SENSE Andlaw House

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated Good with an outstanding rating in caring.

The service provided exceptional ways to enable people to communicate effectively to ensure they were involved in decisions. There was an extremely positive approach to human rights to ensure equality and diversity was embedded into practice. 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.

People were at the heart of the service and supported to make decisions about every aspect of their care and support. Staff were creative and innovative in helping people to express their views and participate fully in the world around them. We observed that staff were kind and patient and treated people with dignity and respect. The service was proactive in ensuring people would be treated and cared for equally regardless of their sexual orientation, culture or religion. People were able to maintain ongoing relationships with their families, who were made to feel welcome and kept fully informed about the wellbeing of their family member.

People remained safe at the service. There were adequate numbers of suitable staff to meet their needs and support them to live their lives as they wished. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People continued to be protected by staff who understood what to do if they suspected anyone was at risk of harm or abuse. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to support them. Good communication in line with people’s assessed needs was key to the support people received at Andlaw House, and the service was compliant with the Accessible Information Standards. People’s healthcare was monitored by the staff and people had access to a range of healthcare professionals according to their individual requirements .

The service remained responsive to people’s individual needs. Care plans were comprehensive, person centred and easy to follow. This meant they provided clear guidance for staff, enabling them to meet people’s needs according to their preferences. People could choose to participate in a range of activities. There was a clear complaints process in place. People’s end of life wishes had not been documented, but action was being taken to ensure this sensitive issue was discussed with people and their relatives at their annual review.

The service was well led. There had been significant changes at the service since the last inspection. 80 per cent of the staff team had left and the provider and registered manager had been working closely with local authority quality assurance and improvement team to address the issues that had undermined the quality and safety of the service. There had been a change in the culture of the service, which had improved communication, openness and honesty and created a more flexible staff team. Staff, people and relatives were extremely positive about the service and the way it was now managed. The provider had effective quality assurance systems in place which enabled them to monitor progress and ensure the continued quality and safety of the service.

Further information is in the detailed findings below.

We visited both flats where seven people lived and received support. We took a British Sign Language interpreter with us and had limited conversations with three of the people living there. Other people did not use sign language or communicate verbally, so we observed their interaction with staff and talked with their relatives and care workers to gain a better understanding of their experience of the service.

The service had a newly 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.

The registered manager was on annual leave during the week of our inspection. We therefore met with the area manager who knew the service well. They told us the ethos of the service was to ensure people were supported to have the opportunity to participate and be active members of the community. They wanted to support people to make choices, build confidence and self-esteem, to be healthy and happy and enjoy life.

At the time of the inspection Andlaw House was in the process of significant change. There had been a high turnover of managers, a restructure in the organisation and policies and procedures had been revised. There had been a stable staff team for a long time but staff told us they were feeling unsupported and concerned by the use of agency staff and changes to the rota system. Managers acknowledged and understood how staff were feeling and were working to address their concerns and support them through the changes.

Policies and procedures were in place to protect people from the risk of abuse and avoidable harm. Staff had received a range of training and information, including safeguarding adults, and they were confident they knew how to recognise and report potential abuse. Safeguarding concerns related to agency staff had been managed appropriately and action taken to minimise risks.

People’s rights were protected, because the service acted in line with current legislation and guidance where people lacked the mental capacity to consent to aspects of their care or treatment.

Systems were in place to ensure people received their prescribed medicines safely. People were also supported to access other health and social care professionals to maintain good health and well-being.

A comprehensive induction and training programme aimed to develop and maintain staff’s skills and knowledge, and to meet people’s individual needs. Additional training was being planned in response to the changing needs of the people using the service. Staff received regular one-to-one supervision and attended monthly staff meetings. They were kept informed and up to date via staff publications, briefings and Sense’s intranet site, where there was an area dedicated to practice sharing and recognising best practice.

Several members of staff had worked at the service for many years, which meant they were extremely knowledgeable about people’s individual needs and preferences. The area manager told us,” The level of care the team offer to those with complex health needs in my opinion is admirable, and they are responsive to any small changes in health to ensure the best support and care is given”.

Staff, including new staff, used a range of communication methods according to the needs of the individual, promoting their ability to make choices and participate in decisions about their care. They spoke positively about the people they supported and were understanding and considerate of their needs. They took pleasure and pride in the progress people were making.

People’s individual nutritional requirements were assessed and documented, and staff had a good understanding of the nutritional support they needed. This meant people received a diet appropriate to their needs and wishes, and had takeaway or meals out if they wanted to.

Staff were proactive in ensuring people had contact with their families and relatives commented on how caring and dedicated they were. “I’m very fond of the staff. They have just been so devoted to [person’s name] over all these years”, “Staff are very polite, caring and friendly”, and, “I’m really happy with [my relative] there. I would hate for them to be anywhere else”.

Staff were guided by care plans which promoted people's independence and were developed with the support of specialists employed by the organisation, for example a behavioural specialist as well as support from other local specialists such as physiotherapists. They detailed people’s complex support needs, related to health, nutrition, likes and dislikes, communication, vision and hearing, mobility, cultural needs and preferences and activities, communication, physical health and personal care. People and their relatives had been involved in care planning and reviews, which meant care plans accurately reflected their needs and wishes.

People engaged in a wide range of activities designed to develop life skills and promote independence. They were supported to access local resources in the community to maintain hobbies, or engage in social opportunities.

The provider had a range of monitoring systems in place to check the environment was safe, the service running smoothly, and identify where improvements were needed. A three day audit had just been completed at the registered manager’s request, looking at every aspect of the service. People using the service, relatives and staff were encouraged to speak out and raise concerns, complaints or suggestions in a variety of ways, including a service user’s reference group (SURG) and an annual satisfaction survey.

We observed people's care and staff interactions in the communal areas of both flats. We spoke with seven staff about people's care needs and looked at four people's care records. We talked with staff about their development and support needs and looked at the training records for all staff employed in the home.

One person told us about their recent trip to a music concert held locally and also about performing in a music event. It was clear from their smiles, gestures and the photographs they showed us that it had been a very positive experience for them. Two of the people in the home were going away on a camping holiday on the day of our inspection, staff told us of the detailed preparations they had made to ensure the trip went smoothly.

Throughout the home, we observed how staff demonstrated positive regard for people, offered person centred care, praised people for their achievements and supported them to fulfil their potential and be as independent as possible. People’s privacy and dignity was respected both within the home and whilst out in the community.

We found that the home was clean and met the guidance standards for hygiene and infection control. The provider had appropriate quality assurance processes in place to ensure that the service was maintained and improved and standards of care were maintained.

We met six of the people living there and spoke with one person. Several people could not communicate with us so we observed people's care and staff interactions in communal areas of both flats. We spoke with seven staff about people's care needs, looked at three people's care records. We talked with staff about their development and support needs, and looked at training, appraisal and supervision in six staff records. One person told us about their recent trip to the paralympics. It was clear from their smiles, gestures and the photographs they showed us that it had been a really special experience for them. Staff we spoke with told us of the detailed preparations they had made to ensure the trip went smoothly. Throughout the home, we observed how staff demonstrated positive regard for people, offered person centred care, praised people for their achievements and supported them to fulfil their potential and be as independent as possible.

We found the required improvements had been made and the provider was compliant with the five standards we inspected.