We (the Care Quality Commission) had previously carried out an unannounced inspection of Parikia on 11 and 14 May 2012. After that inspection we issued warning notices relating to outcomes 4 and 7. The purpose of this inspection was to check whether the provider had complied with the warning notices. The deadline for achieving compliance with these notices was 11 June 2012. The provider had the following outstanding compliance actions which will be followed up at the next inspection:
Outcome 1: Respecting and involving people who use services
Outcome 2: Consent to care and treatment
Outcome 5: Meeting nutritional needs
Outcome 8: Cleanliness and Infection control
Outcome 9: Management of medicines
Outcome 10: Safety and suitability of premises
Outcome 12: Requirements relating to workers
Outcome 14: Supporting workers
Outcome 16: Assessing and monitoring the quality of service provision
Outcome 21: Records
The provider sent us an action plan on how they were going to achieve compliance with the outstanding compliance actions.
This service became the subject of a whole service safeguarding strategy in May 2012, which was ongoing. The service was being monitored via this process. All the people living here were being reassessed by the funding authorities, and the service was being visited weekly by a social care manager and by the responsible manager for safeguarding. The provider had continued to work with all agencies involved to make the required improvements. The provider had cancelled all contracts with people who were receiving respite or day care so that they could focus on meeting the needs of the seven people living there.
As part of this inspection we reviewed all the information we held about this provider before visiting. We visited unannounced and during the visit looked at records, observed how people were being cared for, looked at records of people who used the services and spoke with one person living at the service. We spoke with the registered manager, the registered providers (owners) and with three members of care staff, including one member of agency staff. We were able to speak with one person living at Parikia because other people were out or could not answer our questions because of their profound communication needs. On this occasion, although the views of people living here were important, we focussed on what actions the providers and registered manager had taken to address the risks to people's safety identified at the previous inspection.
One person told us they were happy, and other people, who could not talk with us, appeared to be relaxed. Staff were respectful and helpful to the people they supported. One person said they liked doing the activities they did and liked their holidays. They told us about one thing they did not like, and which affected their behaviour. A care worker told us that action was being taken in relation to this which involved the possibility of another person being moved from Parikia. However, records showed that there was not a risk assessment or action plan in place which addressed the issues identified, whilst awaiting the outcome of this process.
Other records showed that risk assessments and care plans were being reviewed and updated. Although this was yet to be completed. Care plans did not always include information about and potential learning from recorded incidents of individual's aggressive behaviour.
Care plan documentation did not include evidence of proactive and reactive support strategies and did not always provide sufficient detail about actions which could trigger, prevent or de-escalate aggressive episodes. They did not include primary and secondary goals, evidence of skills development or personal aspirations.
Staff told us that they felt better able to meet people's care and welfare needs because of improved communication about people's needs and increased staffing levels. They said that some staff who were inexperienced were being better supported to develop skills to care for the people living at Parikia. Staff also said that their feedback about the people they supported was being used by the management team to help better meet people's needs. The said the introduction of a new deputy manager had provided a good link between support staff and the management team.
There was no evidence that inappropriate or excessive restraint was being used. Staff had received additional support to ensure this did not occur. Updated training in safeguarding adults had been arranged for all staff, who demonstrated a good understanding of abuse and what actions to take if they suspect or witness abuse. Some staff did not demonstrate a good knowledge in relation to decision making and deprivation of liberty. Some staff have not received training in this, or had last received it in 2009.