4 June 2018
During a routine inspection
The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the last inspection of the service in June 2017, the provider was rated as Requires Improvement in all five key questions. They were also in breach of regulations because they did not have effective systems of governance to assess, manage and monitor risks to people living at the service. Following the last inspection, we served a Warning Notice to require the provider to take immediate action in relation to their governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-led to at least good.
At this inspection, we found that regulations had been met, and there had been improvements across all five key questions.
People were supported by trained staff who understood how to recognise, and report abuse or harm. A clinical lead nurse had been recruited which had improved the oversight and management of risks to people’s safety in relation to their medical conditions. Risks assessments were up to date and showed what support people needed to keep them safe. People were supported by sufficient numbers of staff and safe recruitment practices were followed. People received their medicines as prescribed. Shortfalls in nurses keeping accurate medicine records were being addressed with improved checks in place to enable the provider to identify and act on errors.
People received effective care from staff that had the skills and additional training specific to the needs of people. Staff had an induction and regular supervision and described positive support from the management team. Staff had additional support to enable them to understand the Mental Capacity Act and we saw they supported people in line with its principals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s dietary needs were met; they enjoyed the meals provided and had assistance to eat and drink sufficient amounts. People were supported to maintain their health and had access to a range of healthcare professionals. This included on-site therapists who supported people to manage their medical conditions.
Staff were caring towards people and demonstrated a compassionate response to people’s personal circumstances and needs. People were supported with their privacy and dignity.
People had been enabled to identify their personal goals in relation to developing their skills and level of independence. They were involved in the development and review of their care plan. The resources needed to support people were identified and we saw people had benefitted from the combined efforts of the therapist team and care staff to develop their strengths and quality of life. People enjoyed a range of activities and social opportunities which focused on their personal interests and included opportunities for voluntary work and maintaining educational interests. People knew how to raise concerns and were happy these would be responded to.
The provider’s quality assurance systems and processes had improved. We saw audits were carried out regularly and had been effective in identifying areas for improvement. The systems in place had enabled the provider to assess, monitor and manage risks to people’s safety. We found the introduction of a clinical lead nurse had improved the clinical oversight of people’s needs. Records had been improved to show the clinical support people needed and provided. Feedback from external professionals recognised improvements had been made. The provider had addressed shortfalls identified at the previous inspection in relation to staff knowledge regarding people whose liberty was restricted. They had also sourced additional training to support staff in meeting people’s complex medical conditions. There had been an improvement in maintaining up to date care records. The checks in place helped the provider to ensure people who used the service were not at risk of unsafe care. As the provider was previously rated requires improvement on three consecutive inspections the improvements now need to be sustained.