Connect House

We found the following examples of good practice:

Provider had measures in place to prevent relatives, professionals and others visitors from spreading infection. For example, hand washing facilities, personal protective equipment (PPE) and hand sanitiser were available by the entrance and throughout the service.

People had individual visitor plans as part of their care plan to make sure their social contact needs were met. The provider supported people with maintaining contact with their loved ones via window visits, calls and video calls during an active COVID-19 outbreak.

The provider was meeting COVID-19 vaccination requirements for staff and people visiting the service.

Staff had sufficient access to personal protective equipment (PPE) and hand sanitiser. Staff were aware of their role and responsibilities in following infection prevention and control measures. Staff had received relevant training in infection control and the provider ensured staff competency assessments were completed such as hand hygiene and the use of PPE.

Latest COVID- 19 national guidance was continually shared with staff. Staff received regular COVID-19 testing and followed government guidance if they received a positive test or showed signs of infection.

Consideration had been given to how staff entered the building, when and how they had their breaks and how staff meetings were managed. Agency staff were used to ensure safe staffing levels. Agency staff were booked in a way that reduced the risk of infection transmission. Cleaning staff had cleaning schedules, which they were required to complete, including enhanced cleaning of high touch areas. We saw the home was clean and clutter free.

All referrals to the service were triaged to assess their COVID-19 status and on admission, people received a COVID-19 test and were required to self-isolate for a period of 14 days to reduce the risk of transmission.

COVID-19 signage was displayed throughout the service. The provider had a COVID-19 and business contingency plan that provided staff with guidance of how to manage the service should an outbreak occur.

Staff encouraged people to socially distance whenever possible. People received regular COVID-19 testing and if they tested positive or showed signs of infection, they were isolated as per government guidance. This protected people's human rights to move freely around the home and reduced the risk of COVID-19 causing distress for people. A support plan was created which covered the support needed for the person during their isolation period. This made sure people's needs physical, emotional and social needs were met during that period.

We found the following examples of good practice.

National Covid-19 government guidance was generally observed. Where we found action was required to improve staff practice and consistency of standards being maintained, the provider took immediate action.

Staff had sufficient access to personal protective equipment (PPE) and hand sanitiser was available throughout the service. Staff were aware of their role and responsibilities in following infection prevention and control measures. Staff had received relevant training in infection control and the provider ensured staff competency assessments were completed such as hand hygiene and the use of PPE.

Latest Covid- 19 national guidance was continually shared with staff. Staff received regular Covid-19 testing and followed government guidance if they received a positive test or showed signs of infection.

People were supported to maintain contact with their family and friends by telephone, video calls and via window contact. Staff supported people with their welfare by providing information and reassurance. All referrals to the service were triaged to assess their Covid-19 status and on admission, people received a Covid-19 test and were required to self isolate for a period of 14 days to reduce the risk of transmission.

Covid-19 signage was displayed throughout the service. The provider had a Covid-19 and business contingency plan that provided staff with guidance of how to manage the service should an outbreak occur.

Staff used their knowledge of people to support social distancing. People received regular Covid-19 testing and if they tested positive or showed signs of infection, they were isolated as per government guidance. This protected people’s human rights to move freely around the home and reduced the risk of Covid-19 causing distress for people. A support plan was created which covered the support needed for the person during their isolation period. This made sure people’s needs physical, emotional and social needs were met during that period. We observed staff interacting with people postivly and activities were offered.

Consideration had been given to how staff entered the building, when and how they had their breaks and how staff meetings were managed. At the time of this inspection agency staff were not being used.

We conducted an unannounced inspection at Connect House on 29, 30 and 31 October 2019. Connect House work closely with staff employed by CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage and Garden. During our inspection the service was at full occupancy.

Heritage Unit is comprised of 23 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also five people who are long term residents in Heritage.

Garden Unit provides nursing care. 12 beds in Garden Unit are 'Discharge to assess' beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Unit are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining 10 beds, are for people who require long term nursing care. Garden Unit is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners.

Improvements had been made to how risks were assessed, managed and monitored. New and improved audits and checks were completed that enabled the manager and provider to have oversight of the service. Improvements had also been made to how incidents and accidents were monitored and there was a system to investigate, learn and improve when incidents occurred. The manager completed a monthly analysis to consider themes and patterns of incidents and this further supported them to have oversight of any merging risks.

Improvements had been made to the documentation and systems to record and monitor people’s food and fluid intake. There were some shortfalls in other internal documentation completed by staff, and information was not consistently updated. However, staff were very knowledgeable of people’s health conditions and support needs. Information sharing from external stake holders when people transferred to the service was also inconsistent. The manager was aware of the difficulties around documentation and information sharing and was taking action to address this.

People were safeguarded from the risk of abuse and avoidable harm and information was available for people of how to report any safeguarding concerns. Staffing levels were sufficient at the time of the inspection. Staff’s response to calls for assistance was monitored by the manager. It was acknowledged when information about people’s dependency needs transferred from hospital were not correctly shared, this impacted on staff’s ability to provide effective and timely care at times. The manager was taking action to address this concern.

People received their prescribed medicines when they should, and staff had the required information to manage and administer medicines safely. The prevention and control of infection was managed safely. There was sufficient equipment to meet people’s needs. Health and safety checks on the environment had not always ensured people’s needs were effectively managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people were unable to make specific decisions regarding their care, the Mental Capacity Act 2005 principles were applied. However, further training was required to enhance understanding in the assessment and best interest decision making process.

Improvements had been made to staff training and support, the manager agreed to make further improvements to ensure staff training was completed in a timely manner.

Where people required support from staff with eating and drinking, staff were caring and unhurried. This supported people to have a positive mealtime experience.

People received care and treatment from staff who had a kind, caring and person-centred approach. Staff treated people with dignity and respect and their choices and decisions about how they received their care was upheld.

People’s communication needs were known and understood by staff, but some people experienced inconsistencies in the support they received. Advocacy information was available for people. People received opportunities to participate in social activities, but improvements were required to ensure these reflected people’s interests, hobbies and diverse needs.

People had access to the provider’s complaint policy and procedure and complaints were acted upon quickly. People’s end of life care and wishes had been assessed and planned for.

People were invited to share their views and wishes about the service they received, and staff felt involved in the development of the service.

The provider had met their registration regulatory requirements. Whilst the manager was new in post, they had worked at the service since April 2019 as the deputy manager. They had contributed to the improvements made at the service. They were positive and committed about the need for improvements to be sustained and what areas required continued development.

Rating at last:

At the last inspection the service was rated Requires Improvement (published 20 October 2018) and there were two breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

For more details, please see the full report which is on the CQC website at ww.cqc.org.uk

Why we inspected:

This was a planned inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Connect House is situated in Basford, Nottingham and is operated by Medina Connect Limited. Connect House work closely with staff employed by CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage and Garden.

Heritage Unit is comprised of 23 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also five people who are long term residents in Heritage. During our inspection there were 25 people in Heritage Unit.

Garden Unit provides nursing care. 12 beds in Garden Unit are ‘Discharge to assess’ beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Unit are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining 10 beds, are for people who require long term nursing care. Garden Unit is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners. During our inspection there were 26 people staying in Garden Unit.

This was the second time we had inspected the service since its registration in September 2017. At our last inspection in February 2018 we found significant concerns across a range of areas, including; safety, staffing, recruitment, hydration and nutrition, consent and choice and leadership and governance. We acted to impose conditions on the registration of the provider and the service was rated as inadequate. At this inspection we found many improvements had been made and some further work was underway to ensure compliance with the legal regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in place at the time of our 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.

During this inspection we found there had been some improvements to the safety of the service, but further work was needed. Action had not always been taken after incidents to reduce the risk of the same thing happening again. There were not always enough staff to meet people’s needs, people told us this resulted in delays to their care and support. There were occasions were people did not receive their medicines as prescribed. Medicines were not always stored safely or hygienically. People told us they felt safe and there were systems in place to protect people from abuse. Improvements had been made to risk management processes and, overall, we found risks associated with people’s care and support were managed safely. The home was clean and hygienic.

There was a risk people may not be provided with enough to eat and drink. Food and fluid records had not been completed to demonstrate people had been offered adequate amounts of food and drink. Further work was needed to ensure people’s rights under the Mental Capacity Act 2015 were protected. However, we did not find any evidence that people were subject to unnecessarily restrictions upon their rights. Permanent staff had training and support to enable them to do their job effectively, but, we received some concerns about the skills and competency of temporary agency staff. People had access to a range of specialist health care professionals and received effective support with their health. There were systems to share information across services when people moved between them to ensure they received person centred care. The home was adapted to meet people’s needs.

People were supported to be as independent as possible. There was a strong emphasis on building and maintaining people’s independence and we heard many positive stories of people being supported to return to their home. People told us, and we observed, that staff were kind and caring. People’s rights to privacy and dignity were respected by staff and people were involved in decisions about their care and support. People had access to advocacy services if they required, to enable them to express their views.

Overall, we found, people received care and support which met their needs and respected their preferences. Improvements were needed to ensure that staff had access to accurate information about people who used the service and action was planned to address this. People were provided with the opportunity for meaningful activity and this was tailored to people’s individual needs. People’s diverse needs were recognised and accommodated. There were effective systems in place to respond to complaints.

Although improvements had been made to the leadership and governance of the home, further work was required to ensure the effectiveness and sustainability of these changes. Systems to monitor and mitigate risks to people’s health, safety and welfare were not fully effective. Improvements were needed to streamline systems and improve communication. Work was underway to improve opportunities for people and their families to provide feedback about the service. Staff felt supported and people were positive about the impact of the management team. Adjustments were made to meet the diverse needs of staff. There was a clear vision for the service and positive partnership working with health professionals.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Connect House is situated in Basford, Nottingham and is operated by Medina Connect Limited. Connect House work closely with staff employed in CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage Suite and Garden Suite.

Heritage Suite is comprised of 24 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also four long-term bedrooms in Heritage. During our inspection there were 25 people staying in Heritage Suite.

Garden Suite provides nursing care. 17 beds in Garden Suite are ‘Discharge to assess’ beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Suite are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining five beds, are for people who require long term nursing care. Garden Suite is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners. During our inspection there were 20 people staying in Garden Suite.

This was the first time we had inspected the service since its registration in September 2017.

There was no registered manager in place at the time of our inspection. The previous registered manager had left Connect House in September 2017. 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. There was a manager in post at the time of our inspection who had been in post for a period of approximately four months. They informed us they would be submitting an application to register with CQC. We will monitor this.

During this inspection, we found the service was not safe. People were not always protected from risks associated their care and support. Risks were not always identified and addressed in a timely manner and this placed people at risk of harm. Measures in place to reduce risks were not consistently used as intended. People did not always receive safe support to move and transfer with the use of mobility equipment and there was not enough equipment available to meet people’s needs.

There were not always enough staff employed to ensure people’s wellbeing and safety, and staff were not deployed effectively. Adequate steps had not been taken to ensure people were protected from staff that may not be fit and safe to support them. There were systems and processes in place to minimise the risk of abuse and incidents were investigated. The service was clean and hygienic.

People were not protected from the risk of poor food and fluid intake, as monitoring systems were not consistently effective. People’s dietary preferences were not always taken into account and mealtimes were not organised effectively. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff had not received adequate training in key areas such as moving and handling, safeguarding and medicines management. Staff felt supported but were not all provided with regular supervision. People had access to a range of expert health professionals. However, there was a risk people may not receive appropriate support with specific health conditions. Care plans did not consistently contain sufficient information and staff did not always have adequate knowledge of people’s health needs. There were systems in place to ensure information was shared across services when people moved between them, however these were not fully effective.

People told us staff were kind and caring but we observed interactions were task focused. People’s right to privacy was not always respected and people were not treated with dignity at all times. Although people received focused support to maintain their independence from external health professionals, we observed variable practice in the Connect House staff team. People were not always involved in decisions about their care and support. People had access to advocacy services if they required this.

People were at risk of receiving inconsistent support as care plans did not all contain accurate, up to date information and staff did not always follow the guidance in care plans. People’s social and recreational needs were not met, as there were very limited opportunities for meaningful activity in Garden Suite. This meant some people who used the service spent their time unoccupied. People’s friends and family were welcomed into the service. There were systems in place to investigate and respond to concerns and complaints; however, a number of people commented they did not know how to make a complaint.

Governance systems at Connect House were not consistently effective; this resulted in a failure to identify and address areas of concern and placed people at risk. Records of people’s care and support were not always accurate and were not stored securely. Systems and records were not well organised. Staff did not always have a good understanding of their role and this had a negative impact on the quality of care plans and risk assessments. Opportunities for people and their families to provide feedback were limited and where feedback systems were in place they were not effective. Staff felt supported and people were positive about the impact of the management team. The provider had plans in place to address some of the concerns identified at our inspection.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.