This inspection took place on 22 and 23 February 2016. The first day was unannounced which meant the staff and registered provider did not know we would be visiting. The registered provider knew we would be returning for the second of inspection.Twelve Linden Road can provide accommodation for up to six people who live with a learning disability. It is a purpose built detached house in its own grounds within a residential area of Brotton. Care and support is provided to people on both floors of the service which can be accessed via stairs. At the time of our inspection there were six people living at the service.
The registered manager had been in place at the home for many years. 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.
We previously inspected this service on 17 January 2014 and found that the service was meeting all of the regulations we inspected on that occasion.
All safeguarding incidents had been logged on the local authority’s consideration log which the service updated every month. Separate safeguarding alerts had not been made.
Each person had a Deprivation of Liberties Safeguard in place to keep them safe from harm. We could see that these had been carefully considered to look at the least restrictive options.
Accidents and incidents had been reported and appropriately investigated.
People had risk assessments and personal emergency evacuation plans in place.
Staff told us they felt confident in dealing with an emergency situation and had received up to date first aid training.
There was enough staff on duty to provide care and support to people. Staff levels changed to accommodate people’s individual needs.
Staff had been appropriately recruited. Disclosure and Barring Service checks and references had been sought prior to employment.
Staff had been appropriately trained to dispense prescribed medicines which people received on time.
Most certificates for the day to day running of the service were up to date; where two had expired we saw that the registered manager had booked these in with the appropriate services.
Staff training was up to date. All staff received regular supervision and appraisals. Staff told us they felt supported to carry out their roles at the service.
A four week menu was in place, however alternatives were always available. People were supported at mealtimes and monitoring was in place to ensure people received appropriate nutrition and hydration.
People were regularly supported to attend appointments with a variety of health professionals including their GP, dentist and optician.
There was a communal living and dining room at the service; each person had their own bedroom which had been decorated to their individual wishes.
Staff showed kindness and compassion to people. They gave people the time they needed and were not rushed.
Staff involved people in any decisions made during their day. Staff gave explanation and used appropriate communication methods to interact with people.
People had been able to access an advocate to speak on their behalf when they had needed to.
Staff provided detailed examples about how they maintained and respected people’s privacy and dignity.
Staff supported and encouraged people to maintain contact with those important to them.
Care records were very detailed and reflected people’s wishes, preferences and daily routines. This meant staff could provide the most appropriate support to people when, and how they wanted it.
People were encouraged to give feedback generally and in reviews of their care. Staff made sure people’s care reflected their individual needs and choices.
There were some gaps in records looked at during inspection.
Where complaints had been received they had been acted upon and records showed the action which had been taken to address the complaint.
The service worked alongside other organisations involved in people’s care and made sure communication between services was transparent.
People participated in regular activities in the community and were supported by staff.
Staff spoke positively about their role at the service and all told us they enjoyed working at the service.
Staff told us they felt anxious about proposed changes to their contract and felt uncertain about their future at the service.
Staff spoke positively about the registered manager. They had been in post at the service for many years. The registered manager was responsible for managing three services. We questioned the appropriateness of this because the demands of this outweighed the resources of the registered manager.
Regular meetings for people and staff took place at the service. This meant people were kept informed.
Some audits had been carried out; however there were no audits for care plans or record keeping which would have highlighted some of issues in this report.
Safeguarding incidents and accidents and incidents had been investigated.
CQC had not been notified of all safeguarding incidents at the service.
We found one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to records and one breach of regulation 18(1) of the Care Quality Commission (Registration) Regulations 2009 because we have not always been notified of safeguarding incidents at the service. You can see what action we told the provider to take at the back of the full version of this report.