Banstead Road - Care Home

This inspection took place on 11 September 2018 and was unannounced.

Banstead Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Banstead Road Care Home in Ewell is registered to provide accommodation and personal care for up to six adults who have a learning disability . At the time of our inspection five people live here. The service is delivered from a two-story house in a residential area.

It is a requirement of the provider's registration that they have 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 registered manager was present during this inspection.

Banstead Road Care Home continues to provide an overall good level of care and support to people. The diligent work by the registered manager and his staff team had a very positive impact on how people were able to live their lives. As a result, the key question of ‘Is the service Responsive’ has been given an Outstanding rating.

The very responsive nature of the staff enabled people to take back control of their lives and experience activities that gave them a sense of purpose, self-worth and pride. People were supported by a dedicated staff team that went out of their way to enable them to take part in activities that had previously been unavailable to them. They found creative ways of supporting people to have an exceptional quality of life. They took time to understand people and their needs, then work with them to overcome barriers to their independence and life choices. People were supported at the end of their lives to complete goals and aspirations and live as full a life as possible.

People were supported to stay safe. Staff understood their responsibility in responding to any allegation of abuse to protect people, even if it involved senior people within the organisation. Risks to people’s health and safety were well managed, with a minimum impact to people’s independence. Peoples medicines were managed in a safe way, and they received them when needed. A new electronic system had been introduced to further improve the safety of how people’s medicines were managed.

There is a sufficient number of staff deployed to meet people’s needs. A robust recruitment and selection process is in place. This ensures prospective new staff have the right skills and are suitable to work with people living in the home.

Accidents and incidents were reviewed to minimise the risk of them happening again.

Staff were well supported by the registered manager to ensure they had the skill and training to meet people’s needs. People’s needs were assessed prior to them moving into the home to ensure they could be met by the staff and the home environment.

People were supported to have enough to eat and drink. People were encouraged to be involved in their diet and prepare meals and drinks themselves wherever possible. People had access to health care professionals when the need arose, as well as for routine check-ups to keep them healthy. Where people lacked the capacity to make specific decisions, the stuff understood and followed the requirements of the Mental Capacity Act 2005. This ensured that decisions made for people in their best interest and any restrictions put into place to keep them safe were done in a lawful way.

People were supported by kind and caring staff. People formed caring relationships with staff and enjoyed their company. People are very well supported to maintain relationships that are important to them. People are provided with the care, support and equipment they need to stay independent.

There was a robust complaints process in place, however this had not been needed as everyone we spoke with was happy with the service. People were confident that if they did raise a complaint it would be quickly dealt with.

The home and staff team continued to be well led. The ethos of continuous improvement was strong with the registered manager and his team. This was shown by the staff leading trials in new medicines management technology within Leonard Cheshire Disability, and the improvement of their rating from Good to Outstanding in the Responsive domain.

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 home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid with people’s mobility needs. The home had a homely feel and reflected the interests and lives of the people who lived there.

The inspection took place on 03 February 2016 and was unannounced.

There was positive feedback about the home and caring nature of staff from people and relatives. A relative said, “It is wonderful here, everyone enjoys themselves.” An advocate said, “The care is very good.”

People were safe at Banstead Road. There were sufficient staff deployed to meet the needs and preferences of the people that lived there. A relative said, “Whenever I telephone I always get straight through, I am so impressed with the staff.” An advocate said, “Yes, I think there are enough staff here.” Feedback from staff was that they would benefit from having a larger number of staff employed, to make covering for holidays and illness easier. The registered manager and provider were currently trying to recruit more staff.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. An advocate said, “They manage risks well here, and they have made adaptations to meet my friends changing needs.” Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. An alternative location for people to stay was also identified in case the home could not be used for a time.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. Staff had a good understanding of specialist diets that people were on to ensure people could eat and drink safely, and still enjoy their meals.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. “It is wonderful here, everyone enjoys themselves.” Good interactions were seen throughout the day of our inspection, such as staff talking with them and showing interest in what people were doing. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details such as favourite foods in the care plans matched with what we saw on the day of our inspection.

People had access to activities that met their needs. A large proportion of the activities were based in the local community giving people access to friends and meeting new people. The staff knew the people they cared for as individuals, and had supported them for many years.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. No complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management from the provider regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

People had the opportunity to be involved in how the home was managed. Surveys were completed and the feedback was reviewed, and used to improve the service. A relative said, “They let my family member take charge and they refer to him for suggestions.” A staff member said, “The best part of the job is supporting the people. We can make a difference to them.”

All the people we spoke with said they liked living there. One person said 'I think they do support me here. They are helping me to find more voluntary work.' Staff were seen to interact well with people. For example they always spoke to people when they came across them in the lounge, and asked if they wanted anything. People appeared relaxed and happy.

We saw that systems were in place to ensure staff worked with the consent of people. One person told us 'They help me when I want help, and they always ask me first.'

People who used the service and relatives had been involved in the planning of care. We saw that risks had been identified to protect the welfare and safety of people.

We looked around the house and saw that it was clean and tidy. People who used the service told us how they helped with the cleaning, for example by doing their own laundry with staff support.

We saw that the manager carried out appropriate checks when they employed staff. This ensured staff were of good character and had the necessary skills and experience to do the job.

There was a system in place to record and respond to complaints. One person told us they had raised issues in the past and 'The manager had put things right.'

During our visit we spoke with three people who used the service and five members of staff (including the registered manager). We also spoke to one visitor. We spent time observing how staff interacted and supported people. We saw staff treating people with respect and involving them in activities throughout the time we spent at the service. People appeared relaxed and happy.

One person told us that 'Staff are so helpful, I feel very supported.' People told us the food was nice, that they had a choice of what to eat, and they had enough to eat and drink.

A visitor told us that 'There is a very good atmosphere here, staff think of people's needs and how to support them.'

We saw that there were a number of external activities on offer and people were able to regularly access the local community.

We looked around the location and saw bedrooms, communal areas, bathrooms and toilets were clean and free from unpleasant odours.