Ayeesha-Raj Care Home

Ayeesha-Raj Care Home is residential care home registered to provide personal care for up to twenty people living with a learning disability and whose behaviours may be challenging. At the time of our visit there were thirteen people using the service.

People’s experience of using this service:

There had been a lack of managerial oversight in relation to systems in place to monitor the quality of the service. For example, quality checks on people’s medication, infection control and care plans had not identified areas that required actions to be taken.

People’s communication needs, although identified had not been met, for example, there was a lack of information in different formats to meet their communication needs. People were not always supported to have maximum choice and control of their lives and staff (did not support) supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice.

Satisfaction surveys were completed but we could not be assured these reflected the views of people, and we were not able to see how comments made were used to improve the service.

Although the service was clean in most areas we found some areas were not clean and safe from the risk of infection. The premises needed some refurbishment and redecoration. Following the inspection, the operations manager sent us a refurbishment plan to show that on-going repairs were being carried out and future plans for redecoration.

People’s everyday medicines were managed safely, but some ‘as needed’ medicines did not have guidance for staff to follow. Improvements were required to the mealtime experience for people using the service.

Care plans were personalised and provided staff with sufficient guidance about how to support people. These were reviewed monthly, but improvements were needed to the review process.

There were effective systems in place to safeguard people from abuse. The risks to people’s health and wellbeing were assessed and action taken to reduce them.

There were enough staff deployed to keep people safe. People were involved in the recruitment process and all the necessary employment checks had been completed to ensure only suitable staff were employed.

People had an assessment of their needs before they went to live at the service to make sure their needs could be fully met. Staff received an induction and ongoing training and felt well supported through the systems in place for one to one supervision.

People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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

Staff were calm, kind and caring and we observed that they knew people well. There was a ‘link worker’ system in place so that people had a staff member allocated to them to provide any additional support they may need.

There was a complaints policy in place and concerns were discussed with people at house meetings. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

The service met the characteristics for a rating of "requires improvement" in all five key questions when we inspected. Therefore, our overall rating for the service after this inspection was ‘requires improvement’.

Rating at last inspection: Good (The date of the last report published was 8 November 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to Good Governance. Details of the action we have asked the provider to take can be found at the end of this report.

Follow Up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services

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

Ayeesha-Raj Care home provides accommodation for up to 20 people with learning difficulties and sensory impairments. There were 12 people using the service on the day of our inspection.

There was a registered 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.

People were protected from harm and staff were clear of their role to keep people safe and protect them from abuse. People told us they felt safe. There was a recruitment policy in place which the registered manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were managed and administered safely.

People were supported to make decisions about the care they received. People’s opinions were sought and respected. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had identified that the service was not working within the principals of the Mental Capacity Act 2005 (MCA) and was taking action to address this. The registered manager was clear of their role in ensuring decisions were made in people’s best interest.

People told us that they enjoyed the food on offer and we saw that they had access sufficient to eat and drink and maintain a balanced diet. Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff had a clear understanding of their role and how to support people who used the service as individuals. Staff knew people well and treated them with kindness and compassion. People’s dignity was maintained and promoted.

People’s independence was promoted and staff treated people with dignity and respect. People were supported to follow their interests and engage in activities. We observed times of inactivity for some people. Staff told us that there were times when more activities could be promoted.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager and were confident that they would address issues if required.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made. The provider ensured that the registered manager was supported and that the drive for improvement was planned and sustainable.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. There were sufficient staff to meet people's needs. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training. This meant that staff had the right knowledge to meet people's individual needs.

One person in the home was subject to Deprivation of Liberty Safeguards (2007). Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements had been made in maintaining the premises to ensure they were were fit for purpose

Is the service effective?

People who used the service told us the care and support provided at the home was good and they got on well with staff. They said staff were caring and listened to them. One person told us, 'Its good here, staff are nice'. Another said, 'I trust them, they have done everything they could for my relative'.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person's care. This helped staff provide care and support according to the person's needs and choices.

Is the service caring?

People who used the service understood the care choices available to them. They told us staff supported people to make choices about their care. As examples, they told us they could choose how to spend their day and when they went to bed and got up in the morning. One person told us, 'I can choose what I want to do and how I do it'. This meant that people were encouraged to make their own decisions about their daily life.

Is the service responsive?

There was a system in place to gain valid consent from people who used the service.

People had regular opportunities to do things they enjoyed. A range of activities was provided for people who used the service. People told us they enjoyed these activities.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives.

Is the service well-led?

The service had a quality assurance system in place. We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

Two of the people who used the service told us they were happy living at the home. They did not have any concerns about their care and spoke positively about the staff who looked after them. One person told us it was a "nice place." One of the people we spoke with told us that they didn't always feel there was enough for them to do at the home. They said they were limited on when they could go out due to staff numbers. They told us: "I go out occasionally but it is dependent on staff."

Staff working at the home all described being supported by the manager. They told us that they received training on an on-going basis and that they enjoyed working at the home. None of the staff we spoke with had any concerns about the care being delivered at the service.

We spoke with relatives who regularly visited the home. The relatives of two of the people we spoke with told us that they felt the home was in need of some improvements. One person said, "I think it could do with a bit of an up-grade." Another relative commented that: "It's deteriorating. It could do with some money being spent on it." None of the relatives we spoke with had any concerns about the care being delivered by staff at the home.

The staff we spoke with told us they were happy working there, that they felt supported, that staffing levels were adequate and that people's needs were met. One member of staff said, "There are enough staff working here and they are all well trained." Another staff member commented that, "I feel good working here."

People using the service told us they enjoyed living at the home. One person told us, "You can go out when you feel like it and get up when you feel like it." People we observed during our visit seemed comfortable in the home environment and appeared to have positive relationships with the staff looking after them.

We spoke with two visiting professionals to the home. They told us that the home had made timely and appropriate referrals through to them and that the paperwork in relation to people using the service held at the home had been adequately completed.

The relatives of two people living at the home told us they were concerned about the lack of activities for people within the home. One relative commented that, "They used to do activities. I don't think I've seen them do in-house activities in a long time."

We found that the home kept detailed and updated support plans for people which were appropriately risk assessed.