19 Stone Lane

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection, this key question was rated requires improvement, improvements have been made and this key question is now rated good and is no longer in breach of regulations. At our last inspection, we made a recommendation the provider ensures risk assessment systems are person-centred, proportionate and consider the least restrictive option to support people's freedom, choice and control, at this inspection, improvements had been made. People were protected from the risk of harm and abuse, staff understood how to report concerns and who to escalate to within and outside of the organisation. Where people required applications to be made in their best interests under the Mental Capacity Act 2005, these were made in a timely way. People were involved as much as possible to manage their care and support, including risks. Staff were provided with clear guidelines to support people safely, respecting their wishes and preferences. There were enough trained and skilled staff deployed to support people. Staff were recruited safely and supervised appropriately. Medicines were managed safely. Audits were completed to identify areas of concern, management made changes where needed to address areas of improvement. Staff and managers learned from audits, incidents and accidents; plans were put in place to minimise the chance of reoccurrence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager and their staff learned from people and their experiences to improve outcomes. For example, where people showed emotions of distress, staff and management met to understand the causes and put actions in place which were continually monitored to minimise the chance of further distress.

The registered manager and staff constantly looked to see where learning could be applied to drive improvements. The registered manager described how they had put processes in place to follow any incidents or where people may show emotions of anxiety or distress. Staff completed a form which facilitated discussions and reflections of what went well, what could be improved and how they may do things better in the future. A staff member told us, “We do have meetings to discuss incidents, and we do learn from them.”

Processes were in place to audit, monitor and review incidents and near misses. Action was taken where required, for example, a person was identified as requiring more one to one support, the registered manager made relevant applications to the commissioners. Staff accurately completed care records to evidence clear rationale as to why the extra support was required.

People’s wishes and needs were considered and consistently reviewed to ensure they received the right support with the right support network. For example, when people attended hospital appointments, staff continued to provide one to one support which meant people were supported by staff who understood their needs, communication requirements and preferences. A person’s relative told us, “The staff seem to know [person] quite well, I saw what they were like with [person] in the hospital and they seemed to know what might cause upset.”

Staff were aware of when people had or needed health and social care professional input. A staff member told us, “When I am on shift we have handovers, this makes sure we are aware (of appointments). People are supported one to one, or two to one, so this ensures people are calm and assured during appointments.”

Health and social care professionals provided positive feedback about the service and said the registered manager and staff worked with them so people received safe appropriate support. Comments included, “Where there have been concerns about a residents health and/ or a change in their baseline presentation, the manager has contacted me in a timely manner to request advice and support.”

People received a continuity of care when they needed to go for appointments or when health and social care professionals visited them at the service. People contributed to their ‘care passports’ which provided information to professionals who may not know them well. The care passports detailed what can make the person anxious, how the person preferred to communicate and other details which were important to them.

People were comfortable in the company of staff and told us they liked the staff. People’s relatives said if they had any concerns of safety they would speak with the registered manager. One person told us, “I like living here, I like the staff.” A relative told us that their loved one had not shown they felt unsafe, they said, “I think [person] is black and white, if they were worried about anything [person] would communicate this in their own way.”

Staff undertook safeguarding training and demonstrated their knowledge of the prevention of abuse and who they would report to if they had any concerns, this included within the service and to external agencies. A staff member described safeguarding as, “Keeping people safe and reporting anything that harms.”

We observed staff knew people well and supported them safely and with kindness. People who were subject to DoLS authorisations and applications appeared settled; most people were out with staff for various outings throughout our assessment.

Staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). No person was restricted to areas of the service and where needed, MCA assessments were completed appropriately and best interest decisions were made in the least restrictive way. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). DoLS applications were made appropriately and conditions to DoLS authorisations were met, for example, people’s medicines were reviewed regularly. The provider’s safeguarding policy was clear for staff to understand should they have any concerns about people. Systems to safeguard people from the risk of harm or abuse were followed by staff. The registered manager and staff reviewed incidents and where safeguarding concerns were identified, they were escalated to the local safeguarding team and CQC were appropriately notified. Safeguarding concerns were investigated and lessons learned were shared with staff.

People were no longer unduly restricted to use some areas of the service. For example, the kitchen area was no longer locked, people were able to use the kitchen and laundry freely or go out in the garden as they pleased, risk assessments were in place and supported people to live full lives. People were involved as much as possible in the planning of their care so staff were aware of how they wished to be supported. People were supported to take risks and were involved in the planning to mitigating risks. For example, one person liked to smoke cigarettes; the registered manager spent time with the person to discuss how this could be managed safely.

Risk assessments and associated guidelines written by staff and management provided details on how staff could safely support people. The registered manager told us about how they involved people and spoke about a person who smoked cigarettes. They said, “We gave [person] easy read documents on quitting and the negative health effects of smoking. [Person] was involved with the guidelines, I sat with them first, we talked about how many they wanted to smoke a day. It helps with [person’s] anxiety. We gave as much information as possible to help [person] make that decision on their own.” A staff member explained how they empowered a person to feel independent when taking public transport, their risk assessment concluded they would not be safe alone. So staff went with the person but the person took the lead and instead felt they were taking the staff on the bus and not the other way around. The staff member said, “Everything about the journey is explained and then again as we go, it helps them to learn what they need to do.”

We observed people using the kitchen, laundry and spending time in the garden. People were supported by staff regularly throughout the day to go out where they wished, for example, to the shops and to visit their family. People had weekly planners and staff were seen to remind people what the plans were for the day which helped people achieve what they wanted to do. We saw staff were following people’s support plans, when a people became anxious or distressed, staff responded appropriately. For example, a person was appropriately given space when they were anxious. Another person became upset and was quickly comforted and reassured by a staff member.

Risks to people’s health were assessed, mitigated and managed. For example, people who lived with health conditions, had appropriate guidelines to advise staff on how to support them safely. Where people displayed emotions of distress and anxiety, positive behaviour support (PBS) plans were written up so staff could understand the cause of distress and how to support people if they became anxious. People’s care records showed staff were following actions to reduce risks to people.

The service was suitable for the people who lived there. Some people preferred to have less items in their bedrooms and their wishes were respected. When asked about the service, a person told us, “It’s alright, it’s nice.” A relative said, “They made a real effort to redecorate [person’s] room. The room is fine, it could be bigger, but they are happy there, [person] can close the door and have a nice space, they have decent views.”

Staff ensured the environment was homely for people and made sure people had everything they needed and wanted. A staff member said, “Everyone chooses their decoration and design.” One person liked to use a communal space as a quiet area to use their laptop. Staff referred to this is ‘[Person’s] office’ and respected this space. The registered manager told us about changes they had made to the environment based on feedback, this included the refurbishment of conservatory area and new garden furniture which had been purchased.

We observed the environment suited the needs of the people who lived there. There were pictures on cupboard doors in the kitchen which supported people to know what was inside, this aided their independence when choosing meals and snacks. We saw a person checked the photo before opening the correct cupboard. Some people had menu plans on the wall so they knew what they were having at mealtimes. One person liked to update the staff board with photographs of the staff working on the day of our assessment, we saw them doing this.

Regular health and safety checks were completed, the registered manager told us at the beginning of each day, they or their deputy manager would walk around the service to identify if repairs or maintenance were required. Environmental checks and risk assessment, including for fire were completed and were up to date. Staff described what they would do in an emergency situation; their knowledge correlated with the emergency plan. People had personal emergency evacuation plans (PEEPs) which included the level of assistance they may require in an emergency.

People and their relatives mostly gave positive feedback about the staff and their availability to support them when they wanted. A person had been out and told us, “I have been to buy toiletries with [staff name] on the bus.” They told us they did this often and said, “Oh yes, I like to get my things.” Two people wanted to go to a local national park for a picnic, this was well planned and there were enough staff to support them to do this.

Staff provided positive feedback about the staffing levels. A staff member told us, “No issues with staff numbers. We have lots of one to one and two to one support here.” Another said, “There is always at least 4 on shift as well as the manager. They put more on the rota if there is an appointment or if there is a planned outing. We do have enough staff to have outings when the clients want to go out unplanned.” Staff told us felt supported in their roles and received supervision and appropriate training. A staff member said, “For training we have had online and at head office face to face. We have done the Oliver McGowan training we do a lot of training they get sent to us bit by bit but we have to be updated.” The Oliver McGowan training is the government’s preferred training for supporting people with a learning disability and autistic people.

We observed there were enough knowledgeable and experienced staff to support people and keep them safe. One person became upset, a staff member was available to immediately provide comfort which quickly reassured the person. Staff had time to chat to people and were free to go out with people when they wished.

Rotas and staff allocations were planned in advance, the registered manager oversaw staff allocations to ensure appropriate skills mix so people were well supported. The registered manager kept a training matrix to ensure staff had received their required training and that their training remained current. The registered manager knew people well and was also available to provide support when needed. Staff were recruited safely; pre-employment checks had been carried prior to their appointment, this included their right to work in the UK. New staff completed an induction period and had a period of shadowing more with staff who had worked at the service for many years.

People and relatives said they were satisfied with the cleanliness at the service. People were supported by staff to keep the service clean and do their own laundry. Some relatives gave mixed feedback about the cleanliness, comments included, “For me, it’s not as clean as I would do it, but not a criticism of them, my standards are very high. My priority over and above is the care.” And, “I have noticed sometimes there is no loo roll and not sure if there were handwashing facilities. The bathroom near [person’s room] needs updating but it is clean. Everything else, kitchen and dining area seem to be ok.”

Staff had received training in infection prevention and control (IPC) and followed the provider’s IPC policy. Staff were knowledgeable about how to prevent the spread of infection; their knowledge was confirmed in the provider’s question and answer sections in IPC audits.

The service was clean, people were supported by staff to ensure their bedrooms were cleaned. The laundry was well organised, the kitchen and bathrooms were clean. We observed staff using personal protective equipment (PPE) appropriately.

The provider's infection prevention and control policies and procedures reflected current guidelines. Audits of the kitchen, environment and laundry were conducted and any areas of improvement were addressed. For example, a kitchen audit identified an additional temperature probe was required, so the registered manager had ordered one.

People received their medicines as prescribed and in their preferred way. Some people liked to go to the office when their medicines were due, others preferred their medicines to be brought to them. People’s relatives were involved and kept informed of any changes to medicines. We observed people were administered their medicines respectfully in the way they wished. For example, a person came to the office for their medicines, afterwards they took away the used drinks glasses and medication pots to wash them up as they liked to do this.

Staff were trained and assessed as competent to administer medicines safely. Guidance was in place to help staff understand when to give people their ‘when required’ (PRN) medicines and what dosage. Where people were prescribed PRN medicine for anxiety or agitation the registered manager requested staff contacted them first, this was to ensure the medicine was administered as the last resort. Staff said they felt their training equipped them with the knowledge to safely administer medicines. One staff member said, “I do administer medicines, I have refresher training and our line manager asks us to demonstrate how to carry out meds administration regularly.”

The management and storage of medicines was completed safely. Regular audits were conducted to ensure there were no gaps in administration and that the guidance was being followed. Staff and management followed the principles of STOMP (Stopping over medication of people with a learning disability, autism or both with psychotropic medicines.) People received regular reviews to ensure their medicines were appropriate and staff monitored people for side effects. There were examples of where staff and medical professionals supported people to reduce their medicines.