Craegmoor Supporting You in Cambridgeshire received an overall rating of Requires improvement following an announced inspection in June 2015, with two regulatory breaches identified relating to unsafe medication management and failure to follow Mental Capacity Act and Deprivation of Liberty Safeguards procedures. Caring, responsive and well-led domains were rated Good, reflecting person-centred care, effective complaints handling, and a proactive new manager implementing improvements.
Concerns (6)
criticalMedication management: “The MAR chart for one month contained the wrong information for the dosage of medication to be administered for one person. Audits completed by the provider and management had not identified this error.”
criticalConsent / capacity: “The correct procedures to restrict people's liberties in a lawful manner or make best interest decisions for them had not been followed. This was a breach of Regulation 11.”
criticalSafeguarding: “One safeguarding issue had been reported appropriately...no action had been taken to discuss the incident with the safeguarding team or to report the incident to the commission.”
moderateCare planning: “Although there had been a number of occasions when one person had shown behaviours which could challenge others, a risk assessment had not been put in place to address this issue.”
moderateSupervision / appraisal: “During the last year there had been gaps of up to nine months between supervision sessions. The manager stated that supervisions would normally be every two to three months.”
minorComplaints handling: “The provider had a written complaints procedure but this was not in a format that was accessible by everyone who used the service.”
Strengths
· Staff knew people well and treated them in a caring manner, with dignity and respect, including remaining calm when people were anxious.
· Safe recruitment practices were being followed with criminal records checks and references confirmed before employment.
· People's support plans were reviewed regularly and written in a person-centred way promoting independence, dignity and respect.
· People were supported to access a range of healthcare professionals including GP, dentist, and opticians in a timely manner.
· The new manager had carried out audits and compiled an action plan of improvements needed since taking post in January 2015.
Quality-Statement breakdown (14)
safe: Medication managementRequires improvement
safe: Risk assessmentRequires improvement
safe: SafeguardingRequires improvement
safe: Staffing and recruitmentGood
effective: Mental Capacity Act and Deprivation of Liberty SafeguardsRequires improvement
effective: Staff training and inductionGood
effective: Supervision and appraisalRequires improvement
effective: Healthcare access and nutritionGood
caring: Dignity, respect and person-centred careGood
Craegmoor Supporting You in East Anglia received a Good rating across all five key questions at its July 2016 inspection, having successfully remediated two prior regulatory breaches relating to medicines management and mental capacity assessment. The service demonstrated person-centred, rights-based care for 12 people with learning disabilities, with areas for ongoing improvement identified in staff supervision scheduling and internal communications.
Concerns (4)
criticalMedication management: “provider was not ensuring that people were protected from unsafe management of their medicines. This was a breach of Regulation 12(2)(g) HSCA 2008”
criticalConsent / capacity: “provider was not ensuring that people were protected from unlawful care as their mental capacity to make decisions had not been assessed. This was a breach of Regulation 11(3)”
minorSupervision / appraisal: “the current schedule of planned supervisions needed to become more formalised as part of their improvement strategy in managing and supporting staff”
minorGovernance: “remaining three staff surveys said that the communication was not provided when they needed it”
Strengths
· Previous breaches of Regulation 12(2)(g) and Regulation 11(3) fully remediated by time of this inspection
· Sufficient staffing levels maintained with individual care records specifying required staff ratios
· Robust safer recruitment processes including enhanced DBS checks, online values assessments and reference verification
· Staff knowledgeable about safeguarding, MCA principles and behaviours that challenge
· People supported to maximise independence including self-management of medicines, finances, domestic tasks and community access
Craegmoor Supporting You in East Anglia was rated Good overall at its March 2019 inspection, supporting nine people with autism, mental health issues and learning disabilities, with strengths in safeguarding, person-centred care and staffing continuity. The Well-Led domain required improvement due to gaps in governance, inadequate behaviour support planning, poorly embedded medicines audit systems, record-keeping deficiencies, and insufficient depth of staff training in managing challenging behaviour.
Concerns (10)
moderateStaff training: “some staff were not confident in supporting people who had behaviours which could impact negatively on themselves or others. Staff had e-learning around managing and deescalating behaviours but agreed this was not in sufficient depth”
moderateStaff competency: “Staff supervisions were regular, every eight weeks but there were no spot checks on staff performance other than for medicine competencies and visual checks during their probationary.”
moderateIncident learning: “incident management was in place but information not clearly collated too see if additional actions might help reduce the level of incidents.”
moderateRecord keeping: “Gaps in record keeping were identified and clear processes were not in place for every situation.”
moderateGovernance: “Audit tools were not fit for their current purpose and medicines records were not audited as often as the service said they should be.”
moderateCare planning: “behavioural support plans were not in place for everyone we reviewed/discussed and had not been drawn up showing consultation with other health care professionals”
moderateMedication management: “Medicine checks took place regularly but systems for checking medicine records were not firmly embedded. The audit forms used to review medicines...were on a template designed for care homes”
moderateInfection control: “Recent audits identified some significant issues such as exposed wiring, no cleaning schedules and no health and safety checks on the premises.”
minorSupervision / appraisal: “Staff supervisions were regular, every eight weeks but there were no spot checks on staff performance...Annual appraisals were being planned.”
minorEnd-of-life care: “people's care and support plans did not look at people's wishes in relation to treatment they might require or advanced wishes as they got older.”
Strengths
· People felt safe and expressed happiness with the service; staff provided care and support in a timely way around assessed needs.
· Staffing was planned around individually assessed needs with contingency plans and a bank staff team; agency usage was low and reducing.
· Staff had a reasonable understanding of safeguarding and felt confident raising concerns; a safeguarding audit tool was in place.
· People had capacity to make decisions and their consent was recorded; they were involved in their support and encouraged to be autonomous.
· People were supported to access healthcare appointments and annual check-ups; health action plans and hospital passports were in place.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
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
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: Supporting people to live healthier lives, access healthcare services and supportGood
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 meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Planning and promoting person-centred, high-quality care and support with openness; duty of candourRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving careGood