Archived: Royal Mencap Society - 4 The Stables

This inspection was announced and took place on 24 October 2017.

The provider was given 48 hours’ notice that we would be coming to inspect. This is because service is small home for people with learning disabilities who are often out during the day and we wanted to be sure that someone would be available.

4 The Stables is registered to provide care and support for four people who have a learning disability. It is owned by Royal Mencap Society, a national organisation who provide a variety of support services to people who have a learning disability. The house has been adapted to accommodate people who have restricted mobility. It is situated in a residential area of Crosby.

At the time of our inspection there were three people living in the home.

There was a registered manager in post, however they were not available at the service during our inspection. The area manager was available, and there was another manager who made themselves available as well as the deputy manager.

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 we spoke with were clearly able to explain the course of action that they would take if they felt someone was being harmed or abused, and how they would report it, including whistleblowing to external organisations.

Medicines were well recorded and managed for people who required support. Assessments were completed to support people with their medication needs.

Risk assessments were clear, concise and explained the impact of the risk as well as how the staff should support the person to manage it. Risk assessments were regularly reviewed with the input of the people who used the service and their families.

There were enough suitably trained staff to meet their individual care needs. Staff were only appointed after a thorough recruitment process. Staff were available to support people to go on trips or visits within the local and wider community and attend medical appointments.

The deputy manager and the staff understood the principles of the Mental Capacity Act 2005 and associated legislation and had taken appropriate steps to ensure people exercised choice where possible. Where people did not have capacity, this was documented appropriately and decisions were made in their best interest with the involvement of family members and relevant health care professionals where appropriate. This showed the provider understood and was adhering to the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements as set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005).

Care plans with regards to people’s preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. Person centred means the service was tailored around the needs of the person, and not the organisation.

We discussed complaints. There had been no complaints in the home in the last 12 months.

Quality assurance procedures were robust and identified when actions needed to be implemented to drive improvements. We saw that quality assurance procedures were highly organised and processes had been implemented from another internal source to help support the service to continuously improve. We were shown these procedures by the deputy manager during our inspection.

Feedback had been gathered from people who used the service in the form of questionnaires, telephone conversations with families and when family members visited the home.

4 The Stables is registered to provide care and support for four people who have a learning disability. The house has been adapted to accommodate people who have restricted mobility. It is situated in a residential area of Crosby.

A registered manager was 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.

Medicines were not always administered in accordance with best-practice guidelines. There was no clear description or instructions for staff to assist them in establishing if the PRN medicine was required. Additionally, the service did not make use of body charts to indicate where topical medicines (creams and lotions) should be applied.

We have made a recommendation regarding this.

The registered manager implemented an approach to quality monitoring which was appropriate for the size of the service. The quality team also completed annual checks on the service. We saw that this process had been completed. However, none of these checks had identified the issues relating to the administration of medicines noted during the inspection.

The registered manager told us that open communication with families and staff was encouraged at all levels. However, some staff expressed concern about the consistency of management responses and said that they were sometimes reluctant to raise concerns.

Staff were vigilant in monitoring people’s safety and family members spoke positively about the safety of their relatives. Staff clearly understood the different types of abuse and neglect and what signs to look out for. Staff also knew what action to take if they suspected that abuse was taking place.

Risk to the people living at the service was appropriately assessed and recorded in care records. Each risk assessment focused on maximising people’s independence while safely managing any risks and had been recently reviewed.

Staff were safely recruited and deployed in sufficient numbers to meet the needs of the people living in the service. There was a minimum of two members of staff per shift with extra provision depending on activities. However, the registered manager acknowledged that the service regularly relied on staff undertaking overtime and used staff from other services to ensure that adequate staff cover was provided.

Staff were trained in a range of subjects which were relevant to the needs of the people using the service. New staff were required to complete an induction programme which was aligned to the Care Certificate. Staff were supported by the provider through regular supervision and appraisal. We saw from records that this had been delivered as planned. However some staff told us that they did not always feel well supported.

People’s ability to consent to care had been assessed and recorded. DoLS applications had been submitted in accordance with good practice within the previous 12 months.

Staff had been trained to ensure that people received their food and drink in a safe manner. The people living at the service were not always able to demonstrate a preference for a particular meal or drink, but staff knew from experience what people preferred and provided food accordingly.

People’s day to day health needs were met by the services in collaboration with families and healthcare professionals. Staff supported people at healthcare appointments and used information to update support plans.

Throughout the inspection we observed staff interacting with the people living at the service in a manner which was kind, compassionate and caring. We saw that staff spoke regularly with the people living at the service. They explained what they were doing and discussed their needs and activities.

Care and support were provided as required and not in accordance with a timetable. We saw that staff were flexible in the delivery of care and support and adjusted their practice depending on the responses they received from people.

Care records were appropriately detailed and respectfully worded. We saw examples of care plans relating to; staff support, professional support, community activities and relationships. We saw that care had been formally reviewed on a regular basis and following changes in care needs.

The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with great enthusiasm about the people that they supported and their job roles.

The registered manager that we spoke with was aware of the day to day culture and issues within the service. We saw that they knew the people using the service and their staff well. The registered manager understood their responsibilities in relation to their registration. Notifications relating to people who lived at the service had been submitted to the commission as required

We did not meet any people who lived at the service, as they were out on a day trip during the time we were there. We met with two staff to discuss what arrangements were in place to support people with their medicines.

At this inspection we found improvements had been made, so that people's medicines were managed safely. This included the safe storage of medicines in people's individual medicine cupboards and accurate records of medicines in the home. People were therefore protected from the risks associated with the unsafe use and management of medicines.

We observed people being supported with their daily life activities. The people we met with appeared relaxed, comfortable and at ease with the staff. There was positive interaction between the staff and people who lived at the home. It was evident staff had a good understanding of what was important to each person, how they provided care and support and also ensured people's independence was promoted. Care documents recorded people's care needs and provided the information staff needed to support them.

People were not protected against the risks associated with medicines because there were not appropriate arrangements in place to safely manage them.

Staff received training to ensure they had the skills and knowledge to work safely.

A complaints policy and procedure was in place should people wish to make a complaint about the home.