The inspection visit was carried out by one inspector. We spoke with three people who lived at Micholl's house and a visiting relative. We spoke with the manager, deputy manager, an activities coordinator and five members of the care staff team. We observed the interactions between staff and people who lived at Micholl's house. We also carried out a SOFI observation on one of the units where people were unable to communicate verbally with us. This was to assess the quality of care those people received. We looked at some records, including people's care plans files, staff training and recruitment files.
We considered the evidence we had gathered under the outcomes we inspected. We used this information to answer the questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found-
Is the service safe?
CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). The deputy manager told us at the time of our inspection there was no person with a DOLS application in place, but they did have previously and the appropriate arrangements were in place to safeguard that person. The manager was aware of the recent proposed changes to DOLS and was already considering how this impacted on the people they supported.
Where required, we saw best interest meetings took place, but who was present and the outcome of the meetings were not always recorded to confirm the decision that was made.
We looked at care plans and spoke with staff. We found there were risk assessments in place to identify and manage risks to people's health, safety and welfare. However we saw there were no risk assessments in place to identify and manage potential risks to staff and others. We saw staff manage challenging behaviours safely and in line with the guidance in care plans. This meant people's safety was promoted.
We looked at three staff recruitment files, induction and training records. We saw staff were suitably recruited and the required checks were carried out prior to staff commencing work within the home. We saw staff were suitably inducted and trained to ensure they delivered safe care to people.
Is the service effective?
We looked at four care plans. We saw that they were detailed, specific and informative as to how people were to be supported with all aspects of their care. Care plans contained detailed descriptions of people's seizures and protocols for managing seizures. These provided clear guidance for staff on how they supported people.
We saw people's health needs were identified and met and people's medication was appropriately managed to ensure people got their prescribed medication.
The home had a wide range of individual and group activities available seven days a week. The activities were person centred and focused on developing people's communication skills. Objects of reference and visual aids such as pictures and textures were used to promote that. Staff used a therapy called "intensive therapy" to engage with people. This was where a staff member mirrored the person's actions, sounds and behaviours to engage with the person. We watched a video of the therapy and saw the positive responses of the person to the interactions.
Is the service caring?
We spoke with three people who lived in Micholl's house. People told us they were happy there. One person commented " I am well looked after and staff treat me well ". Another person told us "There are lots of things for them to do".
Throughout our visit we observed positive interactions between staff and the people who used the service. Staff were kind, caring, gentle and reassuring. We saw staff maintained good eye contact with people whilst providing reassurance throughout the task they were assisting them with.
Is the service responsive?
A relative told us the staff were responsive to their relatives needs and their relative seemed happy there. They commented "Staff are professional, caring and knowledgeable, they are simply brilliant and are X's life saver". They also told us how their relative had been swimming and horse riding since been at the home and how responsive and happy that had made the person who used the service.
We saw for one person recently admitted to the home, visits and assessments from other professionals had been carried out but an assessment document was not completed to evidence the person had been assessed.
Is the service well led?
Staff told us they felt suitably supported. They said the manager, deputy and seniors were always available, approachable and accessible.
We saw that relatives were asked to give feedback on the service provided. This indicated people were happy with the service and included comments such as "The staff are helpful, kind and competent", "A very well run service ".
We saw that a range of audits took place and issues highlighted in the audits were actioned. We saw that complaints were logged and investigated. They were reported to the provider each month and a central record was maintained.
We saw accidents, incidents and the number of seizures were logged on a computer programme. This allowed the manager to produce graphs and analyse trends in accidents, incidents and seizures. The manager told us the results had been used to review people's epilepsy medication which had resulted in a reduction in the number of seizures some people had. This meant accidents and incidents were being analysed and action taken to reduce risks to people.