The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the home being divided in to two separate houses, fitting into the residential area and the other domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.The accommodation consists of two houses, known as Holly House and Jan Norton House. The houses have separate entrances and facilities but are connected by a large communal area containing an office.
People’s experience of using this service and what we found:
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.
Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
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
There were five vacant posts at Stonepit Close. Two staff were in the process of being recruited at the time of this inspection. Staffing levels had been lower than planned on many occasions in the past year. The registered manager had been required to provide care and support on a regular basis for several months to cover staff vacancies. Regular and consistent agency staff were used on shifts as well as the service’s own bank staff.
There were activities provided for people by staff at the houses, in the community and at day centres, which people visited through the week. However, some families indicated that staffing numbers sometimes limited activity opportunities for people at weekend. Staff confirmed that staffing levels were sometimes lower than planned at weekends.
Supervision and appraisals had not been provided according to the policy held at the service. The registered manager did not have an accurate up to date overview record of staff training requirements. The provider held a matrix which showed some training. However, this did not provide the registered manager with the completed training status for each member of staff.
Risk assessments provided staff with enough guidance and direction to provide person-centred care and support. However, not all risk assessments had been clearly documented as have been regularly reviewed. It was unclear when the next review was due in some care plans. The service’s fire risk assessment was out of date.
The provider had recently shared an infection control concern identified at an inspection of one of the providers other services. This information had been shared with staff. However, there was no named lead for infection control and the service did not hold a copy of the Department of Health Guidance for Infection Control and Prevention in Care Homes as required.
Everyone living at the service had a care plan. However, some care plans were not reviewed as required.
The service had a registered manager who had worked at the service for 20 years. People, families and staff were very complimentary about the registered manager.
There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. There were no authorisations in place at the time of this inspection.
People were supported to have their medicines as prescribed.
Staff were kind. People had their privacy and dignity protected.
People were provided with the adaptations that they had been assessed as needing to meet their needs.
Staff were recruited safely.
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.
The service received many compliments and thank you cards. The service had not received any complaints.
Rating at last inspection:
At the last inspection the service was rated as Good (report published 15/09/2016))
Why we inspected:
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Effective and Well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk