The Meadows

The Meadows is a care home providing short stay and respite care for adults with a learning disability or /and autism. Some people who used the service also had a physical disability. The service was registered to accommodate a maximum of 12 people, and eight people were living at the home at the time of our inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than a domestic style property and was adjacent to other services that used space in the building as offices, these with separate dedicated entrances. These services were also managed by the provider, for example shared care services. The Meadows is registered to accommodate 12 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design offering a range of high-quality facilities, as well as extensive internal and external space which enhanced people’s experiences. In addition, the service did not offer a permanent residence for people, only short breaks which some people likened to stopping in a hotel for a holiday. Support staff did not wear anything that suggested they were care staff when coming and going with people and transport used by the service was not identifiable as anything other than family transport.

People’s experience of using this service and what we found

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People and relatives told us the service was safe and staff were very aware of how to minimise risks to people and promote their safety, without compromising their freedom. Staff knew how to work with people to identify risks and change their approach to minimise these.

People were supported by care staff that were caring, showed compassion and expressed genuine interest about the people they cared for. People received person centred care and support based on their individual needs and preferences. Staff were knowledgeable about people, their needs and preferences and used this to develop a good relationship with the people who stayed at the Meadows.

People were supported by care staff who had the skills and knowledge to meet their needs. Staff understood, felt confident and well supported in their role. People's health was supported as staff worked with other health care providers when needed to support people’s healthcare needs.

People were supported to have maximum choice and control of their lives and staff understood they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they enjoyed meals they chose and there was access to a range of foods that met people’s needs due to their health, culture or specific preferences.

People's care plans reflected people’s needs and preferences and the staff were able to explain how people were involved to ensure care plans were current, person centred and fully involved people and their wider family. We saw the service was responsive to information from people and relatives.

People knew how to complain and felt concerns would be listened and responded to by the staff. Complaints and comments were used as a tool to drive improvement of the service.

People, relatives and staff gave us a positive picture as to the quality of care people received, and said they were able to share their views with staff. People enjoyed their stays at the Meadows and said they were able to follow their chosen routines and enjoyed access to activities at the service.

Quality monitoring systems included audits, regular checks on people’s satisfaction with the service they received, by surveys, phone calls, social events or meetings. The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

People and relatives told us the registered manager and staff were approachable, organised, listened and responded to them and acted on feedback when they shared this with them. The registered manager had high expectations in respect of the quality of the service. This reflected the views of staff. People and relatives told us the service they received was to a high standard. The registered manager demonstrated they were not complacent and wished to improve the service further, for example developing support networks for people so the service was more inclusive.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘good’ (published 12 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection visit was announced and took place on 13 December 2016. This was an announced inspection as we wanted to ensure people would be available to discuss the service with us. The service was registered to provide accommodation for up to 12 people. This service is run by the local authority to provide a respite care service for people with learning disabilities. At the time of our inspection eight people were using the service.

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.

The principles of the Mental Capacity Act were not always followed in relation to people’s capacity. We saw when people’s movement were restricted to protect their safety, they were referred to the local authority for an assessment to consider if their liberty was being deprived. Staff received training and an induction that helped them support people and develop their role.

The staff knew how to keep people safe from harm and people felt safe when they used the service. When people required support with their medicine it was done in line with policy guidance. Some people were supported to administer their own medicine safety. Any risks to people had been assessed . Guidance and when necessary, equipment was provided to reduce people’s risks.

The staff team provided a flexible approach which as dependant on the needs of the people. People were encouraged to make choices about their food; and their needs had been catered for. When people required support with their health care needs, this was provided in line with their wishes.

People received a service which was caring and provided them with their independence. They were supported by staff who respected their dignity and ensured they had the level of support they required. Advocates were available if the person required this supported.

People had been involved in the development of their care plans which were in a format they could understand. Any changes had been recorded and staff received a handover and time to review any changes made to the care requirements.

There was a complaints policy in an easy read format, however people and relatives had not had a reason to complain. Their views on the home had been considered in relation to the service they received and throughout the modernisation of the building.

Staff felt supported by the manager and the provider. There was a positive open culture at the home. The manager had completed regular audits of the home and any actions to make improvements had been completed.

We spoke with two people who used the service, three care staff members, the Registered Manager and the Strategic Manager for the service to help us understand the experiences of people who used the service.

During this inspection we also checked that the provider had made improvements with regards to supporting workers. This is because; in the previous inspection completed on 05 December 2013 we identified areas of non-compliance with regulations we inspect against.

Below is a summary of our finding based on our observations, speaking to people who used the service, the staff supporting them, and from looking at records.

Is the service safe?

Sufficient staff were provided to deliver people's care needs and they received the training they needed to provide the necessary care and support.

Staff encouraged and supported people to make choices and decisions. When people did not have the capacity to make certain decisions, family and medical professionals were involved.

The required environment health and safety checks were completed to ensure that people were cared for in a safe environment but the provider did not always ensure that equipment was serviced at the recommended times.

Planned renovation work at the home had been approved by the Local Authority to ensure that it was safe and comfortable for the people who used it. People who used the service told us that they felt safe at the home. One person said, 'It's fantastic here. I know all the staff here'. Another person said, 'Nobody can harm you or upset you here'.

Is the service responsive?

People's health, social and support needs were assessed and reviewed. Records were seen to demonstrate that care plans were reviewed and updated as people's needs changed.

The service offered additional support and emergency respite to people who required further support at the home due to unforeseen circumstances such as bereavement or safeguarding concerns at their usual place of residence.

People were provided with information on how to complain if they were unsatisfied with the care they received. We saw that the service had a complaints policy and we saw records to indicate that the procedure was followed and complaints responded to appropriately.

The provider had recently undertaken a period of consultation about proposed changes to the premises. The views of people who used the service and those acting on their behalf were obtained and appropriate action taken in respect to the views expressed.

Is the service caring?

People who used the service told us that the staff were very good and they were satisfied with the care and support provided. One person told us, 'Staff are very nice; every single one of them'.

People who were unable to comment or did not wish to speak with us looked comfortable and well cared for. The staff members we saw were respectful and provided care in a sensitive and professional manner. A staff member we spoke with said, 'The biggest thing for me is the respect and dignity we give them [the people who use the service]'.

Is the service effective?

People's care records were personalised, and the provider ensured that people's dietary, mobility and equipment needs had been identified in care plans where necessary.

People who received care at the home had received an assessment by a social worker and a package of care developed to meet their needs. We did not see records that people who used the service or those acting on their behalf had given consent to the care the people received.

People's health and care needs were assessed. We saw that risk assessments and management plans were in place for people who used the service. The provider would benefit from ensuring that risk assessments and management plans were reviewed and updated during each period of respite care for people who used the service.

We saw records that staff had undertaken training in the Mental Capacity Act and Deprivation of Liberties Safeguards and refresher training had been planned. The provider would benefit from ensuring that capacity assessments and best interest assessments are carried out for people who use the service.

Is the service well led?

Staff we spoke with were clear about the management structure and felt supported by the managers. We saw that the service received regular quality checks from the Local Authority.

Staff members we spoke with told us that the Registered Manager was approachable and always available. One person who used the service told us, 'She's [the Registered Manager] very good with everybody and she listens to everybody'.

The provider had quality assurance systems in place to ensure that the necessary checks were in place to provide and maintain a good service.

During our inspection we saw that people were treated with dignity and respect. People were usually able to choose the things they wanted to do and where they stayed. People told us they enjoyed the food they had while staying at The Meadows and we observed people being supported to eat their meals in the way they preferred.

We found that there was an effective system in place to manage, store and administer medication. People had their medication at the time it was prescribed to be given.

We saw that the environment was well maintained and there were systems in place for checking security and safety. The layout of the building meant that people had sufficient space to meet their needs.

Staff received support but did not always have the training they needed to meet people's needs safely. There was potential for the risk of harm.

The service had procedures in place for addressing complaints, but information could have been more easily accessible.

During our inspection we spoke to two people who used the service and two people's relatives. People told us they enjoyed staying at The Meadows. One person said, 'I just love it here'. Relatives we spoke with told us they were happy with the care provided. One relative said, 'They will do anything for anybody here'.

During our inspection we saw that people were treated with dignity and respect. People were offered choices and were supported to make decisions about their care and treatment.

We saw that people received their care in a positive and caring manner and the staffing numbers enabled people to be supported to receive and participate in their planned care.

We saw that people were protected from the risks of abuse because the staff had received the necessary training to identify and report safety concerns.

We found that there was an effective system in place to manage and respond to complaints. The service was able to demonstrate that they had learnt from complaints and had improved the quality of the service as a result of the complaints process.