The inspection took place on 9 and 10 June 2016 and was unannounced. The service was last inspected on 26 May 2014, when we found they were meeting the regulations. The registered manager had been in post since the service was registered in January 2011. 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.
The service provides accommodation and personal care for up to 15 younger adults, who may live with dementia, learning or physical disabilities or a life limiting condition. Fifteen people were living at the home at the time of our inspection.
People were at the heart of the service. Staff understood the importance of being partners-in-care with people who lived at the home. People were supported to maintain their preferred and familiar routines and habits, which made them content and relaxed. Staff took time to understand people’s histories and dreams and encouraged them to be ambitious in making decisions about their day-to-day lives.
Staff’s training, support and skills empowered them to respond to each individual’s unique practical and emotional needs. Staff were encouraged to reflect on their practice and were supported to develop specialist interests, to improve their understanding of how a physical condition affects a person’s emotional well-being. Staff made people feel valued and gave people control of their day-to-day lives, which increased people’s self-esteem.
People’s rights to choose how to live their lives, what to eat and when to eat, were staff’s highest priority. Risks to people’s nutrition were minimised because suitable, nutritious meals were available every day in accordance with people’s stated preferences. People were supported to eat out or buy meals, whenever they chose.
The group exercise sessions were effective and the positive impact on people’s moods was visible. People and staff shared the moment of fun together, which developed trust and positive relationships.
The provider’s policy of employing dedicated exercise and activity staff was adapted to enable staff to adopt the role of lifestyle coaches, which better met the varied and unique needs of people living at the home. People were supported to set up an individual exercise programme, which suited their preferred routines.
People planned their own care, with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.
Staff were attentive to people’s appetites, moods and behaviours and knew them well enough to recognise the possible causes of ill health. Staff ensured people obtained advice and support from healthcare professionals to minimise the risks of poor health. The registered manager worked in partnership with experts in healthcare to ensure people had easy access to the best available advice and support.
Care co-ordinators were part of the duty management system, which meant there was a named manager available to respond to issues and to support staff, seven days a week. Staff were encouraged and supported to develop specialist interests that matched people’s needs.
People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences. The registered manager followed the provider’s principles in modelling and decorating the home according to people’s preferences and needs.
The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their advocates, families and healthcare professionals were involved in making decisions in their best interests.
All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. The provider shared their learning with all the homes in the group.
There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored in their own rooms and administered safely.
Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.