We carried out this inspection on 5 January 2016. Turketel Road is a service for people with learning disabilities and autistic spectrum disorder. It provides accommodation for up to six people. At the time of inspection the service was full. At a previous inspection on 3 March 2014 we found the provider was meeting the requirements of the legislation we checked at that time.
There was a registered manager in post. 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.
Improvements were needed to the way in which surplus medicines were stored, the security of where medicines were kept, and how changes in administration instructions were recorded.
Complaints information was available for relatives, and they told us they felt confident about raising any concerns they might have and that these would mostly be addressed. Relatives concerns however, were not always recorded to show these had been addressed and resolved.
A range of quality audits were in place to help the registered manager and provider monitor service quality and ensure standards were maintained, but these had not been fully effective in identifying the shortfalls highlighted by this inspection. The organisation did undertake surveys but not all relatives had been asked to comment and those that had never received feedback about any comments they had made.
Staff felt supported and listened to but did not receive regular formal support. Opportunities for more frequent one to one meetings with the registered manager, and more regular staff meetings was an area both the registered manager and provider representatives had identified for improvement, and plans were in hand for this.
Fire detection and alarm systems were maintained; staff knew how to protect people in the event of a fire as they had undertaken fire training but fire drills were infrequent. Peoples individual evacuation plans needed review with the fire service to ensure these met the requirements of legislation, and we have identified these as areas for improvement.
People were happy and comfortable in the presence of staff and actively sought their attention if they wanted something. People received individual support from staff that interacted well with them and showed that they understood people’s individual needs.
Relatives told us they were kept informed and had been consulted about their family members care and treatment plans, and felt there were informal routes where they were able to give feedback and felt their views were taken account of at service level.
Staff monitored people’s health and wellbeing and supported them to access routine and specialist health when this was needed. People ate a varied diet and menus took account of peoples individual preferences and dislikes.
People were given individual support with their interests and hobbies and also had their own daily planner that took account of their activity and interest preferences.
Assessments of risk people might be subjected to from their environment, from activities or risks associated with their assessed support needs were developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated.
Staff understood people’s individual styles of communication; some people used new technology to give them more independence in making decisions for themselves.
Accidents and incidents were monitored by the provider to see where improvements could be made to prevent future occurrence. Individualised guidance was available for staff to help them understand how to work proactively with people whose behaviour could be challenging to others. The Care Quality Commission was kept informed of notifiable events when they arose.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Everyone in the service was subject to a DoLS; the registered manager understood when an application should be made and involved relatives in discussions through best interest meetings. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
Staff had been trained to recognise abuse and knew how to protect people. They understood how to report concerns about the practice of other staff through the whistleblowing policy. Staff showed that they understood the actions they needed to take to raise concerns with the registered manager or with external agencies if this was necessary.
There were enough staff to meet people’s needs. Staff recruitment procedures ensured that all the necessary checks were made to protect people from unsuitable staff. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs.
People lived in a clean, well maintained environment. Decoration and furnishings were to a good standard and had been selected to withstand the level of wear and tear they received. People bedrooms had been personalised to reflect to their own interests and tastes and contained a range of personal possessions. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Guidance was available to staff in the event of emergency events so they knew who to contact and what action to take to protect people.
We have made one recommendation:
We recommend that the provider should consult the Fire Service regarding the frequency of fire drills for day and night staff and that evacuation plans for people who may refuse to leave their rooms meet current fire legislation Regulatory Reform (Fire Safety) Order 2005.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.