We carried out an unannounced inspection of the service on 29 November 2017. 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. Huws is a nursing home for people living with a learning disability, physical disability and or autistic spectrum disorder. Huws accommodates 14 people across two separate buildings each of which have separate adapted facilities. At the time of the inspection 13 people were using the service and one person was in hospital.
A registered manager was present during the inspection and had been in post for six months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 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. Registering the Right Support CQC policy
At our last inspection in November 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good’ in Effective and Caring and had deteriorated to ‘Requires Improvement’ in Safe, Responsive and Well-led.
Improvements were required in how people were supported with their prescribed medicines. This included safe storage, management and the checks and audits in place. Whilst the service was found to be clean, improvements were required on the prevention and control of infection. An action plan was required to meet the shortfalls identified in an NHS infection control audit completed in November 2017.
Risks associated with people’s needs had been assessed but the plans in place to mitigate risks lacked clear and up to date information for staff. Support plans were not always followed by staff and information was lacking in places for staff to provide responsive and effective care and treatment.
The systems and processes in place to audit the quality and safety of the service required improvements to ensure staff were clear about their role, responsibility and accountably. The registered manager on the whole was aware of the shortfalls identified during this inspection and an action plan was in place.
Staff were aware of their role and responsibility of how to support people from avoidable harm and had received safeguarding training. Improvements had been made in the recruitment of permanent staff and safe staff recruitment checks were carried out before staff commenced employment.
The environment and equipment was found to be appropriate and safe to meet people’s needs. Staff had received training in health and safety. Accidents and incidents were recorded and analysed by the registered manager.
People’s holistic needs had been assessed and planned for and there was good use of assisted technology to support people effectively.
Staff received an appropriate induction, refresher training was due for some staff and this had been planned for. The registered manager was aware the frequency of staff supervisions needed to be improved upon and had plans for this.
The monitoring of menus required improving to ensure they reflected people’s needs, preferences and provided healthy balanced meals. Staff worked with external healthcare professionals to support people with their health needs and outcomes.
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. New improved documentation to complete mental capacity assessments and best interest decisions were being implemented.
Staff were kind, caring and compassionate and positive relationships had been developed with people who use the service. Staff had a good understanding of equality, diversity and human rights issues. People were treated with dignity and respect and involved as fully as possible in their care. People were supported to access advocacy services. People were supported with goals, aspirations, interests and hobbies. Information about how to make a complaint had been made available for people.
Staff were positive about the registered manager leadership and management and were complimentary of the positive changes they were making at the service.