Archived: RNID Action on Hearing Loss 36 a Gibralter Crescent

RNID 36a Gibraltar Crescent is a care home providing care for up to six adults with learning disabilities and hearing impairments. The home is two story house made up of six bedrooms spread across both floors. At the time of our inspection, there were six people living at 36a Gibraltar Crescent. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 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.

People’s experience of using this service:

Records were not always contemporaneous which resulted in it being difficult to follow up if issues had been addressed. Care plans and other records also contained a lot of out of date information which needed to be archived. Staff were not up to date with training, but the new manager was taking steps to ensure that this was resolved as quickly as possible. A local day centre provided activities for some people living at the service, but there was a lack of meaningful activities for people to take part in when at home. The new manager was in the process of organising new outings and activities for people which suited their interests. The service was not delivering end of life care to any one at the time of our inspection, but discussions around this had not been had with people or their relatives in preparation.

People and their relatives told us they felt safe at the service, and staff were aware of their responsibilities in safeguarding people from abuse. Risks to people were managed appropriately but not always recorded. There were a sufficient number of staff to meet people’s needs, and medicines were recorded correctly and administrated safely. Accidents and incidents were recorded and analysed for trends.

People’s rights were protected in line with the principles of the Mental Capacity Act 2005. The design of the building was utilised to meet people’s needs with additional help from adaptations. Staff felt that the communication within the service was effective and told us they received regular supervision. People were referred to healthcare professionals where required.

People and their relatives told us staff were kind and caring, and we observed friendly interactions between people and staff. People were involved in decisions around their care where possible, and were encouraged to be independent as much as possible. People’s dignity and privacy was respected, and space given to them when needed. The service had not received any complaints, but there was a policy around this in place, and easy read versions for people if required. People’s communication needs were considered, and the majority of staff were British Sign Language trained which aided this further.

The manager has been working at the service for six weeks. People, relatives and staff felt the management team were approachable, and felt the manager had brought a new lease of life to the service. There were plans in place to improve the service for people, as well as audits identifying existing areas of improvement required. People, relatives and staff were engaged in the running of the service.

Rating at last inspection: At the last inspection the service was rated Good (report published on 20 January 2017)

Why we inspected: This was a planned fully comprehensive inspection in line with our inspection scheduling based on the service’s previous rating.

Follow up: We will follow up on the recommendations we have made in relation to ensuring people take part in meaningful activities and improvement of records at our next inspection. We will continue to monitor all information received about the service to ensure the next planned inspection is scheduled accordingly.

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.

There were sufficient staff to keep people safe. There were recruitment practices in place to ensure that staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People’s medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of tasks such as personal care, health, and the environment and they were updated frequently.

The registered manager had oversight of incidents and accidents, but had not always ensured that actions had been taken after incidents and accidents had occurred. The registered manager put a process in place to ensure that this did not happen again.

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken. Staff were heard to ask people’s consent 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 sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place to meet people’s needs. There was an induction programme in place which included staff undertaking the Care Certificate. Staff received regular supervision.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

People, their relatives and health professionals were involved in planning people’s care. People’s choices and views were respected by staff. Staff and the registered manager knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care and support was person centred and this was reflected in their care plans. Care plans contained sufficient detail for staff to support people effectively. People were supported to develop their independence. There were a choice of activities in place which people enjoyed.

The home listened to people, staff and relative’s views. There was a complaints procedure in place. Complaints had been responded to in line with the home’s complaints policy.

The management promoted an open and person centred culture. Staff told us they felt supported by the manager. Staff and relatives told us they felt that the management was approachable and responsive.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. Staff were motivated and aware of their responsibilities. The registered manager understood the requirements of CQC and sent in appropriate notifications.

We found people's nutritional needs were being met and supported. We found people living at the service were supported to be as independent as possible.

We noted warm and respectful interaction between people who lived at the care home and staff who supported them. We observed that the environment was clean, bright and well decorated using art work of people who lived there and photographs documenting enjoyable shared activities and holidays. This meant that people were well supported and the environment was safe, suitable and homely.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

People told us that they were happy living at the home. They said that staff were available when they needed them and that staff were polite and treated them with respect. People told us that they had opportunities to give their views about the support they received and that staff listened to and acted upon what they said.

The relatives we spoke with told us that their family members had benefited from the consistency of support provided by a stable staff team They said that staff supported people to develop skills and to increase their independence. They said that staff promoted people's rights to make choices about their lives and supported them to be involved in their local community.

Staff were positive about their roles and said that they received good support to do their jobs, including regular training, supervision and appraisal. We found that staff had a good knowledge of the individual needs and preferences of the people they supported.