.
People liked the staff team and staff knew people well. Staff took time to learn people’s interests and hobbies and tried to arrange outings to support people with these.