The inspection was carried out over the course of two days on 07 November 2014 by two inspectors. It was an announced inspection. The service provides care and accommodation to ten adults with learning disabilities. There were ten people living in the service at the time of our inspection. All the people who lived in the service had varied communication needs. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to with one to one support from staff while some people were more independent.
We told the provider two days before our visit that we would be coming to allow time for the staff to prepare people who may experience anxiety about unfamiliar visitors.
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.
Staff were trained in the safeguarding of adults. They knew how to recognise signs of abuse and how to raise an alert with the local authority if they had any concerns. Staff were also trained to de-escalate people’s behaviours which challenge with distraction techniques that preserved people’s dignity and did not use restraint. A member of staff told us, “We anticipate and think of how to defuse a situation while not taking control away from the person”. Risk assessments were centred on the needs of the individual and included risks in the community. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow.
There were sufficient staff on duty to meet the needs of the people who lived at the home. We observed that staff had time to spend supporting people in a meaningful way that respected individual needs.
There were safe recruitment procedures in place. These included the checking of references and the carrying out of criminal records checks for prospective employees before they started work. A newly recruited member of staff told us, “I have just started my induction and have to learn as much as possible about each resident and read the policies of the service”. All staff were subject to a probation period and to disciplinary procedures if they did not adhere to their code of conduct.
Medicines were stored and administered safely. Staff were trained in the administration of medicines and kept relevant records that were accurate and fit for purpose.
People lived in a clean and well maintained environment. Staff had a thorough understanding of infection control practice that followed the Department of Health guidelines and helped minimise risk from infection.
Staff had a good knowledge of each person and of how to meet their support needs. One person told us, “I have lived here for over two years and staff know me well.” Specific communication methods were used to converse with people. We observed interaction between people and the staff and saw positive support that promoted people’s independence and protected their rights.
Staff had appropriate training and experience to support people and their complex needs. They had received a thorough induction and had demonstrated their competence before they had been allowed to work on their own. All staff’s annual training was current and staff had the opportunity to receive additional training specific to the needs of the people they supported. Two members of staff told us, “We get full support and can discuss any concerns” and, “We get encouraged to gain qualifications and study”.
People’s quality of life was enhanced by the layout of the premises and the facilities they offered. People’s own rooms were personalised and adapted for individual needs. There was a large enclosed garden, currently laid to lawn that contained a separate summer house structure that had been fitted out with sensory equipment and heated.
The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). All care staff and management were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation.
We saw that food was prepared and people supported to eat at different times to accommodate their different needs and the challenges that meals times posed for some people. Staff knew about people’s dietary preferences and restrictions such as how one person could not tolerate certain foods and fluids.
The service was caring because staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People who were able to talk with us told us they were satisfied with the way staff cared for them. One person told us, “The staff are very good and kind”. A relative of a person who lived in the home told us, “The staff are simply brilliant, they are like an extended family and the care is excellent”.
The service provided clear information about how to communicate with people.
Healthy living and wellbeing was promoted by staff. Specialist equipment was provided. Frequent general wellbeing checks were recorded by staff at regular intervals. Health care professionals’ visits and referrals were routinely facilitated. People were supported by staff when they were hospitalised. The manager told us, “We will always stay with them to make sure they are not anxious, advocate when necessary and facilitate two-way communication with the hospital staff”.
People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. These were updated to reflect people’s changes of needs, wishes, preferences and goals. The delivery of care that we saw being provided was in line with people’s requirements, as outlined in their care plans.
A wide range of activities was available. The registered manager told us, “We are always on the look-out for new activities that people would enjoy”.
People’s feedback was sought and they were involved in the planning of the delivery of their care. Complaints, comments and suggestions were taken into account and acted on. People participated in monthly residents meetings and yearly satisfaction questionnaires were sent to stakeholders and people’s relatives or representatives to collect their feedback. All feedback was analysed and improvements were made. Transition between services was handled with sensitivity by staff who considered people’s psychological wellbeing.
The service was well led because there was an open and positive culture at the service which focussed on people. Staff told us, “The manager and deputy managers are very approachable, we can talk to them any time and discuss any concerns”. The manager had been in post under one year and had implemented changes in the service. New activities and new documentation that supported staff’s practice had been introduced. The manager told us, “We have to be pro-active and interactive, and the more ideas we can explore the better”.
The staff confirmed the registered manager was supportive and understanding of the challenges they encountered. The manager was included in the staff rota and spent time caring for people. The manager told us, “I like to be ‘on the floor’ and work alongside the care staff; I do not want to be one of these managers who sit in their office and lose touch with the residents and what is happening”. A member of staff told us, “He is a leader but he is also one of us”.
There was a system of quality assurance in place to monitor the overall quality of the service and identify the needs for improvement. Satisfaction surveys were carried out. A regional operations manager inspected the service every month to check compliance with regulations and make recommendations. Recommendations were followed up and actioned within a set time frame. The manager carried out weekly and yearly audits to identify how the service could improve.