Archived: Henshaws Society for Blind People - 61 Kings Road Harrogate

People’s experience of using this service: The service met the values that underpin the Registering the Right Support and other best practice guidance such as Building the Right Support. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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. Staff encouraged people to be as independent as possible and ensure their safety. People were encouraged to identify goals to maximise their independence, build confidence and lead fulfilling lives.

Staff had a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were handled safely and people were supported to receive their medicines as prescribed.

People’s care and support was developed in consultation with them and their relatives were involved, when appropriate. Care plans included guidance for staff to provide care and support in a way people preferred. People spoke positively about staff and felt they provided them with consistent care and support.

Effective management systems were in place to safeguard people and promote their wellbeing.

There was a new registered manager. The registered manager and staff were described as supportive and approachable. They were keen to make improvements to ensure people continued to receive high quality, individualised care and worked closely with other agencies and healthcare professionals to do this.

A full description of our findings can be found in the sections below.

Rating at last inspection: Good (report from last comprehensive inspection published 23 June 2016).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection and to follow up on our findings of a focused inspection undertaken in June 2017.

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

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Henshaws Society for Blind People - 61 Kings Road Harrogate on our website at www.cqc.org.uk.

At this inspection, we found improvements had been made to management systems to monitor, assess and improve the quality of care provided. This meant the provider was no longer in breach of the regulation.

Henshaws Society for Blind People - 61 Kings Road is registered to provide accommodation and personal care for five people who have learning disabilities who may have an additional sensory impairment. There were four people using the service at the time of our inspection.

Since our last inspection the provider had appointed a manager who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

We received positive feedback and, from our observations, staff were kind and attentive and they offered care promptly when needed.

Staff were encouraged to share ideas on the development of the service. Meetings were held regularly and comments were listened to and implemented to improve the service.

Overall we found that the arrangements for quality assurance and leadership within the service had improved. A range of audits were completed and identified action was taken to make continuous improvements to the service.

We did not improve the rating for well-led from ‘requires improvement’, because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

61 Kings Road is registered to provide accommodation and personal care for five people who have learning disabilities and an additional sensory impairment. There were three people using the service at the time of our inspection. The house is situated within walking distance of Harrogate town centre and there are local amenities nearby. It is a large three storey Victorian terrace with a small garden to the front and a small courtyard to the rear of the property.

There was no registered manager in post. 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. A manager was in post at the time of our inspection but had not yet started the process to apply to be the registered manager. We have called them the 'manager' throughout this report.

Staff had been trained to recognise and respond to any safeguarding issues. Staff knowledge and understanding of safeguarding was good. The service acted appropriately in reporting such issues to the local safeguarding adults unit, and carrying out any investigations or actions coming out of these referrals. Relatives told us they felt their family members were safe when their support workers were providing them with support. Risks to people were assessed, and risk assessments gave detailed information to ensure that people could be supported safely by staff. These had been reviewed consistently although we found several versions of some that required streamlining. Plans were in place to keep people safe in the event of an emergency. Accidents and incidents were fully recorded and were discussed at meetings to consider ways to ensure there was no reoccurrence.

There were some staffing vacancies but there were regular and consistent staff and gaps in the rota were picked up by regular bank staff. Staff files showed that recruitment was professional and robust to ensure suitable applicants were employed. Staff had been recruited safely and relevant checks were completed before they commenced working within the service.

Medicine administration was managed and carried out appropriately and all staff had received training. People were supported to self-medicate when possible. We found some gaps in recording and some areas of recording that required improvement. These issues had not been picked up through the provider's internal audit system. People were well supported with their nutritional needs and with their general health needs. People's needs were met by a range of healthcare professionals. People were encouraged to maintain a healthy lifestyle and eat a balanced diet.

Staff had received training to enable them to meet people’s needs. Staff had supervision and annual appraisal and this was done in line with the providers own policy. Records of supervision demonstrated two way conversations between staff and the manager. Relatives told us they felt staff had the skills they needed. People were supported by staff who had the skills and experience to carry out their roles effectively.

People who used the service were supported to make their own decisions about aspects of their daily lives. People were asked to give their consent to their care. Where people were not able to give informed consent, their rights under the Mental Capacity Act 2005 were monitored. Staff knowledge of mental capacity and deprivation of liberty was good.

People we spoke with gave us very positive feedback about the service and were very happy with the care and support they received. We observed staff were caring and knew people well. Relatives felt that their family members were cared for very well and were happy with all aspects of their care. Staff showed a good understanding of the importance of dignity, privacy and respect. The staff team knew people's preferences for how care and support should be delivered and had built a trusting and supportive relationship with the people who used the service.

People were involved with the initial and on-going planning of their care. Care plans were reasonably clear although brief and they reflected people’s preferences. They demonstrated others input. Reviews were detailed and updates were recorded clearly. Some areas of people’s files required updating. There were a good range of personalised activities and interventions offered to people on a daily basis.

People were encouraged to maintain relationships with important people in their lives and to follow their hobbies and interests.

The registered provider had a complaints policy which was available in audio format which made it accessible to the people who used the service. When complaints were received they were used to develop the service where possible as required.

People who lived in the home and staff contributed to the development and management of the service. Meetings were held regularly and people's comments were listened to and implemented to improve the service when possible. A quality assurance system was in place that consisted of audits, checks and feedback from people who used the service. When shortfalls were identified action was taken to improve the level of service. We found that some recording issues had not been highlighted through the audit system. We also found that some audits had not been carried out consistently in the months prior to the inspection.

The environment was in reasonable condition. Infection control was well managed and staff demonstrated an understanding of ways to minimise the risk of infection.

There was regular engagement with families for both individual input to the person’s support as well as development of the service. There was very positive staff morale across the staff team and a real sense of teamwork was evident throughout the inspection and in the conversations we had with staff. Staff felt the manager was effective.

The manager was open to improvements to the service. There were systems in place to monitor the performance of the service and although these had not been used effectively in the months before the inspection, the manager understood how to use these going forward to result in improvements across all areas of the service provided. People told us they felt they were listened to.

We found a breach of the Health and Social Care Act (Regulated Activities) Regulations 2010 in relation to governance. You can see what action we told the provider to take at the back of the full version of this report.

On the day of the inspection we met all four people who were living in the service. We talked with two people about their experience of care at 61 Kings Road and we spoke with the relatives of one person. We talked with three staff during the inspection, spoke with the manager of the service by telephone following the inspection and we looked at records. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve. The service had policies and procedures in place for assessment of people under the Mental Capacity Act. On the day of the inspection all the people who lived at 61 Kings Road were assessed as having capacity.

People were cared for in a service that was safe, clean and hygienic. The building was well maintained and any issues were reported promptly. Risk assessments were in place in individual support plans in relation to activities of daily living. Staffing levels were appropriate to meet the needs of the service and were reviewed and adjusted to address any changing needs and to accommodate activities.

Is the service effective?

People told us that they were happy with the care they received and relatives we spoke with said that they believed their relative's needs were met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. People's health and care needs were assessed with them and they were involved in writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living at 61 Kings Road. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. One person told us. "[The person] has always been encouraged to do anything [they] wanted to do and [the person] has grown in confidence."

Staff had received training to meet the needs of the people living in the home. They received regular supervision, annual appraisals and took part in regular staff meetings.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were supported to be as independent as possible. People who used the service were invited to complete an annual survey. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included spending planned days at the Arts and Crafts Centre run by the provider. We saw that they visited local places of interest, went swimming, visited the climbing wall and took part in shopping for the home. People knew how to make a complaint if they were unhappy as this was explained to them and documented by the service.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. People who lived in the service were asked for their views and we saw that there were regular house meetings where people could discuss any concerns and plans for the future. Relatives we spoke with told us that they were well informed about any changes and could talk with staff and discuss any concerns they had. Any identified shortfalls were addressed promptly and as a result the service was constantly improving.

During our inspection we looked at how people were respected and involved in the service. We looked at care records and found people had been involved in deciding what support would work for them and how that support would be delivered.

We saw from people's care plans that people were supported to live as independently as possible. The home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training about safeguarding adults.

We reviewed the level of staffing for the home. People told us that there was always enough staff to support them with their care needs.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.