The inspection was unannounced and took place on 26 November 2015. This service provides accommodation and personal support for up to six people with learning disabilities and autistic spectrum disorder. Accommodation is laid out over a single ground floor bungalow and each person had their own bedroom. At the time of inspection this was an all-male household and there were no vacancies.
This service was last inspected on 18 December 2013 when we found the provider was meeting all the regulations.
There was a registered manager in post who had managed the service for a number of years. A registered manager is a person who is 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.
Improvements were needed to the recruitment procedures for new staff to ensure these protected people from the appointment of staff who were unsuitable. People’s records did not make clear strategies for managing specific health conditions people needed support with. Improvements were also needed to the frequency of fire drills for staff to ensure they knew how to keep people safe in the event of a fire, and the recording of medicines received to ensure processes were guided by good practice. The effectiveness of staff training and supervision were also areas for improvement to ensure all staff felt engaged in and valued these processes.
People were routinely asked to comment about the service and their views were analysed, the registered manager told us that issues raised by people within these surveys were discussed at house meetings but these discussions and how they informed either staff practice or service development were not recorded. Quality assurance audits were undertaken on a weekly, monthly and six monthly basis to highlight and address shortfalls in service quality, but were not sufficiently effective to highlight the issues we found at inspection.
People were supported to develop and maximise their potential for independence at a pace to suit themselves and that they were comfortable with. Staff were guided in the support they gave to people through the development of individualised plans of care and support; risks were appropriately assessed to ensure measures implemented kept people and others safe.
Staff retention was very good and nearly all staff had been with the service for more than eight years. There were enough staff with the right skills to support people properly. Staff received induction and completed a range of on line training to give them a basic knowledge and understanding of how to deliver appropriate care and support. Staff felt listened to. Staff were very experienced and knowledgeable about the people they supported and the routines of the service. Staff said they were provided with regular staff meetings and they valued these, they felt they worked well together as a team and felt confident of raising issues within the staff meeting.
People’s medicines were well managed by trained staff. Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were maintained to a reasonable standard with further planned upgrade works underway but taking time to achieve. All necessary checks tests and routine servicing of equipment and installations were carried out.
People ate a varied diet that took account of their personal food preferences; most participated in some way in the preparation and cooking of meals if they wanted to. People’s health and wellbeing was monitored by staff that supported them to access regular health appointments when needed.
People communicated well with staff and those around them; staff understood their moods and expressions that informed staff how they were on a day to day basis and staff responded accordingly with the level of support and interaction they offered.
People made everyday decisions for themselves, but staff were available to offer support if they needed prompting.
People showed that when they were unhappy about something they made this known to staff. Relatives told us they found some staff really nice and approachable and felt confident they would inform them if there were any issues of concern regarding their relative, or if they wanted an update of what their relative had been doing.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider and registered manager understood when an application should be made and one person had a DoLS authorisation in place. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
People were treated with kindness and respect; their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and staff supported some people to make visits home to their families.
We have made two recommendations:
We recommend that the registered manager reviews NICE guidance around administration of medicines in care home in relation to handwritten changes to medicine records.
We recommend that the registered manager reviews the required frequency of fire drills for night staff in accordance with the
Regulatory Reform (Fire Safety) Order 2005.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.