St Edwards Close

We found the following examples of good practice.

Staff had received infection prevention and control training, including how to put on and take off personal protective equipment (PPE) and hand washing. Staff were wearing PPE face masks inside the home throughout our inspection.

The visiting arrangements for the service were in line with government guidance. People were also able to keep in touch with family and friends using video and telephone calls.

People and staff were tested for COVID-19 in line with government guidance and all staff had been vaccinated. Staff checked the vaccination status of professionals visiting the home.

Staff supported people whilst in the community to reduce the risk of COVID-19 infection, including wearing PPE face masks outside.

The service had enough staff and had measures in place to deal with any staffing difficulties arising from COVID-19.

St Edwards Close is a residential care home for 12 people with autism. The service consists of two houses, the Willows and Conifers and can accommodate six people in each. In each house, there are single bedrooms and people have shared use of a lounge, activity room, kitchen and bathroom facilities. There is an enclosed garden and courtyard for people to access. There were 11 people using the service at the time of our inspection.

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:

Relatives told us they thought their family members were safe living at St Edwards Close and that staff were kind to them.

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

Risks to people, including those associated with their healthcare needs, were assessed and plans were in place to reduce them.

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.

There were sufficient staff to meet people's needs and safe recruitment practices were in place.

People’s medicines were stored, administered, recorded and audited appropriately. The provider had appropriate policies and procedures in place to support people safely with their medicines as prescribed.

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 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.

Relatives of people told us their relationships with the staff team was good. They said their privacy and dignity was respected. They also said they were able to express their views and preferences and staff responded appropriately.

There were systems in place to ensure concerns and complaints were responded to in an appropriate way.

Comprehensive quality assurance processes were in place that monitored a wide scope of practice and procedure by staff, identified shortfalls and drove improvements. The provider worked collaboratively with other agencies and organisations to meet people’s needs.

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

Rating at the last inspection

At the last inspection the service was rated Requires Improvement (published 18 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection in line with our inspection schedule. We found the service met the characteristics of a "Good" rating in all areas.

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.

St Edwards Close is a residential care home for 12 people with autism. The service consists of two houses, the Willows and Conifers and can accommodate six people in each. In each house, there are single bedrooms and people have shared use of a lounge, activity room, kitchen and bathroom facilities. There is an enclosed garden and courtyard for people to access. There were 11 people using the service at the time of our inspection.

At the time of the provider’s registration, the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, the service was continuing to develop their practice to meet this guidance and used other best practice to support people. They have applied the values under Registering the Right Support. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post who joined the service in March 2018. 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.

People were not always protected from the risk of avoidable harm. Environment, equipment and fire safety checks had been regularly undertaken, however, hot water exceeded the maximum safe temperature and the provider was not complying with Health and Safety Executive (HSE) guidance about this.

People did not live in a well maintained environment as parts of the premises remained in need of redecoration or repair. The provider’s refurbishment plan took too long to deliver. Refurbishment of people’s bathroom facilities had not been completed and remained outstanding for over two years. This was highlighted at our last inspection in April 2016.

Other systems were used effectively to assess and monitor the quality of services that people received. Action plans were used to highlight any areas where improvements were required and these were monitored to ensure that changes were made.

The provider's recruitment and employment processes were robust and protected people from unsafe care. People received support from staff who knew them well, and had the skills to provide the care they required. Staff received the necessary training to fulfil their role and had ongoing support and supervision from the registered manager.

The provider’s training programme was designed to meet the needs of people using the service. Staff had the knowledge and skills they required to support people with autism. Training included supporting people who presented behaviours that could result in harming themselves or other people. This helped staff to manage situations in a consistent and positive way, and protect people's dignity and rights.

People continued to experience person-centred, flexible support. People's care needs were assessed, kept under review and they were fully involved in making decisions about their care and support. Assessments considered whether people had any needs in relation to their disability, sexuality, religion or culture. Staff understood and respected these needs.

People's care records recognised their rights and were person centred. People were supported to have 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 knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse.

People had personalised support plans that reflected the care and support they needed. Plans identified any associated risks to their health and welfare. Where risks were identified, there was comprehensive guidance on the ways to keep people safe in their home and in the community.

People decided how they spent their time and staff supported their choices and independence. Pictorial aids were available for those who needed support with communication.

Staff encouraged people to participate in activities, pursue their interests and to maintain relationships with people important to them. Relatives and visitors were welcomed at the service.

People were supported to keep healthy and were encouraged to maintain a healthy lifestyle. Other professionals were involved when people became unwell or required additional services to ensure their healthcare needs were met.

The provider encouraged feedback from people who used the service, relatives, and staff and this was used to improve their experience at St Edward’s Close. People knew how to complain and told us they would do so if required. Procedures were in place to monitor, investigate and respond to complaints.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

St Edwards Close provides accommodation and personal support for up to twelve adults with autism. The service consists of two houses, the Willows and Conifers and can accommodate six people in each. In each house, there are single bedrooms and people have shared use of a lounge, activity room, kitchen and bathroom facilities. There is an enclosed garden and courtyard for people to access. The service is part of a group of homes owned by the National Autistic Society. There were twelve people using the service at the time of our inspection.

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 and associated Regulations about how the service is run.

People were safe because staff knew what to do when safeguarding concerns were raised. Staff had been trained to recognise and respond to abuse and they followed appropriate procedures. The provider’s recruitment and employment processes were robust and protected people from unsafe care.

St Edwards Close provided people with a safe environment although some parts of the premises were in need of redecoration or repair. The provider had plans to refurbish and improve areas of the service.

People received responsive care and support because there were enough staff that were trained to meet their needs. Staffing was managed flexibly so that people received their care when they needed and wanted it. The provider’s training programme was designed to meet the needs of people using the service so that staff had the specialist knowledge they required to support people. This included training on autism and positive behaviour approaches. Staff were supported to maintain and develop these skills through regular management supervision.

People’s needs were assessed, monitored and reviewed. Care records described people’s hopes and aspirations for the future and they were encouraged to be as independent as possible. Plans were kept under review and individual risk assessments set out what to do to keep people safe. There were specific guidelines on how staff could support people to help them avoid becoming upset. When people did become anxious the care plans clearly informed staff about what actions to take. This helped ensure staff took a consistent approach to supporting people.

The provider acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This is legislation that protects people who are not able to consent to their care and support, and ensures people are not unlawfully restricted of their freedom or liberty. The registered manager and staff understood the requirements and their responsibilities. Care plans took account of people's rights and independence.

People were treated with respect and dignity and staff were knowledgeable about the ways in which individuals liked to be supported. Their individual preferences and diverse needs were known and staff supported their choices and independence. People took part in activities they liked or had an interest in. People decided how they spent their time and pictorial aids were available for those who needed support with communication.

People’s health needs were monitored and they had access to health care services when they needed them. Any advice from external professionals was included in their care and acted on accordingly. Medicines were managed appropriately and people had their medicines at the times they needed them.

Staff understood their roles and responsibilities and had access to information, support and training that they needed to do their jobs well. Staff felt well supported and had confidence in the registered manager.

People and their relatives were involved in providing feedback about St Edwards Close. Relatives were confident they could raise any concerns or issues with the manager or staff, and these would be listened to and acted upon.

The provider had effective systems in place to monitor the quality of the services people received. Action plans enabled the provider to monitor whether changes were needed and make improvements.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. Three people spoke with us about living at St Edwards Close. Due to their needs, other people we met were unable to share their direct views about the standards of care. We therefore used observations and looked at care records to help us understand their experiences. We also looked at various records around the way the home was being run and toured the premises. We spoke with the deputy manager, three members of staff and telephoned four people's relatives following our visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Since our last inspection, some essential repairs and redecoration had been carried out. There was an ongoing programme of refurbishment to improve other areas of the home.

People we spoke with told us they felt safe living at St Edwards Close. One person told us, 'Yes I do feel safe, the staff speak to me very calmly.' This was confirmed by discussions we had with people's relatives. One relative told us, 'The home is good at managing risks.' People were safe because staff knew what to do when safeguarding concerns were raised. Staff had been trained to recognise and respond to abuse and they followed appropriate procedures.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. Where people did not have mental capacity to consent, care was provided in their best interests.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Staff we spoke with had a detailed knowledge of people's needs and knew how to provide care and support for them.

People using the service had personalised care plans that were regularly reviewed to make sure they got the right care and support. Behavioural guidelines and protocols were in place to help staff support people to manage individuals' behaviour in a positive way and reduce known stress and anxiety triggers.

The service had made timely referrals for health and social care support when they identified concerns in people's wellbeing. Records showed that staff had followed the advice and guidance provided by visiting health and social care professionals.

Staff received ongoing training and support to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. One person told us, 'I am happy here and happy in myself.' Another person said, 'It's nice here.' One relative told us, 'I am quite happy. If X (name of person) is happy then I am happy.' Another relative commented, 'there is a lot of professional affection with a great deal of caring.' A third relative said, 'On the whole we are pleased with the service.'

People using the service and those close to them were encouraged to make their views known and staff respected their decisions. They were able to provide feedback about the quality of the care and support provided through regular meetings and annual satisfaction surveys.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Care records provided up to date information about people's needs which meant that staff understood how to support each person and provide consistent care. Others close to them, such as their family members, were also involved in decisions about their care. One relative told us, 'They seem to be aware of things and everything is monitored.'

Is the service well-led?

The provider regularly monitored the care, facilities and support for people using the service. Where issues were identified, action was taken where necessary.

External professionals were involved in people's care so that each person's health and social care needs were monitored and met. The service worked well with other agencies and services to make sure people received care in a coherent way.

At the time of our inspection there was no registered manager and the deputy was managing the service. The provider was in the process of recruiting a new manager and we will check for progress at our next inspection.

Three people spoke with us about living at St Edwards Close. Due to their needs, other people we met were unable to share their direct views about the standards of care. We therefore used observations and looked at care records to help us understand their experiences. We also looked at various records around the way the home was being run and toured the premises. We spoke with the new home manager and six members of staff during the course of our visit.

People were supported by a stable staff team who had worked at the service for a number of years. We saw good interactions between staff and people who use the service. Staff knew how to respond to each person's individual communication style. Throughout our visit, people were comfortable and relaxed in the company of the staff supporting them. One person told us, 'the staff are all very nice people.' Another person said, 'I like it here. The meals are good, the staff are very nice.'

People were offered choices and had personalised care plans that were regularly reviewed to meet their needs. Where people did not have mental capacity to consent, care was provided in their best interests.

People received effective care and support because there were sufficient staff.

There were systems in place for ensuring that the service was operating effectively and that where issues were identified, action was taken where necessary. We found however that people using the service were not provided with a well maintained environment. The arrangements for maintaining the premises were insufficient as there were significant delays in addressing necessary repairs and refurbishment.

Two people said they were happy living at St Edwards Close and that they liked their keyworker staff. Due to their needs, other people we met were unable to share direct views about their care experiences. In order to make judgements about the care that people received, we observed care practices; interactions with staff and tracked three people's records of care. Case tracking means we looked in detail at the care people receive. We also looked at various records in relation to the staff and the way the home was being run.

We saw good interactions between staff and people who use the service. Staff were alert to changes in people's mood, behaviour and general wellbeing and knew how they should respond to individual communication needs.

Relatives all commented positively on the support their family member received. Comments included, 'very happy', 'the care is over and above' and 'they are a breath of fresh air, the staff are extremely helpful.'

We found that the staff understood people's care needs and knew how to protect them from risk and harm. Staff told us they had ongoing training and supervision and were supported by management to do their job.

The care provider had effective systems for assessing and monitoring the service they provided.