This inspection was carried out by a CQC inspector. We spoke with eight people who used the service, two relatives, six members of staff and the senior care manager. We also reviewed records relating to the management of the service, which included three care records, staffing records, sample menus and quality audits. We used the information to answer five questions we always ask: Is the service safe?
We saw detailed care records that contained information for staff about people's needs and the support needed to ensure they were safe. Risk assessments identified risks in daily living and the measures in place to reduce those risks. A person at risk of choking had been referred to speech and language specialists for assessment. A person who had frequent falls had been referred to the falls clinic. Information from the assessments had been included in the person's care and treatment plan to ensure their safety.
The provider had a system in place to monitor and review accidents and incidents. Serious incidents were reported in detail and reviewed by managers to see if lessons could be learned to reduce the risks of them happening again.
All care records had been reviewed and updated since our last inspection. This ensured that there was a current profile of risk for each person and staff had the necessary information to keep people safe.
We monitor the operation of the Deprivation of Liberty Safeguards 2009 (DoLS) that apply to hospitals and care homes. No applications had been made to the local authority under this legislation since our last inspection. The service were aware of their responsibility to make applications under this legislation having made previous applications. No DoLS authorisations were in place at the time of our inspection.
Is the service effective?
People's health and care needs had been assessed. Records reflected the correct level of support that people needed. Care records had been reviewed monthly and any changes to individual needs had been reflected in care records and risk assessments.
The GP regularly visited the service. Health checks and medication reviews had been carried out annually. The GP carried out detailed health checks using the Cardiff health check for adults with a learning disability. A copy was in each person's care records. The check is for adults with learning disabilities who may need more health support and who may otherwise have health conditions that go undetected.
Some people were not able to communicate verbally. Staff told us that each person had their own communication style. People communicated with body language, signs, sounds and facial expressions. A communication plan was in place for each person and we observed good communication between staff and people who used the service.
Is the service caring?
We saw that people were well supported by staff. People were cared for in small groups of six people with a minimum of two members of staff. This meant that close and positive relationships were established between people and staff. We saw that everyone was included in the discussions and activities that took place. Staff had a good understanding of what people were feeling and saying and were able to respond to what they needed.
A relative we spoke with told us, "We are delighted with the care that X receives. Staff are sensitive to their needs, they are very, very caring." We saw many similar comments in the questionnaires that had been returned by relatives expressing high levels of satisfaction with the care and support given by staff.
Is the service responsive?
When people's health care needs changed health professionals had been contacted. Their recommendations had been recorded and followed. A relative told us, "They look after X very well who has on-going health care needs. We feel that X has better medical care than most of us in the community."
We saw that suggestions made by staff in team meetings had been acted upon. Staff told us that managers listened to their views and would consider any suggestions they made to change or improve the service.
Is the service well-led?
The service worked well with other agencies and services to make sure people received their care in a coordinated way.
The provider had an effective quality assurance system of checks and audits in place to monitor the quality of the service. We saw that where shortfalls had been identified they had been addressed promptly. As a result the quality of the service was continuously improving.
A relative told us, "Staff keep us informed about any developments relating to X. They listen and respond positively. We know we can speak with the manager at any time."