Archived: New Beginnings Residential Care - 63 Kingsley Road

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Our previous inspection on 2 February 2017 found four breaches of regulation and made one recommendation. We rated the home as “requires improvement”. During this inspection on 22 and 23 February 2018, we found that the home had made some improvements. However, we found that that there was not a clear management structure in place and that there were concerns in relation to staffing arrangements.

There was no registered manager in post at the time of this inspection. 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.

Our previous inspection found that there were some aspects of the care provided that were not safe. We previously found that fire safety arrangements were not adequate and we found a breach of regulation in respect of this. During this inspection in February 2018, we noted that the home had taken action in respect of this and had implemented fire safety checks and staff had received fire safety training.

Our previous inspection also found that medicines were not stored appropriately and we found a breach of regulation in respect of this. During this inspection, we noted that the home had made improvements in respect of this. We however, noted that the home had failed to document one person’s PRN medication appropriately and we have made a recommendation in respect of this.

We looked at the staffing rota and noted that it did not accurately reflect the staffing arrangements in the home. For example; the rota stated that the operations manager would be working from 9am to 5pm on both days of the inspection. However, this was not accurate as the operations manager was only present for a short period of time on both days. Further, the rota did not correctly detail which care staff were working on both days. We were therefore not satisfied that staff were always deployed as required to meet people’s needs and we found a breach of regulation in respect of this.

Risk assessments had been carried out which detailed potential risks to people and how to protect people from harm.

The home had carried out some checks on staff suitability to work with vulnerable people. They had carried out checks on their criminal records and their identity and eligibility to work in the United Kingdom. However, there was a lack of evidence to confirm that references were obtained and we found a breach of regulation in relation to this.

Our previous inspection found that people’s care plans lacked information about what support people required. We previously found a breach of regulation in respect of this. During this inspection, we noted that the home had made improvements in this area. They had implemented a new format support plan for people which included information about what support people required as well as how they wished to be supported with various aspects of their daily life.

Our previous inspection found that there were significant gaps in staff training and a lack of appraisals and we found a breach of regulation about this. During this inspection, we noted that the home had made improvements in respect of this and staff had completed necessary training and where required they had received an appraisal.

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. Our previous inspection in February 2017 found that there was a lack of information about people’s mental capacity and communication in people’s care records. During this inspection in February 2018, we found that information about people’s communication and their capacity to make decisions was documented in care support plans.

The arrangements for the provision of meals were satisfactory. We saw that there was a weekly menu. Staff confirmed that they asked people what they wanted to eat and then prepared meals based on this. We looked at the menu for the week of the inspection and noted that there was a variety of meals available. On the first day of the inspection we observed both people in the home prepare their lunch with the support of a member of staff.

We observed interaction between staff and people living in the home during our visit and saw that people were relaxed with staff and confident to approach them. Staff interacted with people, showing them patience and respect.

Our previous inspection recommended that the provider reviewed the provision of activities at the home to ensure people are provided with mentally stimulating activities. We previously found that there were a lack of activities available to people. During our inspection in February 2018, we noted that the home had made improvements in respect of this. The operations manager confirmed that since the inspection, they had arranged for both people to attend a day centre three times a week. We also saw evidence that each person had their own activities timetable which was documented in their support plan based on their individual interests.

Our previous inspection found that there was a lack of evidence to confirm that regular audits were carried out in respect of various aspects of the care provided and we found a breach of regulation in respect of this. During this inspection, we found that the home had undertaken checks and audits of the quality of the service in areas such as health and safety, fire procedures, medicines management and care documentation.

During both days of the inspection we found that there was a lack of management presence and we were not confident that there was a suitable management structure in place in the home.

We found two 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.

The last inspection took place on 22 January 2015 where we found no breaches of Regulation and rated the service as “Good”.

Clover Residents – 63 Kingsley Road is a care home registered for up to three people. At the time of the inspection two people were living at the home who had learning disabilities. The service was managed by Clover Residents Limited, a private organisation who ran two other care homes in London.

The registered manager left the organisation in August 2016. There was a new manager in post at the time of the inspection. She provided us with evidence to confirm that she was awaiting the results of her criminal check before making an application to register with the Care Quality Commission (CQC). 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 found that there were aspects of the care provided that were not safe. The arrangements for ensuring that people living at the home and staff were kept safe in event of a fire were not adequate. The home had failed to carry out fire drills and regular fire alarm checks. We found a breach of Regulation in respect of this.

During the inspection we looked at the arrangements for medicines. There were arrangements in place in relation to obtaining and disposing of medicines appropriately. However we found that medicines were not always stored at the appropriate temperature and that some of the MARs we looked at had not been completed with all necessary information. We found a breach of Regulation in respect of this and reported this to the manager who said immediate action would be taken to improve the proper and safe management of medicines.

During the inspection we observed that care staff did not appear rushed and were able to complete their tasks. Care staff we spoke with told us there were enough staff. However we noted that there were occasions where care staff worked long hours and discussed this with the manager who advised that she would carry out a risk assessment to ensure that care staff were fit to safely care for people and meet their needs.

Risk assessments had been carried out which detailed potential risks to people and how to protect people from harm. People's care needs and potential risks to them were assessed.

People’s care plans lacked information about what support people wanted and how they wanted the home to provide the support for them with various aspects of their daily life. We found that care plans contained limited information about the healthcare needs of people. We found a breach of Regulation in respect of this.

Staff spoke positively about their experiences working at the home. They said they felt supported by management within the home and said that they worked well as a team. However, we noted that there were gaps in staff training. For example, there was no evidence that staff had received basic life support and food safety training. Staff also required refresher training in various areas which included safeguarding and medicines administration training. There was a lack of evidence to confirm that all staff had received an appraisal since the last inspection.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that where people were potentially being deprived of their liberties, the home had taken the necessary action to ensure that these were authorised appropriately.

The arrangements for the provision of meals were satisfactory. We saw that there was a weekly menu. Staff confirmed that they asked people what they wanted to eat and then prepared meals based on this. We looked at the menu for the week of the inspection and noted that there was a variety of meals available. On the day of the inspection we observed one person prepare their lunch with the support of a member of staff.

We observed interaction between staff and people living in the home during our visit and saw that people were relaxed with staff and confident to approach them throughout the day. Staff interacted with people, showing them patience and respect. People had free movement around the home and could choose where to sit and spend their recreational time. We saw people were able to spend time the way they wanted. They spent some of their time in the communal lounge and some time in their bedroom.

People who lived at the home told us that they would like to go out more during the day. There was a formal activities timetable, however we observed that it did not correctly reflect what activates were available on the day of the inspection. We spoke with the manager about this and she explained that there was flexibility in terms of activities as it depended on what people wanted to do on a particular day depending on their mood. We saw evidence that people went to a day centre twice a week and also went out with staff. On the day of the inspection, we observed that people spent the morning watching television in the lounge and in the afternoon one person was doing a puzzle with the support of a member of staff and another person was knitting. We spoke with the manager about the feedback received from people who lived at the home and she explained that they were looking to introduce new activities within the home. We made a recommendation in respect of this.

We noted that there was a lack documented evidence to confirm that regular audits were carried out by the provider. We saw no documented evidence of recent health and safety checks in respect of the premises, housekeeping, infection control, policies and procedures and staff training, supervisions and appraisals. We found a breach of Regulation in respect of this.

We found four 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 the home had systems in place to gain and review consent from people who used the services and acted on them.

People who use the service told us they were happy living at the home and with the staff working there. They received appropriate care and support that met their individual needs. However, they had not always consented to their care and treatment nor had they been involved with planning their own care.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

People were cared for and supported by suitably qualified and skilled staff. The staff were trained, supervised and appraised appropriately.

There were systems to monitor the quality and safety of the service.