Archived: Patching Lodge Extra Care Scheme

Patching Lodge Extra Care Scheme is a domiciliary care service and is registered to provide personal care and support for people living in their own home in Patching Lodge Extra Care Scheme, a sheltered housing complex managed by a housing association. This accommodation is for people over 60 years of age and care and support can be provided to people with a physical disability or learning disability, people with a sensory loss, for example hearing or sight loss and people with mental health problems or living with dementia. Twenty four hour care, seven days a week is provided with a dedicated on-site care staff team, and with an emergency call facility. Additional services provided include a restaurant (for main meals), organised social activities, a café, shop, library and a hairdressing salon. There were 33 people receiving a service at the time of the inspection, the majority of which received the regulated activity of personal care.

On the day of our inspection, 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 2008 and associated Regulations about how the service is run.

Following an inspection which was carried out on 15 February 2015 we found a number of areas which were in need of improvement. This was in relation to care and support plans and risk assessments not having been reviewed, there was a lack of continuity of staff providing the care calls and times the care and support was provided. Quality assurance systems had not been maintained to check the quality of the service provided and to help drive improvement. The provider sent the CQC an action plan stating what they would do to address these issues. We looked at these improvements as part of the last inspection on 27 June 2015. However, despite the improvements identified, we were unable at the inspection to determine whether these practices were fully embedded into the service. They would need to demonstrate appropriate arrangements over a defined period of time to ensure that the sustainability of good care could be achieved for people. At this inspection we found the improvements had been maintained and embedded in the service. However, we did find areas in need of improvement in relation to using feedback received to continue the development of the service. People were supported with their healthcare needs. Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately. However, recording had not always been fully maintained to evidence the administration of medicines. Feedback was varied as to the frequency of staff meetings. Records showed us meetings had been held, but recently some had been cancelled. Staff meeting minutes had not always been completed to inform care staff of agreements made, especially if they had been unable to attend the meeting.

The majority of people and their carers spoke well of the care and support provided. They told us there was now a more consistent dedicated team of care staff working in Patching Lodge Extra Care Scheme. There was now good continuity of care staff providing their care calls. They felt the registered manager had worked hard to address these areas and had listened to their concerns. People told us they always got their care call and they were happy with the care and the care staff that supported them.

Care staff told us there had been a number of changes to the staff team. However, they spoke well of the new management arrangements, and of the changes which had been made to improve the service provided. Staff told us there had been further recruitment of care staff to help cover staff vacancies and they had not now needed to use agency staff. They felt the team was working well together and there was good communication between the team members. One member of staff told us, “I love it here. I like working in the one building. We are fully staffed and the team are brilliant. If cover is needed people work extra.” A system was in place to ensure priority in the times care calls had been made to people receiving personal care, or assistance with medicines. Senior staff were working to ensure people were notified when call times had been changed.

There were 16 care staff who worked in the scheme. Care staff had been recruited through safe recruitment procedures. People told us they were supported by kind and caring staff who understood their care needs. Care staff received a five day induction, basic training and additional specialist training where required. Care staff had supervision in one to one meetings in order for them to discuss their role, training needs and share any information or concerns. One member of staff told us, “We are fully staffed. We work really well together.”

The needs and choices of people had been clearly documented in their care and support plans. People told us that they felt safe with the staff that supported them. Detailed risk assessments were in place to ensure people were safe within their own home and when they received care and support. Where people’s needs changed, people’s care and support plans had been reviewed to ensure the person received the care and treatment they required. Care and support plans had been reviewed and updated. People and care staff were aware reviews were happening and could tell us where reviews were planned and booked to take place.

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. One member of staff told us, “We always ask if they are happy to proceed and we record.” Where people were unable to make decisions for themselves, staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests.

Where required, care staff supported people to eat and drink and maintain a healthy diet.

Patching Lodge Extra Care Scheme is a domiciliary care agency and is registered to provide personal care and support for people living in their own home in Patching Lodge Extra Care Scheme, a sheltered housing complex managed by a housing association. This accommodation is for people over 60 years of age and care and support can be provided to people with a physical disability or learning disability, people with a sensory loss, for example hearing or sight loss and people with mental health problems or living with dementia. Twenty four hour care, seven days a week is provided with on-site care staff and with an emergency call facility. Additional services provided include a restaurant (for main meals), organised social activities, a café, shop, library and a hairdressing salon.

There have been a number of changes to the service since the last inspection of the service. The registered manager has left and there has been a period of interim management arrangements. Care and support is now only provided to people living in Patching Lodge Extra Care Scheme and not also to people living in the community. About 35 people were being provided with personal care and support with a dedicated team of care staff who worked in the scheme.

On the day of our inspection, there was not 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 2008 and associated Regulations about how the service is run. However, the registered manager from another of the provider’s services had taken over the management of the service. An application had been made to the CQC to add a further location on the manager’s current registration so they can manage this scheme alongside another of the provider’s services.

The last inspection was carried out on 3 and 5 February 2015. We found a number of areas which required improvement. This was in relation to care and support plans and risk assessments not having been reviewed, there was a lack of continuity of staff providing the care calls and times the care and support was provided. Quality assurance systems had not been maintained to check the quality of the service provided and to help drive improvement. The provider sent the CQC an action plan stating what they would do to address these issues. We looked at these improvements as part of this inspection. However, despite the improvements identified, we were unable at this inspection to determine whether these practices were fully embedded into the service. There would need to demonstrate appropriate arrangements over a defined period of time to ensure that the sustainability of good care could be achieved for people.

Systems were in place to audit and quality assure the care provided. However, the changes made had not been fully embedded and it was not possible to evidence these systems were fully up and running and had been maintained. People were able to give their feedback or make suggestions on how to improve the service, through the reviews of their care, and through the completion of quality assurance questionnaires. There was evidence as to how any feedback was acted upon and improvements made to the service provided. People knew who to talk with if they had any concerns. One person told us, “I have not tried to talk to anyone, but I guess if I have to I’d talk to the manager.” One member of staff told us, “We are working to get this place 100 %. (Manager) is really giving this place her all, and is a very hands on manager.”

People spoke well of the care and support provided. However, they told us it had been a difficult time with a number of staff changes, and a high use of agency staff to help cover the care calls. But they felt this had started to improve and care was now provided by a dedicated team of care staff working in Patching Lodge Extra Care Scheme. There was now good continuity of care staff providing their care calls during the week. However, at the weekends there were still improvements being made to the continuity of care staff covering the weekend care calls. They felt the new manager was working hard to address these areas and had listened to their concerns. People told us they always got their care call and they were happy with the care and the care staff that supported them.

Care staff told us there had been a number of changes to the staff team. However, they spoke well of the new management arrangements, and of the changes which had been made to improve the service provided. Staff told us there had been further recruitment of care staff to help cover staff vacancies and they had not now needed to use agency staff. They felt the new team was working well together and there was good communication between the team members.

People told us there had been a period of a lack of consistency of times the care calls were provided, but they felt this was now being addressed. Further recruitment of new care staff had led to the improved delivery of care at the agreed times. A system had been put in place to ensure priority in the times care calls had been made was given to people receiving personal care, or assistance with medicines. People received a weekly rota detailing the care staff covering and when care calls were arranged. Senior staff had ensured people were notified when call times had been changed. One member of staff told us, “I can see an improvement, but people need to have their calls at the time agreed, and that’s what we want to achieve.”

There were 16 care staff who worked in the scheme, who had been recruited through safe recruitment procedures. The operations manager told us the provider had a programme of continuous recruitment and had tried to be innovative in the recruitment of new staff. For example, they had a ‘refer a friend scheme,’ where people already working in the organisation were encouraged to introduce a friend to work in the service.

The needs and choices of people had been clearly documented in their care and support plans. People told us that they felt safe with the staff that supported them. Detailed risk assessments were in place to ensure people were safe within their own home and when they received care and support. Where people’s needs changed, people’s care and support plans had been reviewed to ensure the person received the care and treatment they required. Care and support plans were in the process of being reviewed and updated using a risk based approach. People and care staff were aware reviews were happening and could tell us where reviews were planned and booked to take place. One person told us, “I do have a care plan. It was reviewed last year. “Another person told us, “I have one. I think we looked at it last week.” Another person told us, “Yes we talked at length about my plan. We discussed what I wanted and I was happy with it. I think someone is coming around next week to review it.” Another person told us, “We did have a care plan when I joined. It was very detailed talking about things I liked to do and the things they can help me with. The carers are very good at listening.”

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. Where people were unable to make decisions for themselves, staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. One person told us, “I get asked if I want a cup of tea when they come around. They ask if I’m ready for a shower.”

Where required, care staff supported people to eat and drink and maintain a healthy diet.

People were supported with their healthcare needs. Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately.

People told us they were supported by kind and caring staff. One person told us, “The carers are really good and they do really try their best.” Care staff received a five day induction, basic training and additional specialist training where required. For example, to support people with moving and handling using a hoist. Care staff had supervision in one to one meetings and staff meetings, in order for them to discuss their role, training needs and share any information or concerns.

Where required, care staff supported people to eat and drink and maintain a healthy diet.