Archived: Care Management Group - 3 The Green

3, The Green is an eight bedded care home for people with learning disabilities. There were eight people living at the home when we inspected. These people were living with mild to moderate learning disabilities and autism.

People’s experience of using this service:

People’s experiences of using this service has deteriorated since their last inspection in 2016 which was rated as ‘Good’. The overall rating for this service now is ‘Requires improvement’.

This was because we found breaches with practices to do with the safe administration of medicines and good governance systems. This meant that some aspects of the service were not safe and governance systems were not always effective.

The provider had not consistently reviewed and assessed risks to people’s care to ensure they were doing everything possible to reduce and to manage those risks.

The premises needed some refurbishment and redecoration in the communal areas of the home.

People said they felt safe with the support they received.

The provider had robust recruitment procedures to ensure only suitable staff were employed. There were enough staff to support people safely.

The premises were clean and free from infection.

Staff received effective training, support for staff with supervision needed to be improved.

People were supported to live healthier lives and to access healthcare services appropriately.

People were able to provide consent for their care and where necessary best interest meetings were held. They were able to express their views and be actively involved in their care.

People told us they were cared for by kind and compassionate staff. Their privacy and dignity was respected by staff.

People enjoyed a wide range of activities inside the home and outside in the community.

People knew how to complain and had confidence the management team would respond appropriately to any issues they raised.

The provider’s auditing or governance systems had not identified some of the concerns we found or had not acted promptly to resolve concerns they had found.

We found the service met the characteristics of a "requires improvement" rating overall.

Rating at last inspection: At our last inspection we rated the service as Good (23 November 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Enforcement:

At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 regarding the safe management of medicines and effective governance systems.

Follow up: The provider has a legal responsibility to send us a written report of the action they are going to take meet the breach of regulations we identified in this report, which we will follow up with them.

In the interim, we will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in keeping with our inspection methodology for services rated Requires Improvement overall.

3, The Green provides care and accommodation for up to six young adults. There were six people living at the home when we inspected. These people were living with mild to moderate learning disabilities.

The service had a 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.

Most people had lived at the home for several years and they told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Our inspection of care records showed any risks to people were assessed and there was guidance to staff of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People received their medicines safely from appropriately trained staff.

Staff had access to a wide range of training that they said helped them with their role of providing good, effective care to people in the home. Staff told us they received good support through regular supervision. We saw the home was comfortable, clean and had a homely feel that people felt relaxed in.

People were encouraged to plan and cook their own meals together with appropriate support from staff when it was needed. We saw that people made their own choices about eating. People’s physical and mental health was closely monitored by staff. There was evidence that people had appropriate access to healthcare professionals such as the GP and psychiatrist.

People were treated with kindness and care. We saw that staff understood people well and involved them in planning their care and support. We saw people’s views were sought when decisions needed to be made about how they were cared for.

Staff treated people with respect and dignity. Advocacy services were available for people to use as necessary to support them in making decisions.

People said they felt that the service responded to their needs and individual preferences. Staff supported people according to their personalised care plans. Care plans were reviewed six monthly or earlier if people’s needs changed.

We saw there was an appropriate complaints policy in place that people were aware of. People told us that the registered manager encouraged people to raise any concerns they had and responded to them positively and in a timely manner.

People and staff were positive in their comments about the registered manager. They said he promoted an open and positive working environment that they felt able to contribute positively to the development of the service.

The provider had ensured there was a wide range of quality assurance audits in place that helped the registered manager use the information to develop and improve the service. This included monthly and quarterly audits of a wide range of service provision. People, relatives and other professionals were also asked for their views about the care provided to people living in the home. The responses we saw were all positive. Where suggestions or comments were received the registered manager used the information to develop and improve the service.

The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service.

On the day of our inspection seven men lived at the home and all had complex needs including autism, behaviours that challenged and/or a learning disability. All the people were able to verbally communicate, but were not always able to answer our questions about the care they received. We looked at the care records of three people, spoke with seven people and five members of staff.

Below is a summary of what we found.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

We reviewed maintenance contracts for the building and various pieces of equipment including Legionella water testing, the fire alarm system and equipment, gas safety inspection and portable appliance testing (PAT). We found that these were all valid and within date. People and staff were kept safe because the provider regularly risk assessed several areas of the home. These included the hot water temperatures, fire exits, emergency lightening and door closures. Fire drills were held every three months, including during the night.

Staff had undertaken training on the Mental Capacity Act 2005 but not on the recent changes to the Deprivation of Liberty Safeguards. But staff understood how this could impact on the people they cared for.

Is the service effective?

The home is one of several within the same group and the head office of the company managed the organisation of training for staff. Staff told us about training they had received and we evidenced this through the on-line training matrix we looked at. Training that staff had attended included autism awareness, first aid, preventing and managing challenging behaviours, and awareness of the mental capacity act.

Is the service caring?

We spoke with the manager about the initial assessment process before a person came to live at 3 The Green. They told us that plenty of time and several visits to the home happened before a person decided if they want to live at the home. The person could then decide how they wanted to decorate their bedroom and they would have discussions with staff about the activities they were doing and what they would like to do.

Staff helped people using the service to consider 3 The Green as their own home. We saw that people had personalised their bedrooms and could lock their doors if they wanted to. Staff encouraged people to join in with activities relating to the running of the home. This included helping in the kitchen, preparing meals, keeping the garden tidy and making decisions about group activities.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. People had access to other services and to professionals who worked with the provider and staff for the benefit of people who used the service.

We saw that each person had an activity plan and the staff explained that these were developed based upon the interests and support needs of the individual. On the day of our visit most people were at home and engaged in personal or local activities, such as shopping, cooking, watching the football or listening to music. We saw in the lounge that awards that people had won were on display.

People also attended college and worked. The home had a contract with the local authority to deliver garden maintenance support to local people unable to manage their own gardens.. Staff told us that they were now getting a lot of repeat work and people using the service told us they got paid for their work and really enjoyed doing it.

Is the service well-led?

The home employed a manager who knew their staff and people well.

The manager told us about the audits that they conducted and showed us the recorded evidence to support them. Regular audit of medicines help to reduce the associated risks with the storage and handling of medicines. Monthly checks were made by management and the supplying pharmacy conducted annual checks of storage and handling of medicines. The first aid boxes were checked monthly to ensure that products were within their use by date and sufficient supplies of first aid equipment were available. This meant that people using the service were kept safe from errors in storage and handling of medicines.

An infection control audit had been carried out in May 2014, with no identified actions to be taken. Cleaning audits including the environment, pest control, laundry and the gardens were also conducted. We saw that the fire alarm and fire door closures were checked weekly. People were kept safe because information about them was regularly checked. People's records and associated documents were audited every six months.

We saw that people using the service were involved in their own care and their independence was supported and promoted. With supervision people were supported to shop, prepare and cook their own meals, do their laundry and pursue their personal interests. People told us about some of the activities they did, such as cycling, dry slope skiing and attending college. Another relative told us ''the staff keep me informed of everything; he loves his room with all his things. The staff are very good with the car they let us use it to go out on trips if we need it.''

Detailed assessments were completed involving family members to ensure the staff had a full understanding of each person's needs, likes and dislikes. Staff had a good understanding of the need to seek people's permission to provide care and we observed interactions with people where they were consulted about how they wished to plan their activities for the day.

Staffing levels were safely maintained. We saw that medicines and records were managed and stored securely.