CQC report explained · a residential care home
What the CQC found at 178 London Road
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed, staff knew how to keep people safe, medicines were administered as prescribed and staffing levels were sufficient. The home was still recruiting to fill vacancies and used agency staff in the meantime.
- Effective?
- Good
- Care plans were regularly reviewed and staff had appropriate training, supervision and knowledge. People received support with nutrition, swallowing risks, exercise and healthcare appointments.
- Caring?
- Good
- Staff knew people well and treated them with kindness, dignity and respect. People were supported to make everyday choices, maintain relationships and develop their independence.
- Responsive?
- Good
- Care plans reflected people's preferences, strengths and goals. People were supported with activities and outings that suited their interests, and there was an accessible complaints procedure.
- Well-led?
- Good
- Inspectors found effective quality checks and a culture of improvement. The home had improved its recording and investigation of unexplained bruising since information had been received about earlier practice.
What inspectors found, February 2019
Royal Mencap Society - 178 London Road was rated Good overall; inspectors found safe, kind and personalised care, with improvements since the previous inspection.
The home provides accommodation and personal care for three people with learning disabilities. The inspection was unannounced and took place on 15 January 2019. One inspector observed care, spoke with staff, managers, relatives and a healthcare professional, and checked care, medicines, staffing and other records.
Inspectors rated the home Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found that people received personalised care, their medicines safely, and support with health, food, activities and relationships. Staff were described as kind, trained and supportive.
At the previous inspection, published in February 2018, the home was rated Requires Improvement. Inspectors had found problems with quality checks and record keeping. At this inspection, they found that these issues had been improved and that legal requirements were met.
Personalised support
Care plans reflected people's needs, preferences, strengths and goals. Staff used their knowledge of people to plan activities and support independence.
“People's care and support plans were personalised. The examples seen were thorough and reflected people's needs and choices.” from the report
Kind and respectful care
Inspectors observed warm relationships between staff and people. Relatives and professionals also described the care as kind and compassionate.
“People were comfortable and happy in the company of staff and staff treated people with compassion and kindness.” from the report
Safe medicines and risk support
Staff understood individual risks, including choking and behaviours that could cause distress. Medicines were safely managed and records were clear and accurate.
“There were safe medication administration systems in place and people received their medicines as prescribed.” from the report
Improvement since the last inspection
The home had strengthened its quality checks and record keeping. Inspectors also found that unexplained bruises were now documented, reported and investigated.
“At this inspection we found improvements had been made and the provider had met the requirements of the law.” from the report
Manager registration was pending
needs fixingThe home did not have a manager registered with the CQC at the time of the visit. A new service manager was in post and an application had been made for the area manager to become registered manager.
“The service did not have a manager registered with the Care Quality Commission.” from the report
Staff vacancies
minorThe home was recruiting staff to fill vacancies and used agency workers temporarily. Inspectors found staffing levels sufficient and were told that regular agency staff were used to provide continuity.
“The service was in the process of recruiting new staff to fill vacancies.” from the report
- 01Has the registered manager application been completed, and who is currently legally responsible for running the home?
- 02How many staff vacancies are there now, and how often are agency staff used?
- 03How are night-time staffing levels reviewed if a person's needs or risks change?
- 04How are people and their relatives involved in reviewing care plans and setting personal goals?
- 05How are unexplained bruises, accidents or other incidents recorded, investigated and reviewed for learning?
This was an unannounced inspection covering all five CQC questions, including the premises and care provided; people living in the home were not able to give their views directly, so inspectors used observation and other feedback. This explanation was written from the published report of 20 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2018
Rated Requires Improvement; inspectors found kind, responsive care, but medicines and quality checks were not always reliable.
The inspection was unannounced and took place over two visits. It was brought forward after concerns were received. Inspectors observed care, checked records and spoke with staff, relatives and a community professional.
Staff were caring and knew people well. People were supported with food, health appointments, activities, choices and independence. Relatives were positive about the care and knew how to complain.
There were important weaknesses. Medicines were not always given at the right times, fire safety records were out of date, and care records and quality checks were not consistently complete or acted on. The home was rated Requires Improvement overall, with Good ratings for Effective, Caring and Responsive.
Kind relationships
Inspectors saw a calm and caring atmosphere. Staff knew people well and treated them with respect.
“The atmosphere throughout the home was friendly, calm and caring and people appeared comfortable and relaxed with the staff and support they received.” from the report
Choice and independence
People were supported to make decisions, take part in daily activities and spend time in ways they preferred.
“Staff promoted people's choices and encouraged them to participate in daily activities within the home.” from the report
Support with health and nutrition
The home had individual eating and drinking plans, monitored weights and supported people to attend health appointments.
“People were effectively supported to eat and drink enough to meet their needs.” from the report
Staffing and recruitment
Inspectors found enough staff to meet people's assessed needs. Recruitment checks were completed before staff started.
“There were sufficient staff to meet people's needs and provide personalised care and support with activities.” from the report
Medicines were not always managed safely
seriousSome medicines were not given at the appropriate time. Staff did not have clear enough guidance about recognising pain and using medicines prescribed when needed.
“Medicines were not always managed to ensure people received them at appropriate times.” from the report
Quality checks did not catch problems
seriousAudits did not always identify issues or ensure action was taken promptly. Several records were not clear, complete or current, including medicines, risks, fire safety and staff training records.
“Management systems were not always implemented effectively to ensure the quality and safety of the service.” from the report
Fire records were out of date
needs fixingThe fire logbook had not been kept up to date, including records of alarm testing and fire door checks. A fire safety officer later reported no fire safety issues.
“Fire safety records had not been appropriately maintained.” from the report
Care records were not always reviewed clearly
needs fixingIt was not always clear how and when care records and risk assessments had been reviewed. Work to move to more personalised records was still incomplete.
“It was not always clear how and when care records were reviewed.” from the report
- 01How do you now make sure all medicines are given at the correct time?
- 02What written guidance do staff use to recognise when someone may be in pain and needs a medicine prescribed when needed?
- 03How do you check that relief and agency staff have completed all service-specific training, including emergency medicines?
- 04How often are fire checks, care records and risk assessments reviewed, and who checks that this has happened?
- 05What action was taken after the CQC found the Regulation 17 breach, and can you show how the changes are monitored?
This was an unannounced inspection covering all five key questions; inspectors observed care, reviewed records and spoke with staff, relatives and one community professional, while people could not communicate verbally with them. This explanation was written from the published report of 1 February 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of 178 London Road
3 rated inspections over 3 years: the service has held its Good rating throughout.
- February 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 2 March 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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