St Barbara's

St Barbara’s is a residential service providing personal care for up to 3 people with a learning disability. At the time of the inspection there were 3 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported to have maximum possible choice, control and independence. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to achieve their aspirations and goals. People were supported safely with medicines. Infection prevention and control practices reflected current guidance.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. The service worked well with other agencies to do so. People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff were aware of and were working to best practice guidance for supporting people with a learning disability and/or autistic people.

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

Rating at last inspection and update

The last rating for this service was good (published 6 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Barbara’s on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home is a house that has been adapted to meet the needs of the people living there. 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 service had two registered managers in place, who were responsible for the five locations owned and run by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

St Barbara’s was last inspected by CQC in February 2016 when the service was rated as Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe and there were sufficient staff to meet people's needs. We found that this was a consistent staff team who knew people well.

People received safe support with their medicines. Where people wished to manage their own medicines independently this was encouraged and there were checks in place to ensure it was carried out safely.

People had risk assessments that described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP and social worker.

The premises were homely and suitable for people's needs.

Staff told us they felt well supported in their role; they received induction and training. Staff received supervision but some of this was informal and not recorded. Staff appraisals were planned but staff had not yet been appraised. We found this did not affect how staff performed their duties as the management spoke with staff on a daily basis and promoted opportunities for two-way discussions about performance and development. The registered managers had identified the need to formally record supervisions and appraisals and were working to a plan to ensure all significant discussions were recorded.

People had choice and control of their lives and staff supported them in the least restrictive way; the policies and systems in the service supported this practice.

Staff were aware of the importance of supporting people with good nutrition and hydration. People told us how staff supported them to eat healthily and reduce weight where this was a concern. We saw that people were encouraged to shop for and prepare their own meals.

People had access to healthcare services, in order to promote their physical and mental health. We saw that people were supported to have annual health checks and to attend health screening appointments.

There were detailed, person-centred care plans in place, so that staff had information on how to support people. ‘Person-centred’ is about ensuring the person is at the centre of everything and their individual wishes, needs, and choices are taken into account.

People were able to take part in a range of activities of their choosing and which were meaningful to them. People were supported to look for paid employment, volunteering roles and training to support them to develop the skills for employment. People were supported to play an active role in their local community, which supported and empowered their independence.

There was a complaints procedure in place, should anyone wish to raise a complaint. People told us that any issues would be addressed but no one raised any concerns with us. Staff knew how to access advocacy services if they needed them.

There was a quality assurance system, which enabled the provider to monitor the quality of the service provided. This required minor updates to ensure it covered all aspects of feedback from other agencies and was robust. The provider updated this during the inspection visit.

We received positive feedback about the registered manager, staff and the service as a whole. Comments from people, relatives, staff and visiting healthcare professionals indicated there was a positive, person centred culture within the service.

St Barbara’s provides personal care and accommodation for up to 3 people with a learning disability. On the day of our inspection there were three people using the service.

The home had two registered managers in place, who were responsible for the five locations owned and run by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

St Barbara’s was last inspected by CQC on 30 September 2014 and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and analysed for any trends. Risk assessments were in place for people who used the service and staff. People were protected against the risks associated with the unsafe use and management of medicines.

The home was clean, spacious and suitable for people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue training. Staff received regular supervisions. Appraisals were overdue however a new process had recently been implemented and appraisals were planned.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

Care records contained evidence of visits to and from external health care specialists and people were supported to maintain a healthy diet.

People who used the service, and family members, were complimentary about the standard of care at St Barbara’s. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into St Barbara’s and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service, and family members, were aware of how to make a complaint however there had been no formal complaints recorded at the service since September 2014.

The service regularly used community services and facilities and had links with other local organisations. Staff felt supported by the manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

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

Is the service safe?

People told us they felt safe and secure.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan.

People had access to a range of health care professionals. They told us that staff escorted them to healthcare appointments if needed.

This meant that people were sure that their individual care needs and wishes were known and planned for.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People commented, 'I feel staff listen to me. The staff are very nice'

There was an advocacy service available if people needed help or support to speak for themselves.

Staff were aware of people's preferences, interests, aspirations and diverse needs.

We observed that peoples individual wishes for care and support were taken into account and respected and we saw these were regularly discussed with them and recorded in their care plans.

Is the service responsive?

People told us, that they were able to participate in a range of activities both in the home and in the local community. One person told us 'I like opera music and have recently been to see an opera. I like to play football and I iron my own clothes. I have a keyworker and we go on holiday. This year I have been to Blackpool'. The activities provided included those where people could enjoy as a group and others that met their individual interests.

People told us they were involved in reviewing their plans of care when their needs changed. One person told us 'I recently had my review meeting. I was involved in this where we talked about things I wanted to do.'

People knew how to make a complaint if they were unhappy and were supported by staff to do so. One person said 'I have recently made a complaint about the voluntary driving service I use.'

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.

We found processes were in place, to obtain and record the valid consent of people who used the service about how they should be supported.

People told us they were happy with the care and support they received at St. Barbara's. One person told us "It's alright. I've had a difficult time this last year, but I'm starting to feel better now. I'm happy here.'

We found arrangements were in place to deal with foreseeable emergencies. The provider had contingency plans in place in order to maintain business continuity.

There was enough equipment to promote the independence and comfort of people who used the service. We saw records to confirm all equipment was being safely maintained.

People we spoke with were complimentary about the staff employed by the provider. One person said 'They're like a family, really.'

People's health and welfare needs were being met by staff who were appropriately recruited.

People's complaints were fully investigated and resolved, where possible, to their satisfaction.