We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found.
Is the service safe?
We met with people who used the service but due to the degree of their learning and
physical disabilities they were unable to give us any feedback about the quality of the
service. We spent time with them and observed how they were supported by the staff and we spoke to four people's relatives and a healthcare professional. We saw that staff treated people with respect and dignity. Relatives told us that they were very happy with the service provided. They said people were safe and well cared for. One relative said 'they are definitely completely safe' A healthcare professional said "definitely a safe service. 100%.'
Staff had received training to ensure that they supported people safely. This included safeguarding vulnerable adults, moving and handling and administering medication. People's files included risk assessments relevant to each individual. They indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible.
The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and staff had received training on this subject. Some applications had been made but formal DoLs had not been necessary.
Equipment needed to support people who used the service was well maintained and serviced regularly to ensure that it was safe and did not put people at risk.
Is the service effective?
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One relative told us 'they are good at monitoring people's health and taking action when needed. If they feel there is a risk they contact the GP or take them to hospital.' Another said 'they pay close attention to people's welfare and are on the lookout for any changes. There was a stable staff team and they were able to recognise if people were unwell or in pain and took the necessary action.
The premises were purpose built and accessible for people with physical difficulties or who used a wheelchair.
People's care needs were assessed and detailed plans of care were developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences. We saw that care plans were up to date and were reviewed with the person and their relatives. This meant that staff had current information and details to enable them to effectively meet people's needs. A healthcare professional told us 'there is a person centred approach.'
Is the service caring?
Relatives spoke highly of the care provided by the staff team. One relative told us 'staff are super and seem happy.' Another said 'staff put themselves out to do things.' We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.
People's preferences and diverse needs were recorded and care and support was provided in accordance with this. People's religious, cultural and social needs were identified and addressed. The service celebrated festivals from different religions and people were supported to wear traditional clothing and to listen to music from their own culture. People were also supported to be part of the wider community. They went out to eat, to the theatre and to places of interest.
Is the service responsive?
Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. They told us how they identified if a person was unwell or unhappy and the action that they took if this occurred. A healthcare professional told us 'staff all know people well and are good at giving me the information that I need. They always check things out and raise issues. People receive very good nursing care.'
We saw that care plans included information about people's likes, dislikes and preferences and were reviewed and updated at least every six months to ensure that they had correct and up to date information about people's needs and how these should be met. The service was responsive to people's changing condition and needs. They worked closely with other providers to ensure that these were met. For example the speech and language therapist was contacted when there were concerns about a person's eating and drinking.
Is the service well led?
The service had a registered manager in place and there was a clear management structure. Staff told us that the home was well managed and they received the support and guidance that they needed to carry out their duties and to meet people's needs. They told us that they had team meetings and also had an opportunity to have individual discussions with their supervisor. One member of staff told us 'yes there are clear standards.'
Relatives told us that they were asked for their views about the service provided and that they met with the manager and the provider. This was during relatives meetings and also individual review meetings.
The provider had a number of different quality assurance systems in place to enable them to effectively monitor the quality of care provided. This included monthly visits by a senior manager and also health and safety, financial and quality audits. Any issues were documented for action and followed up.