Archived: Chad Ltd - Cordingley House

Chad Ltd – Cordingley House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support to four adult males who have a range of health needs including an autistic spectrum disorder.

The service also provides care and support to two people living in two ‘supported living’ settings, so they can live in their own home as independently as possible. These people’s care and housing is provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at their personal care and support only.

This 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 life as any citizen.

The established registered manager remained in post. A registered manager is a person who has registered with 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. The registered manager was supported by a service manager who was in the process of applying to become a registered manager.

The senior staff including the registered manager had extensive experience of working with people who had an autistic spectrum disorder or a learning disability. The management team strived for excellence within their team and had themselves researched career progression and engaged in opportunities to develop. Cordingley House had acted as a model of best practice for a similar local service.

People benefitted from a very reliable and consistent team of dedicated staff who told us they were proud to work for the provider and loved their jobs. This made the atmosphere in the home and the supported living settings very relaxed which in turn reduced episodes of behaviour which may have challenged the staff and put people at risk.

The quality assurance framework in place across the services was robust. The service manager and registered manager conducted daily, weekly and monthly audits that were systematic and meaningful. They ensured the service continued to provide excellent quality and safe care. The records kept of these checks demonstrated that they were methodically undertaken and where issues were identified, prompt action had been taken.

Record keeping in all aspects of the service was to a high standard. We found the staff strived to ensure all records were detailed, current and legible. The provider ensured that they held a relevant and accurate record of the care and support people had received in the past and at present.

The provider offered plenty of opportunities for people, relatives and staff to talk to them about the service. Staff and ‘Resident/Relative’ meetings were held regularly and minutes were recorded. People, family members and staff were actively encouraged to contribute to decisions made about the services. The staff also gave family members regular updates about their relatives in relation to their health, progression and social activities. A recent annual satisfaction survey took place which we saw was overwhelmingly positive.

The provider had made a real effort to successfully develop and improve the service further. For example, they had invested in bespoke training and development for all staff and had enthused staff to significantly enhance people’s support plan and risk assessment documentation. The provider had a clear vision for the service and they put people at the heart of it.

The service manager and senior care staff had continued to build on the personalised support plans which were already in place. We saw people’s needs had been holistically assessed and were constantly reviewed and changed to meet people’s varying individual needs and abilities. This had taken place with the total involvement of the person, their family members and external professionals. Support plans were person-centred, comprehensive and extensively described people’s life history including their family, friends, school life, social life, employment, interests and hobbies.

The staff continued to encourage and promote activities which inspired each person to participate in pastimes that were important and meaningful to them. People had their own unique activity plan which empowered them to get involved in social activities that they were interested in. The staff ensured people were afforded the chance to pursue education and work. We saw people had achieved dreams and ambitions. Staff also ensured group activities were arranged to maintain people’s links with their local community and provided an opportunity for social interaction with family and friends outside of the services.

There continued to be no complaints about the service. This demonstrated that people and their family members remained entirely pleased with the service provided.

People told us the staff were very nice to them. Throughout the inspection we saw staff displayed exceptionally kind, caring and compassionate attitudes and they treated people with the utmost dignity and respect. The staff were highly motivated and worked very well together as a team. We found staff were committed to making the lives of the people they supported as enriched and fulfilled as possible.

The provider’s equality and diversity policy was fully embedded into the service. The care and support delivered reflected people’s diverse needs and greatly considered their age, gender, culture and abilities.

People were content during our inspection. Two people told us they were very happy and that they loved living at Cordingley House. We observed people to be familiar and at ease with the staff. Robust policies and procedures were in place to assist staff to safeguard people from harm. The staff we spoke with fully understood their responsibilities with regards to protecting people and their rights.

The staff continued to have high regard for the risks people faced in their lives. The risk assessments in place were extremely person-centred, detailed and robust. Lessons learnt from incidents were a fundamental part of the continuous improvement and development of further preventative measures. The local authorities who commission the services told us they had no concerns about this provider.

The provider completed regular checks of the premises, equipment and utilities in line with their landlord responsibilities. Staff were aware of their responsibilities to report any defects and we saw minor issues had been addressed promptly.

Cordingley House was nicely decorated with modern adapted facilities to promote independence. There was ample communal space as well as private bedrooms. Pictorial signage used around the home helped people identify where things were for themselves. People had individually decorated bedrooms which were filled with their personal items. Any changes to the home or contents was well thought out and staff managed this effectively to avoid causing distress to people.

Medicines were managed safely and appropriately and they were stored securely and in an organised manner. Medicine administration records were accurate and detailed. We saw staff followed best practice guidance in relation to infection control and prevention. We observed people and staff in the kitchen, making meals and there was a high regard for safety, hygiene and areas for potential cross contamination.

Staff files showed the recruitment process continued to be safe and robust. Staff training was up to date and bespoke training had been devised and delivered. Staff had embraced the opportunities presented to them by the provider to progress their careers and had achieved qualifications in health and social care. There remained a great mix of experience, skills and knowledge amongst the staff team.

There were ample staff employed to manage the services safely, consistently and effectively. Each person had a key worker who took overall responsibility for keeping their records up to date.

Staff supervision and appraisal meetings were routinely held to formally discuss any issues, share best practice and develop staff’s skills and knowledge. We saw these were thoroughly documented. Staff told us they felt extremely valued by their managers and co-workers and that there was an open, friendly and honest culture, where they did not feel afraid to discuss anything.

Staff promoted a healthy diet and prepared well-balanced meals for people. Wherever possible, staff supported people to get involved with making meals. Staff encouraged family style mealtimes and we saw people engaged with this in a positive and interactive manner. One person had specific diverse dietary needs and the staff made certain these were meticulously met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems embedded in the service supported this practice. Staff supported people to make decisions when they could but where necessary, a best interests decision was made. We saw these included the people, their family members, staff and an external health or social care professional.

The

We previously inspected Cordingley House in April 2014, at which time the service was compliant with all regulatory standards. This inspection took place on the 13 and 14 January 2016 and was announced.

The service had 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.

The registered manager and staff had put a lot of time and effort into building personalised care plans which were tailored to individual needs. People's needs were initially assessed and constantly reviewed with the involvement of the person, their relative and external professionals. Care plans painted an in-depth picture of each person including their life history, family, school life, interests and hobbies. Records included photographs and pictures along with the written information to ensure people could read and understand their own care plan.

The service encouraged and promoted activities which were meaningful to each person and included their individual hobbies and interests. The group activity programme was devised by the staff team to ensure that the people using the service were included in their local community. The individual activity plans empowered people to get involved in activities in which they displayed a keen interest. The service gave people the opportunity to pursue, education, work and a social life with family and friends. A healthcare professional told us, "Service users attend college sessions and these have been on-going for several years, reviewed and changed as new courses are available. The staff are always looking for new experiences and learning for the service users to ensure on-going progression and interest". A relative told us, "I feel that (person) has made good progress while living at CHAD not only through planned activities, but they are more settled and less prone to episodes of challenging behaviour, their individual self-help skills are improved, they are more tolerant of others and their needs".

The registered manager kept a record for complaints and explained to us how the complaints procedure was managed. There had been no complaints received since the last inspection. People and their relatives told us they had nothing to complain about but did feel confident to tell staff or a manager if something was wrong. The registered manager also kept a record of accidents and incidents, which was monitored regularly.

The people using the service told us that they felt safe living in the home with the care staff who supported them. Policies and procedures had been recently updated and were in place to protect people from harm and to ensure staff understood their role and responsibilities. A healthcare professional described the service as, "One of the best services I’ve worked in, if not the best".

Records were kept regarding incidents including those of a safeguarding nature. Incidents were investigated and reported in a timely manner and where appropriate the registered manager had informed the local authority. These were analysed by the registered manager and used to review care needs, risk assessments and develop control and preventative measures.

Risks associated with the health, safety and welfare of the people who lived in the home were being managed by the service. This included regular checks of the property and equipment in line with their landlord responsibilities. People's care needs had been individually assessed and we saw these were regularly reviewed and monitored.

Medicine was stored safely and securely. Medicines were safely and appropriately managed and medicine administration records were detailed, thorough and accurate. The staff followed company policy and procedures regarding receipt, storage and disposal of medicines. Other records relating to the management of the service were well maintained.

Staff files showed the recruitment process was safe and robust. Training was up to date, and staff had a good mix of experience, skills and knowledge. The registered manager had provided staff with opportunities to progress their career in care and achieve qualifications in health and social care. There were enough people employed by the service to manage it safely and to meet the needs of the people living there.

The director’s alternated staff supervision and appraisal which were held regularly and thoroughly documented. Staff and ‘resident/relative’ meetings were also held regularly and minutes were recorded. The directors provided plenty of opportunities for people, relatives and staff to talk to them about the service. Competency assessments were carried out by senior care staff to assess staff’s suitability for their role.

Evidence and discussions showed that the registered manager and staff had an understanding of the Mental Capacity Act (MCA) including their responsibilities. The service assessed people’s mental capacity and reviewed it as necessary. Care records showed that wherever possible people had been involved in making some decisions, but decisions that were made in people’s best interests’ had been appropriately taken by involving other professionals and relatives.

Staff prepared well-balanced meals and wherever possible supported people to do this. We observed all of the people living in the home enjoyed their food at mealtimes, which were a positive and interactive experience. People had choice around mealtimes and often chose the planned meal from the menu, we also saw people chose different items which they preferred. We saw the service had involved external health professionals as necessary to meet people's changing needs. A relative told us, "(Person) has enjoyed good health during his time with CHAD, their medical condition is well controlled, and they regularly visit the dentist, which is a fabulous achievement in itself".

People told us the all the staff were nice to them. We observed throughout the inspection that staff displayed kind, caring and compassionate attitudes and treated people with dignity and respect. The staff were friendly towards everyone and each other. A relative said, "I feel that (person) has high regard for the people who work with him".

The service regularly monitored the quality of care and support. Daily and weekly audits to ensure the safety and quality of the service was carried out by the deputy manager. The registered manager oversaw this and also audited records. The service obtained feedback and gave people, relative and staff plenty of opportunity to do so. For example, annual surveys were used to gather the opinions of staff and relatives about how the service was managed and how it could be improved. We noted a good response to surveys, which meant the registered manager could collate the data and gather an overall opinion. The registered manager had devised an action plan to improve the service following the last survey. A relative told us, "I am often asked how I feel and advised of any changes that are taking place like staff changes, training taking place, outings and special activities that they are thinking about".

The registered manager had an extensive employment history working with people who had a condition on the autistic spectrum and was well established in the role having known some of the people for many years. There was a consistent team of dedicated staff. Staff told us they felt valued and that they enjoyed working for the company. A staff member told us, “It’s a really strong team, everyone works well together, and it’s really friendly”. This type of approach helped to make the atmosphere at the home much more relaxed for the people who lived there. One staff member told us, “(Directors) tried to arrange a (paid for) staff night out, but due to the needs of the service it wasn’t possible, so instead they gave us all a voucher, some wine and a card at Christmas”.

A healthcare professional commented that, "The managers of this service are approachable and seek advice/support if they feel this is needed. I would definitely rate CHAD as a very good service and recommend it to parents/carers I work with for future placements".

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

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

Is the service safe?

We spoke with two relatives who told us they felt the home was safe and people were well cared for.

Safeguarding procedures were robust and staff had been trained on how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

There was a system in place to ensure people's money was safe and any expenditure was appropriately recorded.

The home had policies and procedures in place related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to help ensure people were appropriately assessed and to make sure that people were looked after in a way that did not inappropriately restrict their freedom. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as and when required.

We saw the premises were safe, clean and suitable to meet the needs of the people who lived there.

We found staff recruitment was both thorough and safe to ensure people were cared for by appropriately experienced staff.

Is the service effective?

People's health and care needs were assessed and care plans were developed with people and their representatives. The care plans provided staff with information about how each person's care needs should be met. Guidelines were in place to inform staff of the actions to be taken to deal with challenging behaviour and these were monitored by the manager.

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure people's health care needs were met.

Is the service caring?

We spoke with two relatives whose comments included, "X is very settled and content there. The staff know X well and there are loads of activities. If I won the lottery I wouldn't move X. The staff are helpful and are very nice people" and "I've been visiting for six or seven years and there has never been a problem. I have no issues, the staff are very accommodating and the manager keeps me well informed. I think it is a good place for Y to be."

We observed good relationships between the people who used the service and the staff on duty. For example, two people were being supported to participate in activities in the community and another person was helping with the garden.

Is the service responsive?

We saw evidence to show that the complaints procedure had been explained to the people who lived at the home. Relatives told us they knew how to make a complaint but had never needed to. They said they felt confident that if they did complain it would be taken seriously and fully investigated.

We spoke with two relatives who told us the staff were very accommodating and listened to their views and kept them well informed. They confirmed they were issued with a survey once a year but they had never made any negative comments.

Is the service well-led?

The service had a quality assurance system and records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We saw records to show the deputy manager was responsible for monitoring care records, incidents, petty cash, risk assessments, food hygiene and diet management on a weekly basis. The manager audited these each month and carried out an audit on the medication system to ensure standards were being maintained and any improvements were implemented.

We saw the manager's development action plan. For example, recent actions included introducing colour coded cleaning equipment for infection control and that health action plans now included missed appointments.

Staff told us they were clear about their roles and responsibilities. Comments included, "The manager is always available if I have any issues and she is very approachable."

We were unable to speak to all of the people using the service because of the nature of their condition. We spoke to staff and observed their practices to determine how care and support was carried out.

Relationships between staff and people were clearly good. Relatives told us and we saw in practice, staff treated people with respect and helped them to remain as independent as possible. One relative told us, "They have him doing things for himself, in a positive way; but at the same time, keeping him safe."

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke with were positive about the care and support people received. One relative told us, 'The care's excellent, the staff are really helpful. I know he's happy there and I feel comfortable he's there and he's treated well.'

We saw that people were provided with a choice of adequate nutrition and hydration.

We concluded that people were protected against the risk of unsafe or unsuitable premises.

We saw that people's personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

In relation to the care and support provided, we found the provider had suitable arrangements in place to obtain, and act upon, consent from people, and those acting on their behalf. One relative said, 'They take notice of my wishes.'

We observed that relationships between people and staff were good and we found that staff were knowledgeable about individual's care needs. We viewed care records for all four people who were using the service and found they contained relevant information to enable staff to care for the person properly.

We walked around the premises and found they were of a suitable design and layout, but not always adequately maintained.

We found there were suitable numbers of skilled, qualified and experienced staff on duty.

There was a complaints policy and procedure in place. No complaints had been received in the previous 12 months but relatives told us they would feel confident approaching staff, or the manager, if any issues arose.