We visited Natalie House and carried out an inspection there. On the day of our inspection, the registered manager told us that five people lived there. We met all five people. However, none of the people were able to share with us their views about their care due to their individual needs. Most people that used the service had limited verbal communication skills so we also observed their interactions with staff and their body language to understand their view of the support they received. We looked at recorded information for four people to gain a balanced overview of the quality of the care and support people who lived there experienced. Following our inspection we spoke with two relatives. We considered all of the evidence that we had gathered under the outcomes that we inspected. We used all the information to answer the five questions that we always ask;' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
We observed that people were treated with dignity and respect by the care staff. We saw that people were given choices about their care. All relatives that we spoke with told us that they were very happy with the care at the home. One relative said, 'They are wonderful. My relative has a busy life. They go away on holiday every year. They are very well cared for. My relative is safe in their hands at all times.'
Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receiving care and were able to make informed decisions. We spoke with staff and the registered manager about Deprivation of Liberty Safeguards (DoLS). This applies to all care homes. All staff spoken with told us and records sampled showed that all staff had received DoLS and Mental Capacity Act (MCA) 2005 training and which meant that they understood their responsibilities and ensured that the rights of people were protected.
The provider had policies and procedures in place to protect people from harm. Some people had complex support needs, with some difficult to manage behaviour. All staff spoken with understood what safeguarding people meant. All staff had up to date training on how to protect vulnerable adults and how to support a person when they displayed behaviours that may harm themselves or others. This meant that the safety of people who lived there and of others was promoted and protected.
We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.
We saw that systems were in place to make sure that learning takes place from accidents, incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.
Is the service effective?
Both of the relatives that we spoke with confirmed that they could visit throughout the day. We saw that facilities were available so people could meet in private if they wanted to.
We saw that staff asked for peoples consent before care and support was given and that their responses were listened to and their choices respected. Where people did not have mental capacity to consent, care was provided by staff in their best interests. Records sampled showed that the provider had appropriate systems in place to ensure that people's mental capacity to consent to their care was documented. This meant that people could influence the care they received.
We saw that relatives were involved with people's care. A relative told us, 'They always ensure that my relative's health care needs are well met, they involve other health professionals and inform me of what is happening.'
All staff spoken with were able to give us good detail about the support they provided to people. People's health and care needs were assessed and care plans told staff what people's care needs were so they could support people consistently. Referrals had been made to external professionals so people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.
Records sampled showed that people were encouraged to eat a healthy and nutritious diet. We saw that they had a choice of what to eat and enjoyed the food provided. Their weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. This meant that people were supported to eat and drink sufficient amounts to meet their needs and ensure their health and wellbeing.
Is the service caring?
We saw that staff treated people with dignity and respect. We saw that were patient and caring they took their time and did not rush people. Staff were seen to be attentive and interacted well with the people they supported. We saw that people responded positively to staff.
People, their relatives and other professionals involved with the service had completed an annual satisfaction survey. We saw that relatives had made positive comments in the surveys we looked at. A health professional visiting on the day of our inspection said, 'The staff have worked very closely with our team to assess and establish my client's communication support needs. We have seen a big improvement in their ability to express themselves since they moved here. Staff have consistently followed our advice with patience and commitment.'
People's preferences, interest and aspirations and diverse needs had been recorded in their care records.
Is the service responsive?
We saw that people were supported to take part in a range of activities at home and in the local community. We saw that staff responded to people's positive responses to individual activity choices and used positive or negative responses to help inform future activity choices. This enabled people to do activities, or to spend their time in a way that they preferred. People had also been supported to go on holiday.
We saw that when needed staff had requested the involvement of other health professionals in people's care and their advice was followed.
Is the service well lead?
The home had a manager who was registered with us, CQC. They were experienced and knowledgeable about the needs of the people that lived in the home.
We found that robust systems were in place to regularly assess the quality of the service that people received. Records showed that regular spot checks on staff skills and work practices were by carried out by the manager. We sampled the findings and saw that they were detailed and feedback was provided to staff following these checks. Supervision and training records showed that supervision and staff training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.
All staff that we spoke with were clear about their role and responsibilities. They had a good understanding of the ethos of the home and the systems in place to monitor quality assurance. This ensured that people received good quality of care.