Archived: Miss Bridget Jane Marshall - 43 Freeman Street

43 Freeman Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides residential accommodation for three adults with a learning disability. They live with Miss Bridget Jane Marshall who is the registered provider/manager. 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.

The service represented an extended family and people at times referred to the registered provider/manager as ‘Mum’. People took comfort and support in being part of an extended family and had lived as a ‘family group’ for many years. In terms of the scope of registration, the service had been registered as a residential home and was therefore expected to meet regulations laid out by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found seven breaches because there was an absence of systems, and audits, which underpinned the health, safety, and well -being of people that used the service. The registered provider/manager supported people with their day-to-day activities and recorded people’s needs in a set care plan and daily diary, which were reviewed at least annually. However, we were unable to see how the manager worked collaboratively with others and sought their views about the care they provided. Feedback from people and their families was sought as part of on-going communication but not always recorded.

The registered provider/manager had not informed us and did not show us records relating to a number of incidents, which had occurred at the service. They are required to notify us of specific events affecting the wellbeing and safety of people using the service. This helps us make a judgement about the service and helps inform our inspection schedule. We might bring forward inspections based on information received. It helps the provider to demonstrate they have taken effective action when people have been injured or involved in incidents that have caused them harm. We look to see if the provider had systems in place to identify and mitigate known risks and how they keep people using the service, staff and visitors informed about how they are learning and limiting reoccurrence. This also involves a ’duty of candour’ when investigating such matters. Without this information, we could not be assured that actions taken to keep people safe from risk, and or harm were sufficiently robust. Information was not shared on a need to know basis with family members and people's wider circles of support.

The key question about staffing was not applicable at this inspection as the registered provider/manager was the sole staff member. However, the provider’s partner was also in the household and we asked the registered provider/manager for a copy of their disclosure, and barring check. Following the inspection the provider sent us evidence that a DBS had been applied for both themselves and their partner.

The service was sufficiently clean and people were having their needs met in relation to a safe environment.

People were prescribed medication and the registered provider/manager administered these along with their partner who assisted at times. The provider/manager told us they were trained to undertake this but their partner had received no training. Although there were records of the medication people took and when it was administered there were no audits or stock checks in place so we could not see if errors had occurred.

The Registered provider/manager did not provide us with any evidence of training but were knowledgeable about people’s needs. However without regular training and the opportunity to meet others and share ideas and gain mutual support we did not know how the registered provider/manager was keeping up to date with legislation and best practice.

People were supported to eat and drink enough for their needs and there was some monitoring of people’s weights. The registered provider/manager took people to see their GP if there were any concerns about their health. However, other professionals told us appointments had been cancelled and routine appointments with other health care professionals were not always kept.

The manager understood legislation relating to mental capacity and told us people were involved in decisions about their care and welfare. Mental capacity assessments were being completed by the Local Authority to help support people in light of the proposed house move to another part of Britain. The registered provider/manager said mental capacity assessments had been completed in the past but there was no evidence of this.

The service ran like an extended family and people had established relationships with each other and with the Registered provider/manager. People were supported to keep in contact with their own families and involved in day-to-day decisions. We could not ascertain if people’s independence was fully facilitated or that people were encouraged to live lives as others do and take responsibilities within their capabilities.

Care plans and daily notes gave us an insight into people’s needs and how these were being met. These were kept under review. The care plans did not record what people’s aspirations and goals were and steps towards achieving these. The terminology used was sometimes restrictive.

Feedback about the service was limited. People felt able to raise concerns to the registered provider/manager and had contact details for the Local Authority. We were not confident that all information that should be shared with us had been which reduced our confidence in the provider.

The service was difficult to assess against regulation because there was a lack of paperwork providing a good audit trail. However, people appeared to be very happy in the service and the registered provider/manager was confident they were meeting their needs.

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 than12 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.

The home is registered to provide accommodation with personal care for up to three adults with a learning disability. On the day of our visit there were three people living at the home.

There was a registered manager at the service, who also lived at the home. 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. The registered manager was also the provider and was the sole person caring for people at this home.

People felt safe living at the home and the registered manager had training in safeguarding procedures and knew what to do if they considered people were at risk of harm.

The registered manager had systems in place to identify risks and protect people from harm. Risk assessments were in place and regularly reviewed. Where someone was identified as being at risk actions were identified on how to reduce the risk and referrals were made to relevant social care professionals.

Medicines were kept securely and given by the registered manager to people living at the home; administration for medicines had been accurately recorded.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was trained in the MCA and DoLS. Consent was sought from people regarding their care. No one at the time of our visit was subject to a DoLS.

People’s health needs were assessed, monitored and recorded and where appropriate referrals had been made to other professionals for assessment and treatment were made. Where people had appointments they were supported to attend these.

The registered manager knew the people well and supported them in a dignified and respectful way. People’s privacy was acknowledged, and people felt that the registered manager was understanding of their needs and provided support during periods of distress. There was a positive working relationship and rapport with the registered manager and the people living at the home.

Care was provided based on people’s individual needs. People and their relatives confirmed that were fully involved in in the assessment of their needs and in care planning to meet those needs.

The registered manager listened and supported the people living at the home to make decisions as to what activities they did, and what they liked doing and what they did not like doing. The registered manager also sought the views of relatives and professionals as part of their quality assurance.

We spoke with all of the three people who were using the service. Everyone we spoke with was very positive about the service. They confirmed that they received good care and support and were happy. One person said, 'I am very happy here.' We spoke with three relatives and everyone told us that the service was excellent. One person said, 'We could not wish for better care'.

People using the service told us that staff consulted with them about their care and support needs and supported them to state their opinions about their own care needs. They told us about the many meaningful activities which they were involved with. They told us that they received support to help choose the activities and also support to attend these activities.

We saw that people using the service were offered healthy and nutritious meals. The staff understood how to support those people who had special dietary needs.

We saw that staff were able to safely administer medication and that they followed appropriate policies and procedures.

The provider had a clear complaints procedure in place and people using the service confirmed that they knew how to make a complaint. The relatives who we spoke with also confirmed that they knew how to make a complaint.

One person told us, 'We always have plenty to eat and drink.' This showed us that people were protected from the risks of inadequate nutrition and dehydration. We saw that regular consultation took place with the people using this service and where appropriate their relatives and friends. We noted that the service had not received any complaints about the quality of the service provided. This demonstrated to us that the provider had an effective system to regularly assess and monitor the quality of service that people received. Each person had their own care plans and individual risk assessments were completed where necessary. We were told about the support that was provided and what each person was able to achieve independently. This showed us that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.