Showell Court, a sheltered housing personal care service, was rated overall Good at its April 2015 inspection, with a Requires Improvement rating for Safe due to gaps in 'as required' medicines guidance, an unimplemented risk assessment for a person at risk of seizures, and inconsistent staffing response to ad hoc call bells. The remaining four key questions were rated Good, reflecting strong safeguarding knowledge, personalised and caring support, responsive leadership, and robust audit and complaints processes.
Concerns (4)
criticalRecord keeping: “One person's records showed that they were at risk from seizures and that staff should encourage them to wear a pendant... The person told us they had not been given a pendant before we had raised the matter with staff.”
moderateMedication management: “We found two instances where there was a lack of guidance for staff to inform them when and how these medicines should be given. Staff were not consistently able to demonstrate that they knew how and when as required medicines should be given.”
moderateStaffing levels: “Three people and some staff told us that staff were not always able to respond to ad hoc call bells in a timely way. One person told us, '[Staff] sometimes haven't come quickly [when the call bell has been activated].'”
minorCare planning: “We find that two people's specialist care plans, in respect of epilepsy and diabetes, required additional information. We spoke with the registered manager who immediately updated these records.”
Strengths
· Staff were knowledgeable about safeguarding, correctly reporting suspected abuse to local safeguarding authority and external agencies.
· People received pre-arranged visits on time and by the number of staff agreed in their assessments.
· Staff supported people's dignity, privacy and independence, knocking on doors and waiting for permission before entering.
· Care records were personalised, including 'About Me' sections, and regularly reviewed to reflect changing needs.
· Provider promoted a positive culture with an initiative emphasising personalised care, staff receiving thorough induction, regular supervision and updated training.
Quality-Statement breakdown (18)
safe: Risk assessmentsRequires improvement
safe: Staffing levelsRequires improvement
safe: Medication managementRequires improvement
safe: SafeguardingGood
safe: RecruitmentGood
effective: Staff training and supervisionGood
effective: Consent and mental capacityGood
effective: Nutrition and hydrationGood
effective: Access to healthcareGood
caring: Kindness and compassionGood
caring: Dignity, privacy and independenceGood
caring: Person-centred assessment and involvementGood
Showell Court achieved an overall Good rating at its February 2020 inspection, with the Safe domain declining to Requires Improvement due to inaccurate medicines administration records, including errors with pain-relieving patches that persisted even after additional checks were introduced. All other domains remained Good, with particular strengths in personalised care, staff training, consistent staffing, and proactive governance by a newly appointed registered manager.
Concerns (3)
moderateMedication management: “records relating to the administration of people's medicines were not always completed accurately...records had not always been completed to reflect their safe use.”
moderateMedication management: “We identified some errors had occurred following the introduction of these additional checks”
moderateSafeguarding: “The service had experienced a number of safeguarding concerns in relation to money and property being stolen.”
Strengths
· People felt safe and staff demonstrated good knowledge of risks and safeguarding procedures.
· Staff received relevant training and regular supervision, and felt well supported by the management team.
· Care plans were personalised, reflecting people's life histories, preferences and diverse needs.
· People were supported to maintain independence and were treated with dignity and respect.
· Consistent staffing with minimal agency use; bank staff used to cover sickness absence.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
Showell Court, operated by Accord Housing Association, received a Good rating across all five key questions at its July 2017 inspection, demonstrating safe care, effective staffing and training practices, and a person-centred culture. The sole minor concern was inconsistency in the staff group visiting people, with agency staff used daily, meaning people did not always know who would arrive.
Concerns (1)
minorPerson-centred care: “Every day we get agency staff. I never know who's coming until they come.”
Strengths
· 100% of survey respondents felt safe from harm with supporting staff
· Risks were assessed and regularly reviewed; falls and incidents were reported and acted upon
· Staff received training including the Care Certificate induction and medicines administration competency checks
· People were supported to maintain independence and treated with dignity and respect
· 100% of survey respondents said staff were caring, kind, and treated them with respect and dignity
Quality-Statement breakdown (18)
safe: Staffing levels adequate; agency cover used during sickness/leave to ensure calls were not missedGood
safe: Risk assessments completed, reviewed regularly and updated when needs changedGood
safe: Safeguarding knowledge demonstrated by staff; concerns escalated appropriately to local authorityGood
safe: Medicines managed safely; MAR records completed accurately; competency checks undertakenGood
safe: Safe recruitment checks completed including DBS, references and proof of ID for staff and agency workersGood
effective: Staff trained and inducted including Care Certificate; competency checks completed by managerGood
effective: Consent sought before care; staff aware of Mental Capacity Act principlesGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candour; Continuous learning and improving careGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with othersGood
effective: Nutritional needs supported; dietary requirements recorded in care plansGood
effective: Access to healthcare professionals facilitated; advice reflected in care recordsGood
caring: Staff described as friendly, kind and respectful; 100% survey agreementGood
caring: People supported to maintain independence; choices and preferences recorded in care plansGood
caring: Dignity and privacy respected; people have own keys to individual flatsGood
responsive: People involved in care assessment, planning and review; care records individualisedGood
responsive: Activities available on-site and community access supportedGood
responsive: Complaints system in place; information about raising concerns available in communal areasGood
well-led: Approachable management team with clear structure; open culture supported by whistle-blowing policyGood
well-led: Regular audits of medicines and training; quality monitoring including spot checks and staff competency assessmentsGood
well-led: People and staff consulted via questionnaires, tenant meetings and staff meetings to improve the serviceGood