Archived: New Partnerships Lynray and Peach Cottage

The service consists of two houses located near to each other in a village outside Braintree. Lynray supports three people and has a self-contained annexe which provides accommodation to one person. Peach Cottage supports two people. An administrative office was located nearby in a converted garage.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

At our last inspection of the service on 14 January and 1 February 2016 we found the service to be good. Since the last inspection there has been a change in ownership and this inspection we found the service continued to be good overall however we have rated Well Lead as requiring improvement because the new provider still had some work to do to improve staff morale and strengthen governance.

Since the last inspection a new manager has been appointed, who has been registered with the Care Quality Commission. 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.

People who lived in the service appeared very happy and at ease with staff. They were not all able to talk to us about the support they received so we spoke with their relatives who were largely positive about the service.

Staff were knowledgeable about the signs of abuse, and the actions they would take should they have any concerns. Medicines were safely stored and administered as prescribed.

Risks were identified and steps were taken to minimise the impact on individuals.

Staff recruitment records demonstrated that the provider took the necessary steps to ensure that they employed people who were suitable to work at the service. We found that there had been staffing shortfalls and recruitment was underway to address this.

We saw that training was provided on an ongoing basis and this included how best to support individuals who present with distressed behaviour.

The staff we spoke with were knowledgeable about people’s needs and a number had worked at the service for some time.

People received a varied choice of nutritional meals. People health was monitored and they had good access to health care support.

People’s care needs were assessed and care preferences identified. Care plans were informative and staff were aware of people’s needs. Staff recognised the importance of supporting people to lead a full and interesting life.

There were systems in place to gain people and their relative’s views about the service and involve them in decision making where possible. There was complaints procedure in place but we could not see that this was in an accessible format and have made a recommendation about this.

Audits were undertaken but were not robust and did not always identify shortfalls. We have recommended that the audits are further developed and form the basis of an overall improvement plan.

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.

At our previous inspection of 30 January 2014, the service was found to be compliant with our then method of inspection.

New Partnerships Lynray and Peach Cottage is a care service providing accommodation and personal care for up to six younger adults with a learning disability, autistic spectrum disorder and/or associated complex needs. There were six people living at the service on the day of our inspection. The service consists of two houses with Lynray supporting three people and Lynray Annexe with its own kitchen supporting one person. Peach Cottage supports two people and the emphasis was placed upon people’s skills and needs to determine in which house they wished to live.

People who used the service had their own en-suite bedrooms and quiet spaces, which they had been encouraged and supported to personalise. People had shared access to a kitchen, lounges and dining facilities. One person lived within part of the service where they had their own lounge and kitchen/diner. Their accommodation had been fully equipped to support and had taken into account their physical needs. Each person had their own support plan, individual to them, which had been written from an assessment and supported them to practice their independence skills. Each unit of the service had access to a garden area.

A strong feature was the time spent developing the service, using innovative and flexible ways to support people to move forward. Some people using the service had part-time employment. Staff had worked closely with people and their relatives to overcome loud and disruptive situations that they found to be disturbing. Clear explanations were given why the disruption would happen and staff were proactive in offering support in situations they knew would cause people distress. This way of working had produced good outcomes for people as they became understanding and accustomed to the disruptions and were better able to deal with them. For example, one person who was originally upset by the noise of fire alarming testing. Staff explained the importance of doing this and supported them by informing them when this would happen and involve them in the testing. The person had taken over the task of carrying out the weekly fire alarm test themselves once per week and ensured that the staff recorded this information.

The provider and manager have worked with people to constantly adapt and strive to ensure people who use the service have developed their skills and talents. For example, one person had developed their interest and skill so that they were playing in organised football matches on a weekly basis. This has supported their fitness and organising skills to attend matches.

There were systems in place to protect people from the risk of harm or abuse. People lived in a safe environment that had been designed and adapted to meet their specific needs. Staff made sure risk assessments were developed to suite each individual in a way that minimised risks.

Each person’s care plan was individualised and flexible staffing supported them to pursue their interests. Staff were skilled at analysing risk while encouraging people to stretch their potential and achieve as much independence as possible. This was based on the service philosophy, aims and objectives and mission statement. The provider, registered manager and team demonstrated passion and commitment to supporting people focus upon individual achievement.

Care records showed people’s individual needs were continually reviewed and both they and their families were consulted appropriately and involved in these. Relatives confirmed their family members were also included in decisions and discussions about their care and treatment. Professionals we spoke with that supported people told us the service had a caring and strong person-centred culture.

Medicines were ordered, stored, administered or disposed of safely. Personalised support plans had been developed to ensure people received their medicines in line with their preferences.

Members of staff described how they worked together as a team to provided person-centred care. Saying that it was vital to write detailed notes, have time for handovers between shifts, attend training and supervision sessions. Staff also told us the registered manager had strong leadership qualities and led by example. They promoted an ‘open door policy’ and were visible within the service, making themselves accessible to all and they knew all of the people using the service well.

We observed staff treated people with respect and dignity and it was clear they knew people’s needs well. Staff encouraged and ensured that people had time to speak to us and encouraged everyone to respect each-others view. This included letting people speak for themselves and to have time to be able to finish their sentences.

The manager and provider had developed a recruitment process so that staff were recruited in a safe way and were suitable to work with people at the service. An in-depth comprehensive induction with training was in place. Staff told us they felt well supported by the time taken with them and the detail given in the induction. There were enough staff on duty to meet people’s health and welfare needs. The service did not use agency staff as there was a core of staff able to work additional hours if so required to meet people’s needs. The manager expressed how important it was that staff knew the people using the service well in order to be able to support them.

People’s individual programmes were designed to provide both familiar and new experiences for people and the opportunity to develop new skills. New experiences were introduced with people’s consent and permission after they had been explained to them. People who used the service accessed a range of community facilities and completed activities within the service. People were encouraged to follow and develop social interests and to maintain and develop relationships with their families. This included regular outings with family members or visits to family member’s homes.

People’s nutritional needs had been assessed. They had access to a range of professionals in the community for advice, treatment and support. One person told us how they had lost weight in a controlled way and enjoyed using the gym regularly. Staff monitored people’s health and wellbeing and had responded quickly to any concerns.

The care plans had been written clearly involving people as far as possible to identify their needs and goals for achievement. Plans had been developed to provide guidance for staff to support in the positive management of behaviours that may challenge the service and others. Staff had received training with regard to the Mental Capacity Act 2005 and Deprivation of Liberty. This knowledge had been applied appropriately.

One person was able to tell us how, with the support of the service, they had explained how and when they required one to one support. They welcomed the support when travelling in the community but it was not required at their place of work. Through working together with the staff the local authority had supported this change in arrangements.

Staff had received training in dealing with concerns and complaints and knew how to report any concerns. There was a clear complaints procedure in place which was also available in pictorial format.

The registered manager used effective systems to continually monitor the quality of the service and had proposals for the on-going plans for improving the service people received. There was a system of audits, checks and analysis to identify shortfalls and to rectify them so the quality of care could continually be improved and developed.

The care records we looked at included detailed information on how people's needs were to be met by staff. We noted that staff knew people well and they were able to tell us about their specific needs. Staff told us people enjoyed their independence and enjoyed going out. We saw that staff listened to people and provided care and support in ways that met their needs and took into account their individual preferences.

The service co-operated with other agencies, such as community health services and the NHS, to ensure people received continuity of care and support when they needed to access other services.

We noted that there were processes in place for the reporting of safeguarding incidents and that these procedures were followed.

Effective staff support systems including supervision and annual appraisals were in place.

We found that the provider had systems in place to monitor and respond to any complaints received by the service.

They felt involved with how their relative was supported and they were aware of their support plans. One person told us that "Their relative liked the relaxed family atmosphere provided by the staff and the manager."

All four relatives told us that they felt able to raise any concerns they had with staff and that they would respond appropriately. One person told us that staff were very friendly and approachable and that they knew how to meet people's needs.

Families confirmed that there was a wealth of activities people participated in and that these were suitable and varied. They considered the manager was a hands on manager and they were always around if they had any concerns or issues they wanted to raise.

People told us that their relatives liked swimming and cooking and staff worked tirelessly to provide people with opportunities to take part in holidays and regular breaks away from their homes. They also told us that they felt people were safe. They told us that staff were caring and aware of the hazards to the people they were supporting.