This inspection was carried out by a CQC inspector. We spoke with all three people who were using the service, two relatives, three members of staff, the assistant manager and a visiting social worker. We also reviewed records relating to the management of the service, which included two care records, staff training records and quality audits. We used the information to answer the five questions we always ask: Is the service safe?
Since our last inspection all care records including risk assessments had been reviewed and updated. Three monthly reviews of people's care and support needs had been carried out and monthly reviews for each person had been completed. Personal evacuation plans had been established for each person. This ensured there was a current profile of risk for each person and staff had the necessary information to keep people safe.
People had given consent to their care and treatment. Where people did not have capacity to consent mental capacity assessments were in place. Relatives and other professionals had been involved in meetings to ensure decisions had been made in people's best interests.
Health care records were available for each person. A range of health care professionals had been involved in assessing people's health needs and their advice and assessments had been included in care information. Contact with health professionals protected people by ensuring they had appropriate care and support.
Training records showed that all staff had received training in safeguarding vulnerable adults. Staff were aware of the various forms of abuse. We found that the protocol for making safeguarding alerts contained out of date information. This meant staff did not have clear and current information about how to make safeguarding alerts. The process for making alerts could be compromised by incorrect information.
CQC monitors the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. No applications had been made to the local authority under this legislation since our last inspection. Key staff were aware of the procedures for making these applications. No one was subject to a DoLS authorisation at the time of our visit.
Is the service effective?
Some people were unable to communicate verbally. Communication plans were in place showing how people communicated in non-verbal ways. This included body language, sounds, signs and facial expressions. We observed good communication between staff and people who used the service.
A person who used the service told us they were happy with the care and support they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. A visiting relative told us, "X is settling well. I am pleased with the care provided for them".
We saw that people's needs had been assessed prior to using the service. A person transferred from another service had visited the home before moving. Staff had visited the person in the previous service and talked to the staff about the person's needs. Detailed information had been obtained about the person to ensure their needs were known and met. A social worker said, "The transfer was well managed and the service cooperated fully with the other provider".
Is the service caring?
People's preferences, interests and diverse needs had been recorded. Care and support had been provided in accordance with people's wishes,
Staff were able to tell us in detail what people's care and support needs included. Before staff provided support they explained to people what they were going to do and sought their permission and consent before carrying out personal care tasks.
It was clear that staff genuinely cared for the people they supported. Staff knew how people liked to be supported and were attentive to their needs. The atmosphere in the home was friendly and informal.
A relative told us, "X has settled down and has a new lease of life. X is so happy and content, has a lovely life and is totally cared for. I only have praise for the staff."
Is the service responsive?
People accessed the community regularly. The home had its own adapted mini-bus that could accommodate two people who used wheelchairs and someone with mobility needs. Some people liked to use public transport. Taxis were also used. This ensured that transport was readily available to promote community contacts.
A person using the service told us they regularly talked to their key worker. The person said, "I have lived here a long time. The staff are great, they know what I like to do and I trust them."
The service worked well with other agencies and services to make sure people received care in a co-ordinated way to meet their needs.
Is the service well-led?
The manager was not present on our inspection visit. The assistant manager was working in the home. We observed good, open dialogue between all members of staff.
The service had a quality assurance system in place. Checks were completed to ensure the home provided a safe and suitable place to live. Quality audits were completed to check that the support provided was meeting people's needs, keeping them as safe as possible and protecting their rights.