We (the Care Quality Commission) carried out an unannounced inspection at1 St Anne's Road on 23 May 2012. The purpose of this inspection was to review the actions taken by the provider to address compliance actions issued following inspections of the home on 14 January 2011, 31 May 2011 and 3 November 2011. The compliance actions related to '
Outcome 2 - Consent to care and treatment
Outcome 7 - Safeguarding people who use services from abuse
Outcome 9 - Management of medicines
Outcome 14 - Supporting staff
Outcome 15 - Statement of purpose
Outcome 24 - Requirements relating to registered managers
During this inspection we also looked at outcomes -
Outcome 4 - Care and welfare of people who use services
Outcome 10 - Safety and suitability of premises
Outcome 13 - Staffing
Outcome 16 - Assessing and monitoring the quality of service provision
Outcome 17 - Complaints
At the time of this inspection there were three people with learning disabilities living in the home. When we arrived there were two people at home.
During our visit we talked to two people who lived there, and also the acting manager and two care workers. We looked at care plan files, daily reports, records of medicines administered, staff training, staff supervision, staff meetings, staff rotas, maintenance records, fire safety records, resident's meetings, policies and procedures, quality assurance, records of accidents and incidents, and complaints. We also looked at issues relating to the management of the home. We carried out a tour of the premises. Before, and after, our visit we talked to a social care professional, and also to the manager of the local Learning Disabilities Team.
We talked to two people about their daily lives. They told us about things they enjoyed doing and people who were important to them in their lives. We saw care workers talking to them in a friendly and respectful manner. The care workers were able to demonstrate a good understanding of people's likes and dislikes and personalities. We asked people if they liked living at the home. One person who had communication difficulties did not respond to this question. The second person talked about some of the things that sometimes upset him, and also described the things he liked about living at 1 St Anne's Road.
We found that people had not been fully consulted or informed about their care. There was no evidence of people being given a copy of their care plan in a format they could understand, or to show they had contributed to the content of the plans or agreed to the content. Risks to people's health, safety and well being had not been fully recognised, and the care workers had not received sufficient guidance, training, support or supervision to enable them to support people at times when they may be distressed or angry, or when they may pose a danger to themselves or other people.
In a tour of the home we found that essential repairs and maintenance had not been carried out in a timely manner. A leaking shower had caused a hole in the sitting room ceiling. The leaking shower had been reported in the maintenance book five times since February 2012 but no action had been taken to repair the leak or the damage to the sitting room ceiling. Since the visit the provider has confirmed that a builder has begun to address maintenance issues highlighted in this report.
We also saw areas of the home that had not been redecorated for many years and where the decoration was in need of attention. A settee in the sitting room was torn and damaged and the carpet in this room was threadbare in one area and badly stained. Bedroom flooring was damaged and torn.
There were six care workers employed to work in the home, and this included a care worker who was temporarily acting as manager. The care workers said they had been working longer hours than they had been originally contracted to work in order to cover vacant posts. This meant that there was limited capacity among the staff team to provide cover for any unexpected leave or sickness. The acting manager said they had attempted to appoint a further member of staff in March 2012 but the provider had not applied for a Criminal Records Bureau check and therefore the person was not appointed.
Care workers had only received one formal supervision session in the last year. The acting manager had not received any formal supervision. Staff meetings were held regularly.
The home's Statement of Purpose and their Service User Guide had not been updated and included references to outdated legislation. The information had not been provided in alternative formats to ensure that people who had difficulty reading had information about the home in a format they could understand.
There were inadequate systems in place to assess or monitor the quality of the service. Regular meetings were held in the home with people who lived there, and these meetings had been minuted. However, where matters had been identified that required action, there was no evidence to show that these had been considered, or any plan put in place to address them. Other areas covered in this report, including maintenance of the home, care planning, staff training and supervision, and complaints had not been included within the quality assurance system.
Records of complaints made by people living in the home showed that their concerns had not been adequately investigated, and action had not been taken to address the issues or to prevent recurrence. This showed that people may have been at risk of abuse or harm through failure of the home to consider the potential implications of the complaints. The home's complaints policy was displayed on the notice board in the dining room. However, some information in the policy was out of date. The policy was in small print, and there was no information about complaints or safeguarding available in alternative formats suitable for people who had difficulty reading text.
There had been no registered manager in post since June 2010. At the time of this inspection a care worker who had worked in the home for a number of years had been given the role of acting manager. They told us they did not want to take on the role of registered manager.
We asked the provider to send us information to help us make a judgement on the standards that we looked at during the visit to the home. We communicated with the provider by telephone and by e mail. Where we have had a response we have added to the report.
We concluded that people who lived at 1 St Anne's Road had not received adequate care and support to keep them safe and to meet all of their care and welfare needs.