Archived: Care Management Group - 4 Vallance Gardens

Care Management Group – 4 Vallance Gardens is a residential care home providing personal care for up to seven people living with a learning disability, aged between 18 and 30. At the time of the inspection, there were four people using the service. People lived in one adapted building.

The service has been redeveloped 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 and what we found

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 felt safe. Staff understood safeguarding, signs of abuse and how to report any concerns. When things went wrong, staff reflected on the incident and learnt lessons. Changes were made when necessary to prevent reoccurrence. Risks to people’s safety and well-being were identified and assessed. People received their prescribed medicines safely from staff who were trained and assessed as competent to support them. Infection control was well managed.

There were enough staff available to support people. Recruitment continued as more people moved into the service. Staff new to the service were supported with induction. Staff were supported with ongoing training and supervision.

People’s needs had been comprehensively assessed before they moved into the service, with the involvement of relatives, previous support services and professionals. People’s move into the service had been well planned, with regular opportunities for staff and people to meet, both at the service, at family homes and in other support environments. One person’s relative told us, “I would say throughout the whole onboarding process we have been delighted with everything that we have seen and been involved with, their standards of care and attention to detail.”

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. People were supported to access healthcare support as needed, and staff worked in partnership with health and social care professionals.

People were treated with kindness, care and compassion. People’s relatives were pleased with the service provided. One relative said, “It’s fantastic, absolutely brilliant. I couldn’t ask for a better place.” People were encouraged to express their views and make choices about their care and support. People’s privacy was respected, and their dignity promoted. People were supported and encouraged to be independent and staff sought to develop and increase people’s independence.

People received personalised care. Staff knew people well and responded to their wishes and needs. People were encouraged to choose their own key workers, activities and ways to spend their time. Key workers are designated members of staff that support the person with managing support needs, achieving goals and updating documentation. People’s communication was well understood by the staff team, and we saw communication aids and assistive technology in use to support people to communicate.

People and their relatives knew how to complain and were confident to do so. There had not been any complaints since the service had been redeveloped. People, their relatives and staff were involved in the ongoing development of the service. Quality assurance processes, such as audits, were used to identify areas for continuous improvement.

There was a positive and person-centred culture, promoted by the registered manager. People and their relatives spoke highly of the registered manager and her dedication to the people and service. Staff told us they were well supported. The registered manager understood their regulatory responsibilities.

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 Requires Improvement (published 25 November 2016).

The provider told us after the last inspection what they would do and by when to improve. The service then went dormant. A location can go dormant on the register when it is no longer providing regulated activity. In this instance, the service had closed whist the building was renovated.

At this inspection, there had been significant change. The registered manager, staff and people living at the service were all new. We found the provider was no longer in breach of regulations.

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.

Care Management Group - 4 Vallance Gardens provides accommodation for people who require personal care. The accommodation is a large house in central Hove providing support for up to ten people with learning and physical disabilities and complex communication needs. People were not able to communicate using speech and used body language, signs and facial expressions to let others know how they were feeling. At the time of the inspection there were eight people living at the service receiving support.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous comprehensive inspection of 9 February 2015 identified a breach of the regulations. We found the registered person had not protected people against the risks associated with unsafe or unsuitable premises because of inadequate maintenance. We also found a number of areas of practice that needed to improve, including improvements to audits relating to cleanliness and infection control and the management of some medicines. The provider produced an action plan to tell us what they would do to meet the legal requirements.

We undertook this comprehensive inspection on 27 & 28 September 2016 and checked whether the required actions had been taken to address the breach previously identified. This report covers our findings in relation to these requirements. Improvements had been made in the areas previously identified. However, we found breaches in relation to the care of people and in the requirement for the registered person to notify us of any incident of abuse or allegation of abuse in relation to a service user.

People's respect and dignity was not always considered. They did not always receive support from staff who initiated interaction or acknowledged the person and their needs. Staff did not always take time to speak with the people who they supported. We also observed some positive interactions and it was clear people enjoyed interacting with staff. However, not all staff interacted with people in a social way or addressed people only to provide a task. A person’s representative said, “I pointed out to staff a year ago that [named person’s] zip was broken on his jacket. Staff helped dress him in the jacket and were going to send him out in it with the zip broken. To me it’s about respect and caring what he wears.”

The registered manager had not informed CQC of a safeguarding incident. This is part of the registered person's responsibilities. By not being informed of incidents, CQC are potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe.

Improvements were needed to ensure that people’s prescribed medicine was administered as directed to protect people from potential risks associated with medicines. A medicine recorded on the Medicine Administration Records (MARs) was not given as directed by the GP.

People’s support plans were extensive but not always up to date. Not all files were updated to reflect changes or to ensure people’s safety and welfare. However, those plans that were up to date were person centred and gave staff the information and guidance they required to give people the right support. People had clear support plans and guidance in place to ensure staff were able to effectively support to help meet their sometimes complex specialist support needs. We identified these as areas of practice that required improvement.

Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Systems were in place to ensure people were protected from the risk of abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure the safety of people, staff and visitors.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The manager and the management team understood their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments and decisions made in people’s best interest were recorded.

There were enough staff with the right skills and knowledge to meet people’s needs. The relative of one person told us, “[Named relative] didn’t want to go out and the staff gradually got him to take small steps each day and now he goes up to the café twice a week and he really enjoys that.” Staff received the appropriate training to fulfil their role and provide appropriate support. Staff were supported and worked well as a team. They told us they were supported by the registered manager and by one another.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People had access to the food that they enjoyed. People’s nutrition and hydration needs had been assessed and recorded. People were encouraged and supported to be as independent as possible. People were supported to remain as healthy as possible with the support of healthcare professionals. One representative told us, “[Named person] should be having some control over his weight and he is supposed to have a healthy diet. He takes things out the fridge and now he has his own fridge for snacks. They put snacks in it like yogurt but they could put in cut up vegetables.”

People participated in activities within the service and the local community. One member of staff told us, “[Person] is quite insular and it can be quite difficult to get a response from them but we have a music therapist who visits and to see them respond by dancing is wonderful.” There were enough staff to support people to participate in the activities they chose.

Processes were in place to monitor and improve the quality of the service provided to people. The provider had a vision and set of values that were followed and implemented by the registered manager and staff team. The registered manager was well regarded by people’s representatives and staff. One relative said, “The new manager is better. When I talk to her, she takes notes and she definitely does things. She went out of her way to get some equipment for [my relative].”

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Some of the people who lived at the home had very specialised means of communication and we were unable to ascertain what a number people felt about their experiences in the home. However throughout the visit we saw that staff took time with people to establish their needs and used different methods to communicate based on their knowledge and understanding of the individual.

We saw that the home was clean and that people's bedrooms were personalised. We viewed communal areas that included a sensory area within the living room and a newly refurbished garden. During our visit we saw that a violinist was playing music for people and we were told that this was a regular activity that occurred every week.

Staff we spoke with told us they felt they had the time and the staff needed to care for people well. One support worker told us "We can do so much more than the basics," another told us "the quality of care is good, we focus on people's quality of life." A relative told us that while there had been some recent staffing difficulties "the care is mostly good". Another relative told us "I'm thrilled to bits with the care".

We looked at how people are cared for and noted that staff are recruited with peoples' safety and security in mind through a thorough vetting process. They receive the correct medication on a regular basis, and are subject to many checks to ensure they receive the correct nutrition.

We noted that there had been improvements started to the fabric of the building to provide better entrance facilities and security. There is an ongoing refurbishment plan which will improve a number of areas in the home.

We also saw that the manager and staff undertake a number of checks to ensure the safety of those in the home.