About the service:

Radcliffe Meadows is a single storey building that provides accommodation and nursing care for up to twelve adults who have a learning / physical disability and /or mental health needs. Radcliffe Meadows was providing personal and nursing care to 11 adults at the time of the inspection. This home is larger than current best practice guidance and did not fit with the guidance contained in the Registering Right Support review document. The home was clearly identifiable as a care home with large signage at the top of the road and outside the premises, four large industrial size bins were visible at the front of the property. However, staff were not required to wear uniforms so there was no suggestion they were care staff as they were coming and going from the property.

People’s experience of using this service:

People told us that they liked living in Radcliffe Meadows and many of people had lived there many years. People were complimentary about the staff who cared for them. Relatives told us that they were satisfied with the care their loved ones received.

However, we found some areas of concern.

Improvements were needed to the environment, which have proved difficult to implement by the provider. In part due to a covenant on the property and the materials used in the original construction of the building.

There were sufficient staff to meet people’s needs. There was a high dependency on agency staff. This could mean people are unfamiliar with the staff working with them. Improvements were needed to recruit permanent staff. Agency staff were not always appropriately trained in fire evacuation procedures, which could put themselves and others at risk.

Ineffective systems were in place for people to raise complaints and concerns and for the service to consult people living in the home, family and stakeholder, including staff.

Risks were identified and managed to minimise harm. Appropriate recruitment checks were carried out to ensure staff were suitable to work in the care environment. Medicines were managed safely by trained staff in the home. However, there was insufficient overview and effective monitoring of the service.

The home complied with the principals of Mental Capacity Act 2005 (MCA), measures were in place to ensure consent to care and treatment. People were well cared for by staff who treated them with respect and dignity.

You can see what action we told the provider to take at the back of the full version of the report.

Rating at last inspection:

The rating was good at the inspection dated 17 May 2016.

Why we inspected:

This inspection was scheduled/planned inspection in accordance with our inspection schedule. The rating is now Requires Improvement.

Follow up:

We will continue to monitor any intelligence we receive about the service until we return to visit as per our inspection schedule. If any concerning information is received we may inspect sooner.

We carried out an announced inspection of Radcliffe Meadows Learning Disability Nursing Home on 03 December 2015.

At our last inspection in April 2014 the service was not meeting the regulation required that they notify Care Quality Commission of safeguarding incidents.

The home provided care, support and accommodation for up to twelve people. At the time of the inspection there were nine people living in the home. All bedrooms were single and communal areas included two kitchens and two lounges. People had access to a pleasant patio area and garden at the rear of the home and there was car parking at the front of the home for visitors.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The experiences of people who lived at the home were positive. Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People were protected from abuse and felt safe at the home. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed.

People’s health care needs were met and their medicines were administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The home was clean and staff had received training in infection prevention and control. Bedrooms were well furnished and contained equipment necessary to support the person such as ceiling hoists and specialist beds.

Consideration was needed in respect of how the home could develop to meet the collective needs of those living there with regard to access to personal space and noise levels.

Staff had an understanding of the systems in place to protect people who could not make decisions and knew how to follow the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

The provider had a whistleblowing policy to inform staff how they could raise concerns, both within the organisation and with outside statutory agencies. This meant there was an alternative way of staff raising a concern if they felt unable to raise it with the registered manager

We undertook an inspection of Radcliffe Meadows on 29th April 2014. During the inspection we spoke with the registered manager, an assistant manager, five staff, two relatives and three people who used the service. We also encouraged other people using the service to participate in our visit using their preferred methods of communication.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

Records viewed highlighted that a mental capacity assessment had been completed for two of the people using the service for various reasons. Two applications for DoLS authorisations had also been made to ensure the rights of people deprived of their liberty were appropriately protected.

We noted that the provider had written to the local authority to seek advice on the use of a restricted egress system (coded door) which was fitted to the main entrance of the home. This is good practice as the use of this lock could prevent many of the people living at Radcliffe Meadows from leaving the premises without assistance.

Training records highlighted that a number of staff had not completed Mental Capacity Act or Deprivation of Liberty Safeguards training. This has been brought to the attention of the provider so that action can be taken to increase staff knowledge and understanding.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

We noted that although safeguarding incidents had been referred to the local authority safeguarding team, information concerning safeguarding incidents between people using the service had not been notified to the Care Quality Commission. This is a requirement of the Care Quality Commission (Registration) Regulations 2009. We have therefore issued a compliance action in regard to this matter.

Systems were in place for the ordering, storage, administration, recording and disposal of medication. Medication checked was found to be appropriately stored and medication administration records had been correctly completed to provide a clear audit trail.

Is the service effective?

We spoke with three people who lived at Radcliffe Meadows and encouraged other people to participate using their preferred methods of communication.

Comments received from people using the service included; “Staff are nice”; “I’ve been to Burger King today for a coffee. Sometimes I go to the park, shopping and the cinema now and again”; “I’ve just got back from my gardening work” and “It’s okay here but I’d like to live on my own.”

No complaints or allegations were received from people using the service during our visit however one relative spoken with expressed concern regarding an incident that had taken place between two service users. Records confirmed that action had been taken in response to the incident in order to safeguard the welfare of vulnerable adults.

We noted that people using the service were offered a choice of meals and support was available for people requiring support with eating and drinking. Feedback from people living at Radcliffe Meadows included: “Every meal is nice” and “The food is tasty but I’m not a big eater.”

Action had been taken to involve specialists such as speech and language therapists and dieticians when necessary, to ensure the changing needs of the people using the service were identified and planned for.

Is the service caring?

We also spoke with the relatives of two people who were supported by the service. Overall feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: “Staff treat the people living there with respect”; “My daughter has come on in leaps and bounds” and “I’m generally very happy.”

We talked with the staff and watched their interactions with people using the service during our visit. We observed staff spending time and engaging with the people living at Radcliffe Meadows in a respectful and dignified manner.

Is the service responsive?

We looked at the personal files of two people who lived at Radcliffe Meadows during our site visit and found copies of assessments and care planning information. Each file viewed contained a plan of care that outlined: 'What is important to me in this area of my life', 'How are we going to accomplish this' and 'How will I know that you have helped me to reach my goal in this area'. This information confirmed the service was responsive to the needs of the people using the service and records viewed confirmed care plans had been kept under monthly review.

People using the service had individual activity programmes / timetables to enable them to follow their preferred daily routines and activities. This helped people to develop a range of daily living skills and to pursue social and recreational activities of their choice.

At the time of our inspection the service was in the process of introducing an alternative care planning model which aimed to look at people’s behaviour and identify strategies to address adverse behaviour.

Is the service well- led?

Radcliffe Meadows had a registered manager in place who provided leadership and direction to the staff team.

The service continued to utilise a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives. This information was used by the provider and manager to ensure the ongoing development of the service.

People using the service at Radcliffe Meadows who were spoken with confirmed that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs.

Comments received included; Comments received from people living at Radcliffe Meadows included: “I like it here. I’m going to Liverpool tomorrow”; “The staff look after me and are helpful” and “It’s alright here but I’d like to move to my own house one day.”

Likewise, feedback received from two relatives included: “My relative appears very happy. I have no worries at all” and “The service appears to be improving and my son is settled and generally happy.”

Systems were in place to monitor that quality of service provided and to offer protection to the people who used the service from abuse. People spoken with confirmed that they felt safe and had no concerns regarding the care provided.

People using the service at Radcliffe Meadows who were spoken with confirmed that they were generally satisfied with the standard of care provided and were of the opinion that staff understood their needs.

Comments received included; “I am treated nicely”; “I was given some information on this place when I moved in” and “Staff ask me how I’m getting on and look out for me.”

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided.

We also received positive comments on the standard of care provided from relatives spoken with. Comments included; “In our opinion our daughter couldn’t have a better place to live” and “The staff are generally okay.”

One relative raised concern regarding limited opportunities for people to access community based activities. Likewise, we noted that there had been occasional problems with the return of incorrect items of laundry to people using the service. These issues have been highlighted for the attention of the provider.

People spoken with reported that they were treated well by staff. Comments received included; “It’s nice here”; “The staff are okay. They are nice”; “Staff knock and ask if they can come into my room” and “They are good staff here”.

We also spoke to the relative of one person using the service who informed us: “The care my son receives is brilliant” and “The staff provide me with regular updates on my son’s welfare.”

People spoken with confirmed that they felt safe living at Radcliffe Meadows and one person stated “I have nothing to worry about.”