This was an unannounced inspection that took place on 18th November 2015.
Threeways is a residential care home for 6 people who have a learning disability, autism and behaviours that can challenge. People have varied communication needs and abilities. Some people are able to express themselves verbally using one or two words; others use body language to communicate their needs. At the time of inspection there were five people living at the service.
There was a registered manager in post. ‘A registered manager is a person who has registered with the Care Quality Commission 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.
This is the first inspection since the provider changed its legal entity.
People were not always safe at Threeways. There were times when there were not always enough staff deployed to meet the needs of people. Some people were assessed to have 1:1 staff support. The provider told us “we sometimes do group sharing.” This means that people were sometimes grouped together for activities when there was not enough staff to provide 1:1 support.
Incidents and accidents had not been recorded appropriately. The incident and accident folder did not contain any forms; the provider stated “We do not have any incidents or accidents.”
Staff had some knowledge of safeguarding people and told us what they would do if they had a concern. They knew to report it to the registered manager or to the local authority.
Risks to people had been assessed, however one person had been identified as a risk of choking. Surrey’s choking policy had not been followed, as the registered manager had not made the appropriate referral to the Speech and Language Therapist. The provider made the referral on the day of inspection.
There were robust checks in place to make sure that staff were suitable before working in the home. Medicines were stored safely and people were given their medicines at the right time in a safe way.
We found the provider had not always met the requirements of the Mental Capacity Act. Peoples consent was not always sought about what care and support they needed. We saw staff leading people around the house by holding onto their wrists or hands.
Some mental capacity assessments had been completed regarding people being able to leave the home and accepting care and support. Relatives and relevant health and social care professionals had been consulted on these decisions.
Staff were not always sufficiently trained to support people. Most staff had not received specific training or had a refresher in current practises in working with people with autism, communication difficulties and physical interventions.
People had access to health professionals such as psychiatrists, dentists, GPs and opticians to ensure their health and wellbeing was maintained. People had enough to eat and drink, but people did not always have a choice as to when they could have it or what they wanted.
The service was not always caring. People were not always involved in making decisions about their care. People did not have individual goals to allow them to develop their skills and life opportunities. People had person centred and care plans in place.
Staff were not always interacting with people in an age appropriate manner; phrases like “good boy” were common place. People’s dignity and privacy was not always respected. Staff did not always knock on people’s bedroom doors.
People did not always receive individualised care that was tailored to their needs. People’s activity timetables were very similar and people did in house group activities together. There was little opportunity to participate in activities out in the community.
A relative told us “We are very pleased our relative is there, it is the best home they have been in, it’s family orientated.” Another relative told us “The family environment the service offers was very relaxing and had helped him in many ways.” Staff supported people to maintain relationships that were important to them.
We observed an activity outdoors; the staff member engaged with the person about road safety, nature and plans for later that day. Staff treated people with kindness and compassion.
There was a complaints policy in place; the registered manager told us that no complaints had been received by the home. However the complaints policy was not on display around the home for people or relatives.
The registered manager and the provider spent most of their working week supporting people. This does not allow them time to develop the service and to drive improvements with regards to staff practise. There were quality audits in place, but they were not always effective as they did not identify any of the areas that have been identified in the report.
Staff told us that they felt the manager was approachable. Staff received regular supervision and there were regular staff meetings.
We found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.