Archived: College House Residential Home

College House is a ‘care home’. People in care homes receive accommodation and 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. The home is in one adapted building over two floors.

There was a registered manager at the time of the inspection. However, during our inspection visits, we were told they were not available, and would be de-registering. A new manager was in post who told us they would be applying for registration, however five days after our inspection we were told they were not working at the service.

Rating at last inspection: At the last inspection the service was rated Good. The report was published 25 January 2017.

Why we inspected: This was a scheduled inspection based on the previous rating. However we had also received significant concerns from the Local Authority following their recent quality monitoring visit to the home so brought the inspection forward.

People’s experience of using this service:

¿ People were not always protected from abuse because the provider’s systems and processes to protect them were not in place to identify and respond to all allegations of abuse.

¿ People were exposed to significant risk of harm as their care needs had not been assessed, monitored and reviewed.

¿ There were enough staff on duty to keep people safe and meet their needs.

¿ People’s medicines were not always managed in a safe way.

¿ Infection prevention and control practices were not monitored or reviewed.

¿ People were not supported to have maximum choice and control of their lives and staff did not work within the principles of the Mental Capacity Act (2005)

¿ Staff sought external healthcare professionals’ advice but did not follow their guidance in how to support people.

¿ Staff spoke to people in a kind and caring way

¿ People’s care was not delivered in a timely way, and changes in care were not always clearly communicated to the staff team.

¿ People were not supported to go on outings. People with dementia were not provided with activities that stimulated them.

¿ Record keeping of complaints was poor to enable the provider to demonstrate whether any had been received and acted upon in-line with their policy.

¿ The provider’s quality assurance systems had not always been effective in identifying shortfalls in care and treatment for people. Improvements in quality assurance to assess, monitor, mitigate and improve the service were underway.

We found four breaches of regulation at this inspection: Regulation 11, 12, 17 and 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager in place. 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.’

People told us they felt safe and well cared. Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were safe. People were cared for by staff that demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse.

People got the assistance they asked for and staff ensured they were available to help people when needed. People told us they enjoyed meals times and were positive about the choice of food they received. People were supported by staff to have their medicines when they needed them and staff recorded when they had received them.

Staff understood people’s individual care needs and had received training so they would be able to care for people in the best way for them. There were good links with healthcare professionals and staff sought and acted upon advice received, so people’s needs were met.

People said staff were caring and their privacy and dignity was maintained and we made observations that supported this. People and relatives valued the positive relationships they had with staff. Relatives told us there were no restrictions on when they could visit and they were always made welcome by staff.

People received care that met their individual needs. People were encouraged to express their views and said staff listened to them and they felt confident they could raise any issues should the need arise. People chose how they spent their day and said staff respected their choices.

Staff spoke positively of the registered manager and felt supported and listen to. Staff said teamwork was good and the staff team supported each other. The quality of service provision and care was monitored by the provider and actions taken where required.

Since our last inspection on 2 and 8 April 2015, the provider had made improvements to the home. A new lounge area had been added to the home and new furniture purchased. People, relatives and staff all told us the changes had improved the daily lives of people living in the home.

People were positive about the care and support they received, the management of the home and the service as a whole.

College House is registered to provide accommodation for 13 people. At the time of our visit there were 11 people using the service. One of the registered managers named on the front of this report was not in post and not managing the regulatory activities at this location at the time of the inspection.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People told us that they felt safe. Individual risk assessments were well completed and actions to minimise the risks identified were reflected in care plans.

Appropriate systems and processes were followed with regard to the Mental Capacity Act 2005. Staff had received training and were clear about their role and responsibilities.

The provider had effective medicines management processes and procedures that were applied in practice.

People were cared for in clean premises. Staff had received infection prevention and control training and were clear about their roles and responsibilities. Appropriate measures had been taken to ensure the security of the premises. A key code entry system prevented the risk of unauthorised access.

The building was in urgent need of refurbishment and repair. Bathroom facilities were inadequate. Progress with building work had been delayed. There were no risk or impact assessments relating to the building work or lack of suitable bathrooms. A recent fire safety inspection by the Local Authority had highlighted a number of areas requiring attention with regard to fire safety systems and procedures. We asked the provider to provide us with an action plan of work planned and when it would be completed.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care plans developed. People told us that they had been involved in developing their care plan. Care plans were not always updated when people's needs changed.

Staff had access to a range of relevant training to meet the needs of the people they cared for.

Is the service caring?

People told us that the care they received was very good. One person told us, 'People here look after me very well.' We observed staff speaking to people in a friendly and caring manner.

People told us that the staff supported them to undertake the activities of their choice.

Is the service responsive?

People told us that the service was very responsive. People felt able to raise any issue and were confident that it would be acted upon. However people were frustrated about the lack of progress and information about the refurbishment programme. People were able to express their views about their care through satisfaction surveys and resident meetings.

People who used the service and staff were clear about the complaints process. None we spoke to had ever had the occasion to raise a complaint. However people were confident that if they did it would be acted upon.

Is the service well-led?

Staff told us that they felt supported by the registered manager. Staff meetings were held regularly. The proprietor was not regularly visiting the home which meant that the manager was not always adequately supported.

Systems to monitor and manage the risks to people who used the service were not effective. Environmental audits had failed to identify the risks relating to the incomplete building work and inadequate bathing facilities. We have asked the provider to take action to improve systems to identify and monitor the risks to people who used the service.

People expressed their views on how they wanted to maintain their independence. Care workers we spoke with told us how they supported people in their choice.

People were complimentary about the care and support they received. One person told us: 'You feel like you belong'. Another person said: 'I enjoy being here'.

The provider had a system in place to make sure care workers recruited had the required documents and checks in place to protect people.

People told us that they felt safe when care workers provided care and support. Care workers had received training on how to recognise signs of abuse and knew how to raise concerns.

People who used the service were supported by care workers who were suitably trained and qualified to meet people's needs.

The provider made sure care workers were trained to an appropriate standard to meet people's needs. They also encouraged care workers to participate in team meetings and supervisions.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

We spoke with people who used the service. One person told us that changes had been discussed and made to their room since moving to live at the service. This person said the service had "made me comfortable". They told us that many activities took place at the service and that they liked to take part. The person told us that they did not have to wait long if they had pressed the call bell as they required assistance. One person said that they were supported to maintain their appearance how they wanted to and that their clothes were well looked after. This person said the staff were "very good".

We found that there were enough suitable and trained staff to meet people's care needs. We observed a meal time and saw that people received drinks and meals when required and that those that needed support at meal times were given that support. We also saw that people were offered healthy options including fruit for pudding.

We found that people's preferences were considered and their independence was supported. We heard that staff addressed people differently depending on what they preferred to be called. Some people were called by their Christian name and others were addressed using their title.

The service had systems in place to monitor and where necessary improve care quality. The environment was clean and well maintained.