Cornfields

The service is located in a residential home that has been developed and adapted in line with values that underpin the Registering the Right Support and other best guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can lead as ordinary life as any citizen.

The service did not have a registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The previous registered manager moved to another role within the care group in November 2017 and their vacancy had been filled by another manager, who was completing the process to become the registered manager.

This comprehensive inspection took place on 16 and 20 March 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from all types of bullying, harassment, avoidable harm, neglect, abuse and discrimination by staff who understood their responsibilities to safeguard people. Staff and relatives who raised concerns received sympathetic support from the manager and provider. Risks to people were assessed and plans were devised to minimise potential risks, whilst promoting people’s independence. Medicines were administered safely, as prescribed and in a manner individuals preferred. Prospective staff underwent robust pre-employment checks to ensure they were suitable to work with the people who lived with autism or a learning disability. There were always enough staff with the right experience and skills mix, to provide care and support to meet people’s needs.

Staff were enabled to develop and maintain the necessary skills to meet people’s needs. The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people were subject to restrictions to reassure and keep them safe, these were minimised to promote their freedom and the least restrictive option(s) possible.

The manager had developed effective partnerships with relevant professionals and quickly referred people to external services such as GPs, neurologists, dieticians, urologists, opticians and dentists, when required to maintain their health. People supported staff to maintain high standards of cleanliness and hygiene in the home, which reduced the risk of infection. Staff followed required standards of food safety and hygiene, when preparing or handling food. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it. The physical environment was personalised to meet people's individual needs.

People’s needs were assessed regularly, reviewed and updated. People had detailed care plans which were enhanced by positive behaviour and communication support plans, which promoted their independence and opportunities to maximise their potential.

People were supported by regular staff who were kind and caring. There was a warm and positive atmosphere within the service where people were relaxed and reassured by the presence of staff. The manager designed rotas which ensured people’s preferred staff were readily available.

Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. People were encouraged and enabled to be involved as much as possible in making decisions about how their support needs were met.

Staff demonstrated a real empathy for the people they cared for and one another. Staff spoke passionately about people, recognising their talents and achievements, which demonstrated how they valued them as individuals.

The service was responsive and involved people and their relatives in developing their support plans, which were detailed and personalised to ensure their individual preferences were known. Staff consistently demonstrated in their day to day support of people that respect for privacy and dignity was at the heart of the home’s culture and values.

People were supported to take part in activities that they enjoyed. Staff supported people to maintain relationships with their families and those that mattered to them, which protected them from the risk of social isolation.

The manager regularly sought the views of people and their relatives and used these to drive improvement of the home. There had been no complaints since the last inspection. Relatives were confident that the manager and staff would listen to them if required and take the necessary action.

The service was well led. The vision, values and culture of the service were understood by all staff, which they demonstrated when supporting people. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service.

Further information is in the detailed findings below.

At the time of the inspection there were three people living in the home. One person had their own en-suite bedroom which had been specially adapted to meet their needs. There were two other bathrooms located adjacent to other people’s bedrooms which they regarded to be theirs. Since our last inspection a small room had been converted into a private lounge for one person to support their anxieties. A sensory room and space was in the process of being completed in a large cabin in the rear garden. There was a large rear garden to which people had constant access.

The service had a registered manager. 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.

Relatives and an advocate told us staff always provided reassurance when people were anxious and made them feel safe. One person often chose to be alone in their private lounge when their anxieties increased. Staff supported the person discreetly whilst ensuring they were safe.

Staff had completed safeguarding training and had access to current legislation and guidance. Staff had identified and responded appropriately to a safeguarding incident to protect people from harm. People were safeguarded from the risk of abuse as incidents were reported and acted upon.

Staff were able to demonstrate their understanding of the risks to people’s health and welfare, and followed guidance to manage them safely. Risks associated with people’s care and support needs were identified and addressed to protect them from harm. Environmental risks were managed safely through regular servicing and audits.

The registered manager ensured there were always enough staff deployed to respond immediately when people required their support. Staff had the necessary experience and skills to support people safely.

All staff completed an induction course based on nationally recognised standards, then spent time working with experienced staff, before being allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively.

Staff had undergone required pre-employment checks, to ensure people were protected from the risk of being supported by unsuitable staff.

People’s prescribed medicines were stored and disposed of safely, in accordance with current legislation and guidance. Staff were trained and assessed to ensure they administered people’s medicines safely.

Staff supported people to identify their individual wishes and needs by using their individual methods of communication. People were supported to make their own decisions and choices. People’s human rights were protected by staff who demonstrated clear understanding of consent, mental capacity and deprivation of liberty issues.

The Mental Capacity Act 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff supported people to make informed decisions, and followed people’s wishes if they declined offered support. Records demonstrated that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA 2005, and whether any conditions on authorisations to deprive a person of their liberty were being met. DoLS applications had been submitted for all three people in the home, because external doors were kept locked to protect people, as they were unable to recognise traffic risks. At the time of our inspection one of these was authorised, with the other two in the process of review and authorisation. Paperwork associated with applications demonstrated that the lawful process of mental capacity assessment and best interest decision was completed before applications were submitted. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, protecting them from harm and promoting their dignity.

People were supported to attend regular health checks by staff who recognised when people were unwell or upset, and took prompt action to promote their health and wellbeing.

Relatives and health and social care professionals told us people were happy and content in the home. We observed people appeared relaxed and calm in the company of staff who they readily approached for support when required.

Staff promoted people’s independence, and praised people when they undertook or completed household tasks or activities. The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to pursue social activities which protected them from social isolation.

Relatives told us they had no reason to complain but knew how to do so if required and that the staff. One complaint had been made since the last inspection which had been dealt with in accordance with the provider’s policy. The registered manager listened to people’s comments and implemented identified learning from incidents and accidents.

The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.

Feedback from people, their relatives, advocates and supporting health and social care professionals was sought to identify changes required to improve the quality of care people experienced. The provider’s audits and service improvement plan were used to review changes implemented, and ensure all required actions were in place to address improvements identified. Systems were in place to ensure people were supported in a home that was well-led and focussed on providing them with high quality care.

People’s needs were assessed and regularly reviewed to ensure their care and support was responsive to changes identified. Support plans and regular reviews documented the support and care people required, and how this should be provided in accordance with their wishes. Records accurately reflected people’s needs and were up to date. Staff were provided with necessary information and guidance to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.

The provider told us that people who use the service were supported to reach as much independence as possible. Representatives of people who use the service told us that the provider helped their relatives to make choices and that their relatives were happy, content and had an active social life. We evidenced that the provider used a variety of methods to ensure that people who use the service were fully involved and where possible to, were able to consent to the care, support and treatment they received. Communication methods used by the provider included the use of makaton, photographs, picture boards and visual aids.

One representative of person who uses the service told us that 'the staff at Cornfields engages my relative as much as possible in making decisions and anything that is decided for them is fully discussed with me'. Another representative told us that they were involved in all decisions about their relative.

The premises were clean and tidy and bedrooms decorated to the individual style of people using the service. Safety equipment was in place and had been tested regularly. Evacuation plans for each resident were recorded and on their personal file. Risks to people living at the premises had been fully assessed and measures put in place to ensure their safety.

We found that medication was stored securely and its administration was recorded and monitored appropriately. Regular audits were undertaken to ensure that staff were complying with the provider's medication policy.

The training of staff was of a good standard and met the needs of people using the service. The provider supported the ongoing training and development needs of staff. The representatives we spoke with were very complimentary of the training provided by the provider. One representative told us 'staff are trained to meet the very complex and specific needs of my relative and this means they receive fantastic care'.

Care plans and risk assessments were person centred and clearly detailed the support needs of people. We spoke with the parents of people who told us they were very happy with the variety and suitability of activities available. One told us, 'I know he is really happy there because he always has a smile on his face. Another said, 'The level of care is first class.'

Medicines were administered safely and no medication errors had been reported. Staff had a good knowledge of the different medicines taken by people, including rescue medication when supporting people on visits away from the home.

Parents told us that the staff provided excellent care, which gave them confidence in the quality of their training. Their desire to help the people they supported shone through. There was a scheme for rewarding achievements by people using the service and for those caring for them.

There was an effective complaints system in place, although there had been no complaints since the last inspection in September, 2011. People said they were confident that if they needed to complain they would be listened to and their grievance would be acted on swiftly.