Archived: RNID Action on Hearing Loss Apollo House

At our last inspection in July 2016, we rated the service Good although we identified a breach of regulations in relation to the recruitment of staff. At this inspection, we found the required improvements had been made. The evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The recruitment procedures had improved and were now sufficiently robust to protect people from the risk of unsuitable staff.

People received safe care. The staff we spoke with were aware of how to safeguard adults at risk of abuse. There were safe processes and practices in place for the management and administration of medicines.

People told us there were always sufficient staff available to meet their needs and support them to attend activities of their choice. Staff used a range of methods to communicate with people, including British Sign Language (BSL), pictures and the written word. People told us all staff were competent in the use of BSL.

Staff told us they received the induction, training and supervision necessary for them to carry out their roles effectively. People told us staff knew them well and understood their wishes and preferences in relation to the support they needed.

People told us staff respected their right to privacy and dignity. They told us staff took their time when providing support and encouraged them to be as independent as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice.

People lived in their own homes and were therefore able to make their own choices about the food they ate. However, staff told us they would always encourage people to make healthy choices. This inspection was carried out during a period of very hot weather and we noted the registered manager had taken action to remind people of the importance of remaining hydrated during this period.

People’s needs were assessed before they started using the service and this information was used to develop a series of care plans and risk assessments. Records showed that all care plans and risk assessments had been regularly reviewed.

We saw evidence that people had been involved in reviewing their care and support needs. We saw that staff were responsive to people’s changing needs and involved health professionals as necessary.

People were encouraged and supported to be involved in a range of activities to help reduce social isolation and maintain their well-being.

People who used the service, staff and community based professionals were positive about the way the service was run. The values of the organisation were well understood by staff and they told us how these were put into practice in their day to day support of people.

Audits and checks of the service were completed regularly. We found the checks completed were effective in ensuring that appropriate levels of quality and safety were maintained at the service.

Further information is in the detailed findings below.

RNID Action on Hearing Loss is registered to provide a domiciliary care service to people who are deaf, deaf/blind or hard of hearing and have additional care needs. All staff use British Sign Language (BSL) to communicate with people who use the service. At the time of our inspection there were five people receiving personal care and support from the service. All the people who used the service lived in the same complex of flats. Staff from the service also provided support to other people living in the complex who had housing related support needs.

There was a registered manager in place at the time of the 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 registered manager was also responsible for a separate residential care service. They were therefore supported by a deputy manager in the day to day running of the domiciliary care service.

During this inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes in the service were not sufficiently robust to protect people from the risk of unsuitable staff. You can see what action we have told the provider to take at the back of the full version of the report.

We found the provider’s recruitment policy did not meet the requirements of the current regulations. This was because it did not make it clear that additional pre-employment checks were required when applicants had worked previously with vulnerable adults or children. This meant that these checks had not taken place for two of the staff who were employed to work in the service. In addition we could not find evidence that the provider had taken the necessary steps to follow up on a reference from a person’s previous employer which indicated they would not re-employ the person. This meant there was a risk that the provider might employ people who were unsuitable to work with vulnerable groups.

People told us they felt safe with the staff that supported them and considered staff had the right communication skills and experience to meet their needs. Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns they raised would be taken seriously by the managers in the service. People who used the service were regularly given information in an accessible format to advise them of how they should report any incidents of abuse they might experience either within the service or the local community.

We were told that staff were matched with people who used the service; this helped to ensure they had the best chance of getting on well together and being able to provide the support individuals required. People who used the service told us staff were always available to provide the support they needed. During the inspection we observed staff responded promptly to any requests for assistance. They were also kind, caring and respectful in all their interactions with people who used the service.

People told us they received the support they needed to take their medicines as prescribed. Staff had received training in the safe handling of medicines. The deputy manager completed regular assessments to ensure staff were competent to administer medicines as prescribed. Regular medication audits were also completed; these audits help to ensure people have always received their prescribed medicines.

Care records contained detailed information to guide staff on the care and support people required. The care records showed that risks to people's health and well-being had been identified, such as the risk of poor mobility and managing their own medicines. Risks were also assessed in relation to general safety issues within people’s homes. We saw that plans were in place to help reduce or eliminate any identified risks. Arrangements were also in place to help ensure the prevention and control of infection.

We found that staff received the essential training and support necessary to enable them to carry out their role effectively and safely. New staff received an induction when they started work at the service; this included checks by the deputy manager on their ability to communicate effectively with all people who used the service.

Staff demonstrated a good understanding of the Mental Capacity Act (MCA) 2005. This legislation is designed to ensure people are supported to make their own decisions wherever possible. Staff demonstrated their commitment to ensuring people were always able to make choices about how they wanted their care and support to be provided. We saw that people who used the service had been given information about consent in an accessible format and had signed to say they were in agreement to staff providing care in line with their support plan.

Where necessary people who used the service received support from staff to ensure their nutritional needs were met. People told us staff would accompany them to health appointments and ensure qualified interpreters were available to help people communicate their needs to health professionals.

People were involved in regular reviews of their care to ensure the support provided met their needs, goals and ambitions. Care records included details of people’s achievements as well as their dreams and aspirations for the future.

People had regular opportunities to provide feedback on the care and support they received. Staff told us they encouraged people to express their views and opinions in order to continue to drive forward improvements in the service.

Robust quality assurance systems were in place in order to ensure that that people received high quality, safe and effective care and support. Systems were also in place for receiving, handling and responding appropriately to complaints.

We found plans of care were developed with people who used the service to ensure their wishes were taken into consideration and updated to keep track of progress or changes.

We found there were robust safeguarding procedures and both people who used the service said they, "Felt safe".

Two staff we spoke with told us they were, "Well trained" and "Supported" to be able to meet the complex needs of people who used the service.

There were quality assurance systems in place which gained the views of people who used the service and stakeholders to analyse and where necessary improve service provision.