This inspection took place over five days with an unannounced site visit on 22 January 2018 and announced site visit on 26 January 2018. Where we receive information of risk or concern about a service, or information that indicates a service has improved, we may carry out a comprehensive inspection sooner than originally scheduled. The comprehensive inspection for this service was carried out sooner as we received information of concern and risk which we needed to explore.When we conducted a previous inspection in September 2015, we rated the service ‘Good’. During this inspection breaches of legal requirements were found and the service was rated ‘Requires Improvement’.
15 Archers Green provides care, support and accommodation for up to three adults with autism/learning disabilities and complex needs. People living at the home are supported by staff on a 24 hour basis. At the time of our inspection there were three people living in the home; each person had their own bedroom and shared communal areas. Two of the bedrooms had en-suite facilities with an additional bathroom and downstairs cloakroom. People had access to a well maintained garden at the rear of the home.
15 Archers Green is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
There was a registered manager in post. The registered manager was also the registered provider.
Staff recruitment processes were not always safe. Files that we checked did not demonstrate robust recruitment checks in line with the provider’s policy.
Systems and processes were in place to monitor the quality and safety of the service, however these were not always effective. We saw evidence of quality assurance audits being completed, however they lacked a review and analysis from the management team and had not identified the issues found during this inspection.
Accident and incidents were recorded where required and reviewed by senior staff and managers. However one report did not contain detailed information to provide a rationale as to why physical intervention had been used. This was discussed with the behaviour manager during inspection.
Consent for care was not always gained in line with the principals of the Mental Capacity Act 2005 (MCA). We could not see any evidence of best interest involvement within the support plans viewed.
We saw evidence of detailed risk assessment at Archers Green that provided guidance for staff in managing identified risks. Risk assessments were reviewed regularly.
Each person living at Archers Green had a Personal Emergency Evacuation Plan (PEEP) in place. We saw the PEEPs did not provide guidance for staff to safely evacuate people during an emergency. This was discussed with the deputy manager during inspection.
We saw evidence that medications were stored and administered safely. Staff had received appropriate training to safely administer medication and had their competencies assessed regularly.
Staff had received training in relation to safeguarding adults from abuse and neglect. Staff we spoke with showed a good understanding of how to safeguard adults from abuse and how to report any concerns.
Staff had received training in relation to behaviours that challenge and physical intervention. Staff told us they felt confident dealing with situations when people may present with behaviours that challenge or if they became physically aggressive.
We saw that staff had received training in most areas relevant to their role, however training provided for autism was an 'introduction to autism' delivered by the registered provider and not an accredited training program. Relatives told us they did not feel that some staff had received adequate training around autism and felt this affected their ability to manage people and their behaviours effectively whilst out in the community. This was discussed with the registered manager during inspection.
Staff were supported in their role through supervision and appraisals.
We saw that applications to deprive people of their liberties had been applied for appropriately.
People living in Archers Green did not always have access to health care appointments when required. We saw from care files that appropriate referrals were made for health/medical care but relatives told us that medical treatment was not always requested within an appropriate timescale.
People were supported with their nutritional needs. We saw from care files that people were encouraged to maintain a healthy, balanced diet. Staff encouraged people to be involved in the choices made and the preparation of meals provided.
Relatives told us that staff were kind and caring towards people living in Archers Green. We observed staff to be kind and patient with people and interact in a positive, effective manner.
Staff we spoke with were able to explain how they would maintain people’s dignity whilst providing personal care and the importance of treating people with respect.
Relatives were encouraged to express their views and from the care files we looked at we saw evidence that relatives were involved in the decisions about people’s care. When staff conducted reviews of people’s care files, relatives were involved in any changes that were made.
The care records viewed showed that staff encouraged development and independence from people living in the home. They were encouraged to be actively involved in events throughout the day such as cooking, cleaning and personal care.
Care records were based on individual needs and were reviewed and updated regularly. People living with autism each have individual characteristics and behaviour traits; care files that we viewed contained information specific to the individual. People’s support plans provided detailed guidance for staff to provide the right support.
People living in Archers Green were provided with a wide range of activities; we saw evidence that people were supported to access regular activities ; such as the park, swimming, cinema, shopping, sensory centres and trampoline parks.
The registered provider kept a record of complaints for all five of their locations; there were none recorded for Archers Green. However those recorded for other locations did not provide a detailed account of the complaint or how it was dealt with.
Relatives and staff spoke positively about the registered manager and the management team. Relatives told us the registered manager was always approachable and easy to contact and regularly kept them informed of any changes/updates.
The registered manager showed a continued desire to improve on the quality of care and support being provided to people using their service.