Archived: New Beginnings Residential Care - 6 Harrow View

Our previous inspection on 7 March 2017 found three breaches of regulation and made one recommendation. We rated the home as “requires improvement”.

The first day of our inspection was unannounced. On this day we observed that two people were in the home and there were two care staff on duty. However, there was no manager on duty. As a result we went back to the home on 16 March 2018. The second day of the inspection was announced.

This inspection on 9 and 16 March 2018 found that the provider had made improvements to the home and care provided. However, we found that that there was a lack of consistent management presence in the home.

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 March 2018, we noted that the home had taken action in respect of this and had implemented fire safety checks and staff had received the necessary 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. However, we observed that there were two errors on one MAR chart we looked at for the day of the inspection. We raised this with the operations manager and she advised that she would speak with the member of staff concerned.

Accidents and incidents had been recorded. However, we noted that the remedial action following the incident was not documented. It was therefore not evident what the service had done to prevent the reoccurrence. We 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 the first day of our inspection. However, this was not accurate as the operations manager was away on leave. We were therefore not satisfied that management 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.

Our previous inspection found that people’s care plans lacked information about what support people required and we made a recommendation about this. During this inspection, we noted the home had made improvements. 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 in respect of this. During this inspection, we noted that the home had made improvements and staff had completed the 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 March 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 March 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. 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 prepared their breakfast with the support of a member of staff.

Each person in the home had an individual varied activities programme which was devised based on their interests. On the first day of the inspection we noted that one person went to a day centre and another person went to visit their family.

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, staff files, fire procedures, medicines management and care documentation.

During the first day of the inspection we found that there was a lack of management presence and we were not confident that there was a consistent and regular management structure in place in the home.

We found one breach 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 – 6 Harrow View 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.

During the inspection we found 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 regular fire alarm checks and staff required refresher fire safety training. 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 stored appropriately and raised this with the manager. We also found that there were two unexplained gaps on the MAR for one person. 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.

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 included some 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. However we found that care plans were not completed fully and there were gaps in these. We made a recommendation 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. One person was potentially being deprived of their liberties, the manager confirmed that they had taken the necessary action to ensure that this was authorised appropriately.

The arrangements for the provision of meals were satisfactory. 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.

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.

Each person had an activities timetable detailing what activities they participated in. Activities included going to the cinema, shopping centre, gym and local club. On the day of the inspection people went out to a local shopping centre and to a Church.

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 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 three 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 were not able to speak to people using the service because they had complex needs. We gathered evidence of people's experiences of the service by observing how people were cared for, looking at their care records and speaking with staff.

People who used the services received appropriate care and support that met their individual needs and were treated with dignity and respect. One relative told us they were' very pleased and very happy with the service, it's the best thing that has happened to him in a long time'.

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.

The staff were supported to provide care and treatment to people who use the service and were being trained, supervised and appraised appropriately.

There were systems in place to monitor the quality and safety of the service and accurate and appropriate records were maintained.

We found that care records had improved and people were receiving better standards of care. We also found people were not being inappropriately restrained and staff had received training and awareness with regards to restraint. We also looked at records and found people were supported by a staff team which had suitable skills and experience to deliver care.