Archived: Canonbury Residential Home

People’s experience of using this service:

People continued to be supported by an established team of staff who provided kind and personalised care to people living in the home. Safe recruitment of staff ensured people were supported by staff of good character.

Staff understood how to communicate with people effectively to ascertain and respect their wishes.

Care plans provided staff with information about people’s preferences and ways in which staff could support people emotionally and with the activities they enjoyed.

People were protected from abuse and harassment.

People received appropriate support to take their medicines safely as and when required.

The provider arranged training for staff that met the needs of people using the service. Staff competency was assessed which helped to ensure they were safe to work with people.

People were empowered to decide how and when their care was provided and had their capacity assessed.

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, relatives and health professionals told us the care provided was effective and people experienced positive outcomes.

A range of quality checks and audits were undertaken to monitor the service provided and systems were in place to manage and respond to any complaints or concerns raised.

Rating at last inspection: We last inspected on 15 September 2016. At the last inspection the service was rated Good (this report was published on 3 November 2016). At this inspection the overall rating for the service has remained as Good.

Why we inspected: This was a planned inspection based on the previous Good rating.

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

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

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 and has the legal responsibility for meeting the requirements of the law; as does the provider. When we inspected in January 2016, the registered manager had employed a home manager to run the service. This had not been successful and their employment had been terminated. The registered manager who is also one of the providers, returned to run the service in March 2016 and has made significant improvements to the service and addressed the breaches in regulations.

From speaking with people and staff it was evident that Canonbury had returned to be a happy service, achieving good in all five key areas. Work practices that had been ceased by the home manager had been re-instated.

Staff were aware of their responsibilities to keep people safe and protect them from being harmed. They received training in safeguarding adults and knew how to raise and report any concerns they had. Staff recruitment procedures ensured unsuitable staff could not be employed because the pre-employment checks were robust. Risks to people’s health and welfare were well managed and the premises and facilities were checked to ensure they did not pose a risk to people and the staff team.

Medicines were well managed and all medicines were stored correctly. Staffing numbers on each shift were sufficient to ensure each person’s care and support needs were met.

There was a programme of refresher training that all staff had to complete. The induction training programme for new staff met the requirements of the Care Certificate introduced in April 2015. The Care Certificate is a set of standards that social care and health workers must work to in their daily working life. Staff were well supported by their colleagues and the registered manager or the deputy supervised their work on a daily basis.

People were asked to give their consent before being provided with care and support. The registered manager had already identified the need to arrange additional Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training for the staff team.

People were provided with sufficient food and drink and their individual preferences, likes and dislikes were met. Where necessary, staff monitored how much people ate and drank, and reported any concerns to healthcare professionals. People were supported to access the health care services they needed.

People were looked after by staff who were kind and friendly and had good working relationships with them and each other. People were encouraged to be as independent as possible and to continue activities outside of the home environment.

People received the care and support that met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service. The care records were well maintained and good accounts were recorded when the care plan was reviewed.

The registered manager provided good leadership for the staff team and managed the service well. There were processes in place to assess and monitor the quality and safety of the service. Where improvements were identified these were acted upon. People were satisfied with the service they received and their views, opinions and experiences were acted upon.

Any risks were assessed as part of the care planning process. Where needed a care plan detailed how that risk would be managed.

We carried out an announced comprehensive inspection of this service on 26 January 2016. During that inspection we found five breaches of legal requirements. Two of the breaches were of a more serious nature and we issued warning notices.

The overall rating for this service was ‘Inadequate’ and the service was therefore placed in to ‘special measures’. The purpose of special measures is to ensure that providers found to be providing inadequate care significantly improve. It was also to provide a framework within which we used our enforcement powers, work with, or signpost to, other organisations in the system to ensure improvements were made. Services placed in special measures will be comprehensively inspected again within six months. The service would be kept under review and if needed could be escalated to urgent enforcement action.

This focused inspection on 24 June 2016 was to check that appropriate action had been taken to meet the two warning notices and the legal requirements. We will be caring out a further unannounced inspection to check the other three requirement notices have been met.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Canonbury Residential Home’ on our website at www.cqc.org.uk.

Since the last inspection the home manager had left the service and the registered manager was back full time and in day to day charge of the service. 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 and associated Regulations about how the service is run.

The improvements we had asked the provider to make in respect of essential checks of the premises (for fire safety and to mitigate the risks of being scalded by hot water) had been acted upon. Checks had been made, and recorded, on a weekly basis of the fire alarm, fire extinguishers and emergency lighting, the fire officer had visited and the staff had additional training. The temperature of the hot water had been reduced and the checks of the temperature at tap end were consistently below the recommended 43°C.

The provider had re-implemented a programme of regular audits that looked at all aspects of the service and enabled them to monitor the quality and safety of the service. The level of the checks were adequate for a small service of this kind and meet the regulations. Because these improvements had been instigated since our last inspection in January 2016 we will check again at the next comprehensive inspection to ensure the consistency of these arrangements.

The breaches of regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 have been addressed. Although improvements have been made and we have been able to review the ratings of the safe and well-led areas we have not revised the overall rating of the service. This will be reviewed when we complete our next comprehensive 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 and has the legal responsibility for meeting the requirements of the law; as does the provider. They were not available on the day of our inspection but we spoke with them after our inspection and told them our findings. The registered manager has employed a home manager who was in day to day charge of the service.

A significant number of improvements were required to ensure that people were kept safe. This was because unsafe recruitment procedures were followed, not all medicines were managed correctly and fire safety and maintenance checks were not being carried out regularly.

Improvements were also needed with the induction training programme for new staff. The current induction plan did not meet the requirements of the Care Certificate that was introduced in April 2015. The Care Certificate is a set of standards that social care and health workers must work to in their daily working life. All records relating to the running of the service and accounts of the care and support provided to people were not all up to date.

The arrangements in place to ensure that the service was well led were unsatisfactory. There were no formal processes in place to assess, monitor and improve the quality of the service. Although people were satisfied with the service they received, there were no records of feedback they provided.

Staff were knowledgeable about safeguarding issues and would act to protect people from coming to harm. They knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. All staff had received training in safeguarding adults. Staffing numbers on each shift were sufficient to ensure each person’s care and support needs were met. There was a programme of refresher training that all staff had to complete. Staff were well supported by their colleagues.

Any risks were assessed as part of the care planning process. Where needed a care plan detailed how that risk would be managed. People received the care and support that met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

People were satisfied with the food and drink they were served with. They were provided with the sort of food they liked to eat and any preferences and dislikes were taken in to account. The staff monitored how much people ate where there were concerns about maintenance of a healthy body weight. Arrangements were made for people to see their GP and other health and social care professionals as and when they needed to.

The staff team had good relationships with the people they looked after. We found the staff to be caring and friendly. People were involved in making decisions about their care and support.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that the provider/registered manager had put in place the improvements they said they would, and the checks had been completed at the stated frequency.

People were cared for in a clean, hygienic environment and we found high standards of cleanliness.

All but one of the staff team had worked at the home for many years. Effective recruitment and selection processes were in place and appropriate checks had been undertaken before staff began to work in the home.

We have asked the provider to make improvements in the way that the quality and safety of the service is monitored. This is because there were a number of health and safety aspects that had been overlooked.

There was a four week menu plan, which took account of the different seasons and had been amended following completion of a 'food survey'. People told us the meals were good, they were offered choice and they had plenty to eat and drink.

We found that the systems in place for the management of medicines were on the whole satisfactory but the arrangements for storing some medicines were unsuitable..

People were complimentary about the staff, some of whom had worked at the home for many years.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity. Their name appears because they were still a registered manager on our register at the time. We have asked the new manager (registered provider) to submit their application to be the registered manager.