Archived: Mount Adon Park

Mount Adon Park provides accommodation and support for up to four people with a learning disability. At the time of our inspection four people were using the service. The home is an adapted residential property with accommodation over three floors. There was a communal lounge, dining area, kitchen and large garden.

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

People told us they liked living here and that they felt safe. They told us they were treated with kindness and respect. The home had a welcoming, happy atmosphere and we saw staff and people having genuine fun together. A relative said, “The place is just brilliant.”

Most people had lived in the home for many years and there was a low turnover of staff. This meant people had continuity of care and were supported by staff who knew them well and understood their needs. Staff and people communicated comfortably using various methods according to people's needs. People told us staff listened to them.

People’s independence and dignity was promoted. Their risk assessments and support plans were written in a positive, person-centred way. People helped write their support plans and took part in regular reviews.

People were supported to have relationships with their friends and families and took part in local activities and volunteering opportunities. They went on outings to visit family and pursue their interests and took regular holidays in Britain and abroad with staff.

People's medicines were safely managed and stored.

The home was clean and free of malodour. Good infection control practices were followed.

Fire safety checks and drills were regularly completed. There were regular, documented safety checks and external assessments of safety and equipment.

The registered manager regularly audited and reviewed the home's records, policies and procedures.

Staff told us they enjoyed working at the home and felt supported by management. They were well-trained and had regular supervision and appraisal.

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.

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.

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

Rating at last inspection:

The last rating for this service was good (published 23 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the previous inspection of 8 March 2016 we found two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service did not always have management plans in place to address identified risks to people. The service had also not followed the correct process under the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Mount Adon Park Care Home’ on our website at www.cqc.org.uk.

At this inspection we found the provider had made the required improvements. Risk management plans had been put in place. These were comprehensive and provided sufficient information for staff to follow to reduce risks to people. The registered manager had made applications for authorisations to deprive people of their liberty appropriately. DoLS approval had been obtained from the relevant authorities in line with DoLS legislation. The conditions of the DoLS were monitored and reviewed regularly to ensure they continued to be relevant.

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 2008 and associated Regulations about how the service is run.

People were supported to consent to their care and support. People’s relatives or advocates were involved in decision making processes. Staff involved people in their day to day care and support and enabled people to determine what they wanted to do and how they wanted it done.

Care was planned in a way that met people’s individual needs. It took into account their choices, preferences and interests. Care plans provided sufficient information for staff to follow to support people to achieve their goals and positive outcomes. People were supported to participate in reviews of their care plans.

People and their relatives were given opportunities to feedback about the service and this was used to shape the way the service was delivered to people. People took part in activities they enjoyed. They were supported to engage in employment and develop skills for daily living.

People and their relatives told us they knew how to complain if they were unhappy with the service. The complaints procedure was available in an easy read format so people could understand it.

Staff knew the people they supported and what made them anxious or distressed. Staff supported people in a way that reduced their anxiety. Staff treated people with dignity and respected their privacy. People’s confidential matters were discussed in private and records kept secured.

People received the support they needed from staff because there was enough staff on shift to support them safely. Staff managed people’s medicines safely including the administration, recording, storage and disposal. Staff knew the signs to recognise abuse in the people they supported. Staff understood how to respond if they suspected people were being abused.

Staff were supported well through regular training, supervision and appraisal. Staff told us they felt confident and competent to support people. People had access to the healthcare services they required to maintain their health. People enjoyed the food and drink they received and were provided with food and drink of their choice.

There was clear and visible leadership in the service. Staff knew who to speak to if they needed advice and direction. The team leader and registered manager understood their roles and responsibilities. A range of audits were carried out to assess, monitor and improve the service. The registered manager met their statutory responsibilities. They submitted notifications to the CQC of important events and incidents as required.

The service had a registered manager. The registered manager was also managing other services for the provider. 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 service had a team leader who was responsible for managing the day-to-day running of the service.

We carried out an inspection of this service on 6 June 2014. At that inspection, we found that the service was not compliant in relation to supporting staff. The service did not provide staff with regular appraisals. At a follow up inspection on 23 September 2014 we checked if the service was meeting this essential standard and found that the provider had taken actions to support staff as required.

At this inspection we found two breaches of regulations for good governance and safeguarding service users from abuse and improper treatment. We found that not all identified risks were assessed and had risk management plans in place to reduce them. The service had not applied for DoLS authorisations. There was a risk that people were unlawfully restricted.

We found that the provider had not addressed our concerns in relation to staff support long term. We saw that staff did not have regular appraisal meetings, which meant that their developmental needs were not monitored to ensure good practice.

We recommend that the service seek guidance and support in relation to staff appraisals and take action to update their practice accordingly.

Staff provided people with support to ensure safe care. Staff had the skills and knowledge to identify potential signs of abuse and act on risks to people. Sufficient numbers of staff were available to people, which ensured their needs were met. Staffing numbers were increased when people required additional support. Safe recruitment practices were in place and followed to ensure that staff had the required skills to provide good care. Appropriate systems were in place to record incidents and accidents, which ensure that actions were taken as required. People received their medicines safely and as prescribed.

Staff were supported to provide good care for people. The service had systems in place to monitor staff’s performance. Regular supervisions were carried out to discuss people’s individual needs and to review staff’s training requirements. Staff attended relevant to their role training courses and applied gained knowledge in practice.

The service followed the Mental Capacity Act 2005 principles and ensured that people were supported to make decisions for themselves on a daily basis. Staff provided adequate support to people with their eating and drinking needs and ensured their nutritional needs were met. People had necessary support to attend their health appointments when required.

People developed relationships with staff and felt respected by them. Staff were aware of people’s preferences and provided support according to their wishes. Care plans had information on people’s likes and dislikes Records showed that people were involved in planning their care and made choices about the support they received. Staff supported people to learn new skills.

Staff supported people to attend regular meetings in order to review their needs and goals. Relatives were involved in making decisions about the support people received. People were supported to provided feedback about the services provided. Staff supported people to raise their concerns and complaints.

Staff were involved in developing the service and knew what was expected of them. Staff worked together as a team to provide good care for people. The team leader provided advice for staff when required. Internal audits were carried out to monitor the quality of the care provided for people at the service.

People were provided with limited support to make choices about the food they wanted to eat and activities they wished to attend. This meant that we could not be reassured that the informed choices were available to people as required.

We made a recommendation for the service to seek advice and guidance from a reputable source, in relation to the requirements to support people with food and activity choices as appropriate.

Below is a summary of what we found. The summary describes what staff told us and what the records we looked at included. Due to the focus of this inspection we did not speak to people who used the service.

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

This is a summary of what we found:

Is the service safe?

Not reviewed at this inspection.

Is the service effective?

Not reviewed at this inspection.

Is the service caring?

Not reviewed at this inspection.

Is the service responsive?

Not reviewed at this inspection.

Is the service well-led?

We found that since our last inspection the required improvements had been made and staff that had been with the service for at these 12 months had received an appraisal.

As part of this inspection we spoke with people who used the service and three care staff. We also reviewed records relating to the management of the home which included the care records of every person who used the service.

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.

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

Is the service safe?

There were procedures in place to protect people from abuse. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Each person's care file contained guidance for staff about how to manage any identified risks to ensure their needs were met as safely as possible.

We found there were adequate arrangements in place to deal with foreseeable emergencies. There were procedures in place to carry out health and safety checks to ensure that people were getting a safe service and there were enough qualified, skilled and experienced staff to meet people's needs.

At the time of our inspection people at the service were not subject to the Deprivation of Liberty Safeguards (DOLS). The team leader at the service was aware of their responsibilities within the framework of the DOLS and that an application to the local authority had to be made if a person's liberty for any reasons needed to be restricted.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The care plans were available and were subject to reviews to ensure they contained up to date information on people's needs. People had monthly one to one meetings to identify any changes in their care needs or whether they were satisfied with the support their received. People's individual needs, choices and preferences were reflected in their care plans. People's health was monitored and they received medical attention when it was needed.

Although people's assessed needs, preferences and choices were met at all times by staff that had the necessary skills and knowledge we found that staff did not have appraisals for over two years. Staff told us they would have more opportunity to get feedback about and review their professional development if this was formalised through appraisals.

Is the service caring?

We observed during our inspection that people were treated with respect. People's privacy, dignity and independence were respected. We found people's needs in respect of age, disability, gender, race, religion or belief were understood and met.

Staff supported and involved people in planning and making decisions about their care and support through monthly one to one meetings and regular meetings. Records of these meetings showed that people were asked about what they liked or didn't like and they planned future activities such as holidays and day outs.

Is the service responsive?

People have access to activities that were important and relevant to them and were protected from social isolation. People were supported in promoting their independence and community involvement. We found that people had busy activity schedules and they participated in many different social activities in the community such as going to a community centre, cinema, visiting their family and eating out. Each person had an individual weekly activity schedule that reflected their personal interests and choices.

People's health was being monitored and they were supported to receive medical check-ups. People had 'hospital passports' which contained information to help ensure the continuity of support in case of hospitalisation. Health support plans were also in place and records showed that people' received medical and dental check-ups.

Is the service well-led?

There was a system in place to monitor the service to ensure people's well-being and that the quality of the service. We saw records of an audit regarding how people's finances were managed and recorded. We found that changes were implemented in-line with the recommendations. We also saw records of regular health and safety checks; fire safety tests and drills were also carried out.

We found that people's views were regularly sought regarding the quality of the service and whether they were satisfied with the support their received.

We were told that the quality of the service was also monitored through visits from the provider however we found no written evidence of the findings from these visits since our last inspection. This meant we could not be assured of the outcome of these visits or if any action was required to improve the quality of the service provision.

We spoke with three members of staff who told us they felt there was enough staff and they were able to meet people needs with the current staffing arrangements. Staff also told us they enjoyed working at the service and felt supported.

People had their care and support needs met through individual support plans. Staff demonstrated knowledge of people using the service, their likes and dislikes and their support needs.

People were involved in planning their meals provided at the service. A nutritious and balanced meal choice was offered, and people were supported to access food and drink.

Medicines were safely stored and administered.

Effective recruitment and selection processes were in place. All staff were supported through a process of induction and monthly supervision sessions. Staff had access to training and their learning and development needs were identified through their supervision sessions.