Yarrow Housing Limited - 1-2 Elmfield Way

1-2 Elmfield Way is a care home for up to six people with learning disabilities and autistic spectrum conditions. At the time of our inspection there were three people using the service.

We found the following examples of good practice.

Social stories were used to explain to people the risks from COVID-19 and how to access the community safely.

The premises were used creatively to support people to self isolate, including creating lounges for people to use after they had tested positive.

The provider reviewed infection control measures after a person tested positive, and used enhanced personal protective equipment (PPE) and cleaning schedules to help contain the outbreak.

People’s experience of using this service:

• People using the service experienced positive outcomes. Care was designed to meet their needs and support people to develop their independence. Staff were able to provide positive behavioural support to reduce the risks from behaviour which may challenge by de-escalating situations and maintaining routines which were important to people. People were supported to develop their independence and to improve their health and community involvement.

• The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. 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.

• The provider followed safer recruitment processes. Staffing levels were planned to meet people’s needs. There were sometimes short periods when staffing levels were not safe due to staff sickness and there was not a clear risk management plan to address this. We have made a recommendation about this.

• We observed positive interactions between people using the service and staff. Staff were able to communicate effectively with people using a range of tools. People’s plans were reviewed regularly to make sure their needs and goals were met. The provider worked closely with the local authority and health teams in order to meet people’s needs and manage risks to their health and wellbeing. The provider assessed peoples’ ability to make particular decisions and met legal requirements to act in people’s best interests when they were not able to do so.

• Managers had systems in place to ensure good communication, to develop staff skills and knowledge and to ensure the service remained of a good standard. There were systems to learn from incidents and from people and the service was open about when things had gone wrong. People were safeguarded from abuse and improper treatment. People’s medicines were safely managed with appropriate oversight and measures to prevent over-medication.

• A relative of a person using the service told us, “Overall I’m completely satisfied with Elmfield Way and the staff, they’re very very nice. All of them.”

Rating at last inspection: At our last inspection we rated the service ‘requires improvement’. Breaches of regulations were also found. At this inspection we found the provider was now meeting these regulations.

Why we inspected: This was a routine inspection. We also carried out this inspection to check that the provider had followed their action plan.

Follow up: The service has been rated ‘good. We will continue to monitor the service and will carry out another comprehensive inspection within 30 months of this report.

1-2 Elmfield Way is a six bedded care home for men and women with a learning disability or autistic spectrum disorder. It is a bungalow with single occupancy bedrooms, a combined dining and lounge area, a small sitting room and a rear garden. None of the bedrooms are en-suite; there are shared toilets and bathrooms in the communal areas. At the time of this inspection there were four people living at the service.

There was a registered manager in post, who had managed the service for several years. 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. The registered manager was present at the inspection.

The systems in place to identify and manage risks to people’s safety and wellbeing were not sufficiently rigorous. Staff understood how to protect people from the risks of abuse and how to report any concerns about people’s safety and welfare.

There were sufficient staff deployed to support people with their personal care and their preferred activities at home and in the wider community. Thorough recruitment practices were followed by the provider to ensure that people were supported by staff with appropriate experience and knowledge.

The premises were being safely maintained in regards to areas such as fire safety and the professional maintenance and servicing of equipment and installations. Medicines were managed in a safe way and staff received medicines training.

Health and social care professionals told us that people were not always supported to meet their needs. We found that some staff had experienced difficulties in completing monitoring charts required by external professionals.

Staff received ongoing training, one to one formal supervision and an annual appraisal of their performance. Staff received mandatory training, such as moving and handling people and fire safety. Training was being provided to enable staff to effectively support people by providing positive behaviour support.

Staff had received training about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and they understood how to protect people’s rights.

Processes were in place to support people to meet their nutritional needs and to report concerns to relevant professionals if people needed more intensive support.

There were positive interactions observed between people who use the service and staff. People were treated with respect and their privacy was protected when they received personal care.

We received some negative comments about how people were supported to engage in meaningful activities. During the inspection we saw that people were actively using community resources and returned home pleased with their visits to places and activities of their choice.

Systems had been established to enable people and their supporters to make a complaint.

People were provided with a pictorial complaints leaflet and other more detailed pictorial materials were used to help people express their concerns and views.

Staff told us they felt well supported by the registered manager. However, we found that there were issues that needed to be improved on that had not been identified by the provider’s own quality assurance systems.

We have issued two recommendations. The first recommendation is for the provider to seek guidance about how to complete behavioural monitoring charts and the second recommendation is for the provider to seek guidance about how to ensure that people's Health Action Plans are kept up to date. We found two breaches of Regulation. These were in regards to the provider ensuring that risk assessments are kept up to date to reflect people’s current needs and carrying out regular monitoring visits to ensure that people’s needs were being met appropriately.

You can see what actions we asked the provider to take at the back of the main report.

We found that staff asked people for their consent prior to providing care and that people using the service were able to withdraw their consent at any time.

We found that care was delivered in an individualised way that ensured that people's rights were protected. We also found that the provider documented care appropriately and could respond to foreseeable emergencies in an organised way.

People using the service were cared for in a building that suited their needs and that the provider ensured that the care provided was of a consistently high quality.

Each person had a person-centred plan that was available in easy-read format with images and pictures. One relative said that staff had a "respectful attitude" and another said that they knew who the key worker for the family member was.

Staff knew how to recognise the signs of abuse and said that they would report all forms of abuse to their line manager. Staff were trained in specific techniques to deal with difficult situations for example, aggression and violence. Relatives told us that their family member was safe at the home and if they had any concerns they would report it to the manager and their social worker.

Staff had attended various training courses including safeguarding vulnerable adults, fire safety, medication and Makaton. Staff were supervised by their line managers and records were kept. Annual appraisals of staff performance was carried and recorded.

Staff documented people's care in their personal diaries. These were clear and concise. Staff records were kept in the staff office in a locked cabinet and the manager kept the keys.