Archived: 54 Cowden Road

54 Cowden Road is a small residential care home providing support for up to five adults with learning disabilities. At the time of our inspection there were five people using the service. There was a registered manager in post 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.

At this inspection we found the provider had made the required improvements and was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. People’s support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. There were systems and processes in place to monitor and evaluate the service provided. People using the service and their relatives were asked for their views about the service.

54 Cowden Road is a residential home for up to five adults with learning disabilities. At the time of our inspection there were five people using the service.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not operate effective systems to monitor and mitigate risks to people because the medicines audits that were in place did not highlight some of the issues we identified at inspection, or highlight that one staff member was overdue a medicines competency assessment.

We also found a breach of the Care Quality Commission (Registration) Regulations 2009 in respect of notifying the CQC of other incidents. Although a registered manager was in place, notifications had not always been sent to the Care Quality Commission as required.

You can see what action we told the provider to take at the back of the full version of the report.

Staff felt well supported through supervision and training and the registered manager was addressing any gaps in supervision and training..

Staff understood the requirements of the Mental Capacity Act 2005 (MCA 2005) and we could see decisions made in people’s best interests. However the provider did not have appropriate measures in place to ensure people’s capacity was assessed prior to making best interest decisions. The registered manager told us they would implement these at the soonest opportunity.

Medicines were managed, stored and administered safely. Staff had completed medicines training and the home had a clear medicines policy in place which was accessible to staff. The home maintained adequate staffing levels to support people both in the home and the community.

Staff were subject to regular appraisal and were safely recruited with necessary pre-employment checks carried out.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse and how to raise safeguarding concerns.

Risks to people using the service were assessed reviewed, recorded and managed appropriately. Detailed and current risk assessments were in place for all people using the service.

We saw friendly and caring interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and pictorial and we saw that people had regular keyworker sessions.

People were supported to eat and drink. People were involved in planning their weekly menus and supported to maintain good health and have access to healthcare services.

An appropriate complaints procedure was in place. The registered manager was seen to be accessible to people, and staff spoke positively about the support available to them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were five people residing at 54 Cowden Road. We looked at the personal care and treatment records of people who use the service, observed how people were being supported and the interactions they had with staff, talked with people who use the service and their family members and spoke with members of staff.

Is the service caring?

Family members and representatives of people using the service that we spoke with talked positively about the service. They told us they were very much a part of their family member's care and support and were consulted about the way the service provided support to people. One person told us 'We are very happy with the care and support provided at the home. The staff are brilliant, we couldn't ask for more. We always get asked by the service for our feedback on how they are doing and the communication with the home is always very good'.

People were supported in promoting their independence and community involvement. During our visit we observed several people who use the service going out into the community independently or with support from members of staff. One person went to a regular knit and natter group which they enjoyed and another person was accompanied to a hospital appointment. People told us about the types of activities they took part in. One person told us 'I like living here very much. The staff support me to go to the cinema and other clubs I go to on a regular basis'. Another person said 'I like to visit my family frequently'.

Is the service responsive?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Each person had a set of risk assessments which identified hazards they may face within the home environment and whilst out in the community. These provided guidance to staff members on how they should support people to manage these risks and keep them safe. Staff members we spoke with told us how they monitored people's general well-being and health needs, which was reflected in their care plans.

Staff we spoke with informed us that the home holds monthly tenants meetings which were attended by everyone using the service. Records we examined demonstrated that regular meetings were held and attended by all people who use the service. Topics discussed at tenants meetings included peoples wishes with regard to social activity programmes, planning holidays and the homes environment. People using the service also had monthly keyworker meetings which provided people with the opportunity to discuss their care plan and support received with their identified keyworker. One person using the service told us 'My keyworker sits with me on a regular basis and we talk about how I am and what I like to do, it's nice'.

Is the service safe?

There were arrangements in place to deal with foreseeable emergencies. People using the service had a missing person's form which included a picture of the person in their care plans in the event they went missing from the home. These records detailed what action should be taken by staff in this event and we noted they were reviewed on a regular basis to ensure up to date information was recorded about people's health and care needs. People also had a personal evacuation plan which measured the support people required in the event they needed to be evacuated from the premises. Staff training records we looked at demonstrated that staff were trained in delivering first aid support to people if required.

The service had clear procedures on safeguarding vulnerable adults from the risk of abuse including how to recognise types of abuse and what action to take. We looked at the provider's safeguarding adults from abuse procedure and noted this was reviewed by the provider on a regular basis. We spoke with the registered manager who told us this procedure was used in line with the "London Multi Agencies Procedures on Safeguarding Adults from Abuse" (PAN London). We also noted that the home displayed the local authority's procedure for reporting abuse which had details of who to contact should they have any concerns.

Is the service effective?

It was evident from comments we received, records we looked at, and staff practises observed that the home was good at promoting independent living and enabling people to do as much for themselves as they were willing or capable of doing safely. For example, people using the service were actively encouraged and supported by members of staff to take 'rational' risks, such as travelling independently to local amenities. People's care records we looked at were well documented and written in a way that respected people's dignity. There was evidence of regular discussions with people and their family members or where appropriate referrals to advocates about their care and support and choices made. There was also detailed information about the spiritual, cultural, sexual and communication needs of people. Our conversations with staff demonstrated their commitment to meeting individuals' preferences and recognising what was important to each person.

Is the service well-led?

Appropriate checks were undertaken by the provider before staff began work. New members of staff were given an appropriate induction period into the service and completed induction training throughout the process. Staff files we looked at demonstrated that appropriate pre-employment checks had been carried out for new staff in line with legal requirements. New staff members were required to provide proof of identity, address, evidence of their right to work in the United Kingdom and underwent medical checks where required. The provider had obtained references from previous employers to verify people's skills and experience and DBS (Disclosure and Barring Service) checks had been completed.

We were shown how the service recorded, monitored and acted upon incidents, accidents and complaints and we saw a copy of the provider's most recent complaints procedure. We saw evidence of the various health and safety checks and audits that were conducted by the home on a monthly or weekly basis and that these were reviewed frequently. Reports examined included various areas of possible risk within the home environment and support offered to people using the service. These included water and refrigeration temperature checks, occupational health checks, fire safety, manual handling, electrical safety and outdoor safety.