Cambridgeshire County Council - 40/44 Russell Street Cambridge

We found the following examples of good practice.

On arrival at the home staff had their temperature taken, completed a health questionnaire and declaration, were required to wash their hands and were given personal protective equipment (PPE) to put on. Visitors to the home were asked to undertake a Lateral Flow Test before gaining entry to the home.

The home had an ample supply of PPE. All staff had received training in the correct use of PPE, and how to take it off and put it on safely.

People were supported to have regular contact with their families and friends via video calling. People were supported to take part in activities that they enjoyed with staff.

Testing was carried out for both people living in the home and staff on a regular basis. If anyone had symptoms of COVID-19 they were tested immediately and isolated until the results were received.

Cleaning of the home, including frequently touched surfaces, had increased to reduce the risk of transmission of infection. There were ample supplies of cleaning equipment. Due to the size of the property it was difficult to maintain social distancing at all times. To mitigate the risks of spreading any infections the number of people using the respite service at the same time had been reduced.

Cambridgeshire County Council – 40/44 Russell Street Cambridge provides short-stay and long-term accommodation and personal care for up to nine people who have learning disabilities.

The service is divided into three areas: a four bedroomed house for people who live at the service, a four bedroomed house for people who have short stays at the service, and a flat for one person who can live semi-independently.

At the time of our inspection there were three people living at the service.

The service was a large home, incorporating three domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

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 received exceptionally and highly personalised care that was responsive to them and respected their individuality. We received very positive feedback about the service. Without exception, healthcare professionals told us that staff were extremely responsive to people needs and preferences and that staff provided very person-centred care.

Staff recognised people’s diverse needs and their rights and choices. People made their own decisions and staff listened to them. People were involved as they wanted to be in the local community. People celebrated events and staff actively encouraged them with their hobbies, interests and personal goals. People and their relatives were involved in their, or their family member's, care reviews. People’s needs were constantly reviewed, and support adapted as required.

People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Staff assessed and minimised any potential risks to people. There were effective processes in place to reduce the spread of infection. Staff managed people’s medicines safely.

The provider continued to have a system in place to ensure that they only employed staff whose suitability to work at the service had been verified. There were enough staff to meet people’s needs safely. Staff worked well together to ensure people were safe and well cared for.

The management team ensured that staff delivered up to date care in line with good practice and current guidance. People received care from staff who were competent, trained and well supported to meet people’s assessed needs. Staff supported people to have enough to eat and drink and to access external healthcare services when needed. Staff worked well with external professionals to help improve and maintain people’s physical and emotional wellbeing.

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 in the service supported this practice. People were involved in making decisions about their care and support. Where people needed additional support to make decisions, staff referred people to external advocates.

Staff knew people extremely well and displayed genuine fondness for them. They supported people in a caring, respectful and person-centred way. Staff supported people to develop their independence. Privacy and dignity were embedded into the team’s practice and people were treated with the utmost respect. People were supported and encouraged to express their views and to be involved in decisions about their care. They were involved in care planning and reviews.

Staff worked in partnership with a wide range of professionals to ensure that people received joined up care. The service played an active role in the community and had links with other resources and organisations to support people’s preferences and meet their needs.

Staff member's commitment and enthusiasm for providing a high-quality service was evident throughout our inspection and by the feedback we received. The registered manager was committed to ensuring staff provided a high-quality service and sought information from people using the service, their relatives, and staff, on a regular basis. Staff worked well together and demonstrated the values and vision of the service. People and their relatives felt able to raise concerns. The provider had systems in place, including a procedure, to deal with any concerns or complaints. The registered manager and staff were committed to learning and to improve outcomes for people using the service.

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

Rating at last inspection: Good (report published 04 November 2016).

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.

This unannounced inspection took place on 22 September 2016. There were six people receiving care at that time.

The service had a registered manager in place. 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 was also registered to run another of the provider’s services, Cambridge Supported Living Scheme, from the same address.

People were supported to safely manage their other prescribed medicines. There were systems in place to ensure people’s safety was managed effectively. Staff were aware of the actions to take to report their concerns. People’s risks were assessed and measures were in place to minimise the risk of harm occurring. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

Staff were only employed after comprehensive and satisfactory pre-employment checks had been obtained. There were sufficient staff to ensure people’s needs were met safely. Staff were well trained and had the skills and knowledge they needed to support people. Staff were well supported by the registered manager.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. People’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, they had been supported in the decision making process. Staff were aware of the key legal requirements of the MCA and DoLS.

People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs. People had access to the health care services they needed.

People received care and support from staff who were kind, patient, compassionate and caring. Staff treated people with dignity and respect. People and their relatives were encouraged to be involved in decisions about the service provided. People were involved in every day decisions about their care.

People’s care records were detailed and provided staff with sufficient guidance to ensure consistent care to each person. People were supported to engage in varied social and recreational activities. People were supported to maintain relationships that were important to them.

The registered manager was experienced and staff were managed to provide people with safe and appropriate care. The registered manager was approachable and supportive. People had access to information on how to make a complaint. The service had an effective quality assurance system that was used to drive and sustain improvement.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people using the service had complex needs which meant they were not all able to tell us about their experiences. We spoke with one person who received a service, three people who visited the home regularly and six staff members.

Is the service safe?

Staff were provided with the knowledge they needed to ensure people's rights were respected and taken into account when care was provided. This included training in the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DOLs). The staff we spoke with were clear about how they obtained people's consent to their care and support. They also spoke of the importance of people being supported to make informed choices about their lives and the involvement of advocates. This ensured that people who could not make choices for themselves were protected.

We saw that care plans and risk assessments were in place and were reviewed regularly. We noted that one person's file did not contain an important document that informed health care professionals about a person's needs. The manager told us that this did not impact on the care the person received because a member of staff who knew them well had accompanied them and provided the hospital staff with the information.

There were effective systems in place to reduce the risk and spread of infection. On the two days of our inspection the home looked clean and smelled fresh. We saw that the service had up to date policies on the prevention and control of infections and that staff had received training in this area.

We found there were effective recruitment and selection practices in place. This ensured that only suitable staff were appointed to provide care for people.

Is the service effective?

People and their relatives told us that they were very happy with the care that they, or the person they visited, received. One person who visited the home very regularly told us that staff understood the needs of the person they were visiting. They described how staff acknowledged and responded to the person's non-verbal communication. Two other visitors told us that their relative was, 'very happy' at the home and that the staff knew their relative 'really well'.

The staff we spoke with clearly knew the people they were working with well and spoke about the importance of understanding each person's individual preferences when providing care.

Is the service caring?

People and their relatives confirmed that they were consulted about, and happy with, the care and support they or their family member received. One person who visited the home very regularly described how staff acknowledged and responded to the person's non-verbal communication.

People's needs were assessed and care was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing care to people living at the home. The staff interactions with people that we saw were respectful and caring in their approach.

Is the service responsive?

We saw that the provider asked people, and their relatives, to complete annual feedback forms about the quality of the service provided. The feedback had not been completed for the year of our inspection. However, we found that the feedback forms for the previous year had been analysed and actions had been taken to address any issues raised.

The visitors we spoke with told us they had no concerns about the service. They told us they would feel confident raising any issues they had with senior staff and felt they would be listened to.

Is the service well-led?

A registered manager had been in post for over a year. At the time of our inspection the registered manager was on extended leave and the service was being managed by the deputy manager.

The staff we spoke with told us the senior staff were very approachable. They said they had received comprehensive induction, training and support which helped them to meet the needs of the people they provided care and support to.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.

We saw there were various audits in place to ensure that standards were maintained. For example regular checks were made by seniors that people's care plans had been updated. The provider may find it useful to note that there were some gaps in the completion of these.

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

We observed that, people showed they were content living at this home and that they had good relationships with the staff. They told us that they felt safe, and were satisfied with the service being provided. There was laughter and friendly banter between staff and people living in the home during our inspection.

Care records we looked at were well written and the people living in the home told us they understood the care and support being provided.

Medication administration procedures and records were well managed and checks carried out to prevent any errors.

Staffing levels were adequate to meet people's needs and the staff felt well supported and received appropriate training to ensure their skills and knowledge remained up to date and in line with best practice.

People were given the opportunity to raise any concerns they had about their care and support.