We inspected this service on 9 July 2018. The inspection was unannounced and carried out by one inspector and an ‘expert by experience.’ An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The expert by experience on this inspection had experience of learning disabilities and mental health services. Ingleby House is a ‘care home’ operated by Voyage 1 Limited, who are a large provider of care services. Ingleby House provides accommodation with personal care for up to eight adults. People cared for at the home are living with learning disabilities, autism, mental ill health conditions and behaviours that challenge. People in care homes receive accommodation and 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. At the time of our inspection visit, there were eight people living at the home.
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.
At the last inspection in February 2016 all five key areas were rated as Good. At this inspection we found, overall, the quality of care had been maintained and people continued to receive a service that was safe, caring, effective and responsive to their needs. However, this inspection found some areas that related to mitigating risks and risk management required improvement. The safety of the service was rated ‘Requires Improvement’ and the other four key areas remained good, which gave the service an overall rating of 'Good'.
There were enough staff on shift with the appropriate level of skills, experience and support to meet people’s needs and provide effective care. Action was taken to cover shifts, due to staff absences, so people and others remained safe. Risk management plans were in place and, overall, gave staff specific guidance about potential risks to people’s health and wellbeing. However, some actions were not always taken to mitigate risks. Staff were trained in how to respond to behaviours that challenged so that the safety of people and others was protected and risks were minimised. However, whilst individual actions were taken when incidents occurred, the registered manager did not undertake any overall analysis of incidents that involved behaviours that challenged. Such analysis may potentially reduce risks of reoccurrence.
Staff understood their responsibilities to protect people from the risks of abuse. Staff had been trained in what constituted abuse and knew how to raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process. Staff received training and used their skills, knowledge and experience to provide safe care to people.
People were encouraged and supported to maintain good health. Staff frequently liaised with other healthcare professionals and followed their guidance. Staff promoted healthy eating choices and knew about people’s nutritional needs. Prescribed medicines were stored and managed safely. Overall, medicines were given to people safely and in accordance with the provider’s policy. Medicine errors were recorded and investigated by the registered manager.
Overall, people liked living at the home. Whenever a person expressed a desire to move to a more independent supported living setting, steps were taken to enable discussions and options to be considered. Relatives felt their family members were well care for. Staff were patient and understood how to respond to people’s behaviours that challenged. People had varying levels of communication and these had been assessed so staff knew the appropriate communication methods to use to enable people to express themselves and make choices and to tell staff when they were anxious about something.
The registered manager understood their responsibilities under the Mental Capacity Act 2005. They had applied to the supervisory authority for the right to deprive three people of their liberty when their care and support included restrictions in the person's best interests, these restrictions had been authorised. Further applications were pending approval for two people.
People had detailed individual care and support plans which provided staff with the information they needed to respond to people’s needs. Staff shared information about people at the start of each shift and read a ‘communication’ book to update them on any changes so there was continuity of care. Staff recognised people as individuals and care was given in a person-centred way. This included people being supported to plan their own weekly activity plan for both inside and outside the home. Some people preferred a routine of when things happened which made them less anxious.
The registered manager and provider regularly checked the quality of the service to make sure people's needs were met safely and effectively. People and their relatives were encouraged to share their views and provide feedback about the service and felt they would be listened to. The provider and registered manager understood their regulatory responsibilities and worked with other organisations and healthcare professionals to ensure positive outcomes for the people who lived at Ingleby House.
Further information is in the detailed findings below.