Archived: Care Management Group - 101 Cheam Road

101, Cheam Road is registered to provide care and accommodation for up to seven people with a learning disability and autism. The aim is to help people to live with more independently in the community.

At the time of this inspection there were five people accommodated in one adapted building. Each had their own room, ensuite accommodation and shared communal space. The house was near the town centre and people were able to access community services easily.

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.

People’s experience of using this service and what we found:

People told us they continued to feel safe with the service they received. Relatives confirmed this with us.

Staff received training to do with safeguarding adults and the provider followed clear safeguarding procedures that helped to protect people from harm.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The provider ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable. There were sufficient staff to meet people's needs.

Safe medicines management processes were in place and people received their medicines safely.

Whistleblowing procedures were in place and displayed on notice boards for all to see. Staff told us they were confident any concerns they reported would be dealt with appropriately.

Effective infection control procedures were in place and staff received training with food hygiene.

Comprehensive needs assessments were carried out and there was sufficient detail and personalisation in the care plan to ensure the person's needs were met in a personalised way.

The registered manager ensured staff completed training to ensure they were able to meet people’s needs effectively. Support was provided appropriately for staff with regards to their professional roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Records showed people were supported to have their health needs met, with access to health professionals as required.

The registered manager and staff spoke about the people they supported with care and kindness.

The service was responsive to people’s needs. Staff worked together with people and their relatives to provide care and support to people to meet their individual needs. Staff were passionate about encouraging people to stretch their boundaries and to make safe but positive steps to advance their wellbeing and their life opportunities.

Staff understood people well and were able to provide consistent, supportive care which reduced people's anxieties and helped them engage in opportunities both they and their relatives told us they only once dreamt about achieving. Staff demonstrated good interpersonal skills in their communication with people. Staff were cheerful and showed tolerance and patience. They supported people to make their own decisions and gave people the tools they needed to overcome the difficulties they faced.

Assessments and care plans included details of people’s preferences and wishes for care and support. They told us they were fully involved in the assessment and care planning process. Paperwork and care plans were well kept and reflected the person-centred care we observed.

Management and oversight of the service was robust, and the staff worked in partnership with health and social services to provide the best possible outcomes for people.

The provider had systems in place to ensure concerns and complaints were responded to in an appropriate way. Staff knew how to raise concerns or recognise what might constitute a safeguarding concern and actions they should take.

There were well developed quality assurance mechanisms which took into account people's feedback and how the staff were meeting people's needs in line with their wishes and expectations.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 10 June 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care Management Group Limited (CMG) is a national provider of services for people with learning disabilities, physical disabilities and mental health needs. There is support to the registered manager and staff from a regional management team and a team of trainers. 101, Cheam Road is registered to provide care and accommodation for up to seven people with a learning disability and autism. The aim is to help people to live with more independently in the community. Since the last inspection a new annexe has been specially designed and built in the back garden of the property for people who were more independent than those people living in the main house. There were seven people using the service when we visited.

The service had a registered manager. 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 the associated Regulations about how a service is run. The registered manager took a leave of absence and returned to manage this service at the end of March 2017.

We found that the premises were not always maintained adequately to ensure people continued to live in a well- maintained and pleasant environment. Several areas of the home were not in a very good state of redecoration or were in a state of disrepair and needed to be made good to ensure people’s quality of life was not adversely affected by the quality of the environment they lived in. The registered manager told us there was a plan in place to ensure the refurbishment was carried out as required.

Over the course of the last year we found that most of the health and safety audits and risk assessments had been updated, except for the service's manual handling risk assessment. The registered manager told us this risk assessment would be reviewed immediately to ensure compliance with policy and procedures.

People told us they continued to feel safe with the service they received. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place that staff were well informed about. People who used the service and their relatives were encouraged to report suspected abuse so appropriate action could be taken.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The provider ensured there were safe recruitment practices to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Safe medicines management processes were in place and people received their medicines safely.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so.

People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals to support them with their healthcare needs.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Throughout the inspection we saw that people had the privacy they needed and were treated with dignity and respect by staff.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. People could choose the activities they liked to do and every person had a variety of paid and voluntary activities throughout the week. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Staff we spoke with described the registered manager as approachable and responsive to their own and to people’s needs.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Was the service safe?

People who use the services were treated with respect and dignity by the staff. They told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. The registered manager ensured there was sufficient staff on duty who were appropriately qualified to meet the care needs of people who used the services. This helped to ensure that people's needs were met.

Was the service effective?

People who use the services health and care needs were assessed with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected three people's care files. They included essential information about the person, needs and risk assessment information, service delivery plans, a 'my plan', records of health care appointments, a 'my health care booklet' as well as records of keyworker meetings.

Staff received regular and appropriate training and supervision to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

People who use the services were supported by kind and attentive staff. We saw that support workers showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The three people we talked to said the staff treated them well and respected their privacy. One person said "The staff are nice, they help me where I need it", and another told us "I like my key-worker we've just been out shopping together, she helps me do my shopping'.

People who use the services told us they attended regular house meetings where they were able to discuss relevant issues and make decisions about what they wanted to do. We saw from reading the minutes of these meetings that meeting the wishes and prefences of people where appropriate was the main priority. This reflected the caring environment that we found on the day of the inspection.

Was the service responsive?

People who use the services met regularly with their keyworker to review their care and support. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and although no complaints had been made since the last inspection staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in relation to maintaining and developing their independence.

The manager carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

Peoples received safe and appropriate care and support to meet their needs and enabled them to achieve a degree of independence. A relative we spoke with said ''I'm over the moon with the care they provide. It's so good to have peace of mind and know my daughter is being well cared for.''

Medicines were handled safely securely and appropriately. Staff had access to guidance about medicines and there were controls in place to ensure appropriate use and administration of medicines.

There were sufficient levels of staff with the appropriate skills and competencies to provide safe effective care. There were effective arrangements in place to ensure the provider could respond to unplanned absences such as sickness or emergencies.

We saw that people's records were well maintained and fit for purpose. Records were retained and stored securely to ensure confidentiality and meet regulatory requirements.

People we met told us how they were able to make choices about how they live their lives. We were told about regular monthly resident meetings with the staff where people had the opportunity to talk about the things they wanted to do and things they wanted to change. One person told us she wanted her room painted and that staff helped her to choose what colour paint and curtains she wanted.

We were told that the staff that worked at the home were always kind and caring, and listened to what people had to say. During our inspection we saw that staff always treated people with respect and dignity.

During our inspection we saw staff encouraged the people they supported to be independent and to learn new skills. For example, we saw people involved in household activities such as cleaning, laundry and cooking. We were told that people always choose the food they want to eat, regularly go food shopping with staff, and that everyone is expected to take their turn cooking the main meal once a week.