Background to this inspection
Updated
26 August 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 1 and 2 August 2017 and was unannounced. The inspection was carried out by one inspector and an expert by experience who spoke with people who used the service, families and relatives. Our expert by experience had knowledge and understanding of residential services or caring for someone who uses this type of care services.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the home, what the home does well and improvements they plan to make. We looked at previous inspection reports and notifications about important events that had taken place in the home, which the provider is required to tell us by law.
We spoke with 11 people who use the service. Conversations took place in people’s rooms and communal rooms. We observed how staff interacted with people when supporting them. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk to us.
We spoke with four relatives who were visiting people, the registered manager, training manager, administration manager, the provider and seven staff. We spoke with two health professionals who visit the service.
We reviewed records including ten people’s care records, which included care plans, health records, risk assessments and daily care records. We looked at four staff files, audits, quality assurance, staff rotas and policies and procedures.
The previous inspection was carried out in August 2016. There were five breaches of regulations identified at this inspection.
Updated
26 August 2017
This inspection took place on 1 and 2 August 2017 and was unannounced.
Littlebourne House Residential Home provides personal care and accommodation for up to 64 adults. Accommodation is flexible with a detached house with a new extension for 42 people, a separate detached house, the King William for 18 people and four one bedroom self-contained flats. At the time of the inspection 64 were living at the service.
There was a registered manager working at 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.
We last inspected this service in August 2016. We found shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated to keep people living with diabetes, epilepsy and behaviours that challenge as safe as possible. Staff were not recruited safely. The service had not been working within the principles of the Mental Capacity Act 2005. There was a lack of oversight of the service, there were no quality assurance systems in place to monitor and drive improvements within the service. Staff had not received training appropriate for their role, staff were not deployed effectively to meet people’s needs.
We asked the provider to provide an action plan to explain how they are going to make improvements to the service. At this inspection we found that improvements had been made.
At the last inspection, there were no detailed guidelines for staff to mitigate risks to people and keep them safe. Improvements had been made. There were risk assessments in place to identify potential risks to people’s health and safety. The risk assessments gave staff detailed guidance to mitigate risks to individuals living with diabetes, epilepsy and behaviours that may challenge. Accidents and incidents were analysed for trends and action had been taken to prevent them from happening again.
Improvements had been made in the recruitment of staff and their development. Staff were recruited safely and received training to perform their roles. Staff received supervisions and appraisals to discuss their development. There were sufficient numbers of staff. The provider had reviewed the deployment of staff, as recommended at the last inspection, to meet people’s needs.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
At the last inspection, staff had not received training about MCA and were not working within the principles of the Act and DoLS applications had not been made when appropriate. Improvements had been made at this inspection. Staff had received training and were aware of their responsibilities under MCA. Appropriate DoLS applications had been made and some had been authorised.
At the previous inspection, there were no effective systems in place to assess and monitor the quality of the service provided. There were no formal checks to ensure that all records were up to date. Care plans and assessments had not been consistently reviewed. Improvements had been made, care plans and assessments were reviewed monthly and before if needed. There was now a system in place to check the quality of the service, shortfalls had been identified and action plans had been put in place to rectify the shortfall.
People told us that they felt safe living at Littlebourne House. Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. People received their medicines safely and on time.
People enjoyed a choice of healthy meals and told us they had enough to eat and drink. Relatives were able to eat with their loved ones. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.
People said they were happy living at the service and that their privacy and dignity were respected. Staff spoke with and engaged with people in a kind, caring and compassionate way. People, when able, were involved in the planning of their care and support and told us that care was provided in the way they chose. People’s confidentiality was respected and their records were stored securely.
Each person had a care plan that contained details of their choices and preferences, and how they wanted their support to be provided. People’s religious and cultural needs were recorded and respected.
Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restrictions on the time of day. People were encouraged to be as independent as possible.
There was a range of activities and outings available to people, staff including the activities co-ordinator spent time with people on a one to one basis.
People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy. Resident and staff meetings were held so that suggestions about improvements could be made. The management team had implemented suggestions made at the meetings. Quality assurance surveys had been sent to people, staff and stakeholders such as GP’s and the results were being analysed.
People spoke positively about how the service was run. The management team were visible and people were comfortable with them. People and staff told us the management team were very approachable and supportive. The management team and staff understood their roles and responsibilities and shared a vision for the service.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.