Wingfield Road

At the previous inspection in November 2016 we rated Safe and Responsive as requires improvement. At this inspection we found the key question rated as requires improvement had improved their rating to good.

This inspection took place on 11 April 2018 and was unannounced.

At Wingfield Road staff can support five adults with learning disabilities that were also autistic. The home is registered to provide accommodation personal care for a maximum of five people.

It 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. Registering the Right Support CQC policy.

A registered manager was in post. 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.

Safeguarding processes were in place and ensured people at the service were safeguarded from potential abuse. Staff had attended safeguarding training on how to identify the types of abuse and the actions needed where there were concerns of abuse.

Risk management systems were effective. People were supported to take risk safely which enabled them to be independent. The staff we spoke with were knowledgeable about people’s individual risks and the actions needed to minimise the risks. Where risks were identified risk assessments were developed on how to minimise the risks.

There were people who expressed their anxiety and frustration using behaviours that placed them and others at risk of harm. Staff had attended training to help them manage these situations. Positive behaviour support plans gave staff guidance on how to respond to people when they expressed feelings of frustration and anxiety.

Staff documented accidents and incidents. Debrief with staff and people took place where the incidents were significant. The registered manager then analysed the reports for patterns and trends.

Steps were taken to ensure medicine systems were safe. People administered their medicines and risk assessments and support plans were in place for this. Where staff administered people’s medicines there was a profile which included their photograph and essential information such as known allergies and how the person preferred to take their medicines.

People told us there was staff on duty for them to have the attention they needed. Staff told us the team was stable and people received continuity of care from staff that knew them.

Staff attended training set as mandatory by the provider and there were opportunities for vocational qualifications. Staff told us they received basic mental health training during induction but not specific to one person’s medical condition. The registered manager said a staff meeting themed on this topic was to take place.

The people at the service had capacity to make decisions and told us they made all their decisions. The staff we spoke with were knowledgeable about the day to day decisions people made.

Support plans were person centred and reflective of people’s preferences. However, we found them to be repetitive and not all the action plans were related to support plan for the same area of need. We saw copies of the updated support plans which included all aspects of needs.

People told us how they kept busy. There were people that had joined groups and attended clubs. One person worked at a farm everyday and another worked on building a shed. One person was in part time employment. While we were at the home one person went on a shopping trip with staff and two people went on a trip for coffee with staff.

We saw people seeking staff attention and reassurance. We observed staff approaching people in a caring manner. For some people the staff used banter to gain their attention. We observed staff support one person to express their discontent with their current situation. We saw staff use an understanding approach and supported them with unravelling their issues.

The staff were knowledgeable about the values of the organization. They knew how these values were embedded into practice. Staff told us the team was stable and they worked well together. They told us the manager was approachable.

Quality Assurance systems were in place. Governance meetings were held with the registered manager and appropriate staff such as the deputy manager, team leader and maintenance staff. At the meeting the outcomes which included audits and events were discussed. Action plans were then devised where outcomes were not met. Copies of the minutes were then sent to senior managers. The registered manager said at the quarterly meetings the reports of unmet outcome were discussed at regional level.

This service supports adults who have learning disabilities, some of whom may have autistic spectrum disorder. The home is registered to provide personal care for a maximum of five people.

A registered manager was in post. This registered manager also had management responsibilities for three other locations. 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 saw areas of the property were in need of remedial attention. We saw one bedroom lacked ventilation and placed the person at risk from poor infection control. The registered manager subsequent to the inspection informed us of the improvements made.

Care plans were inconsistent and in places and at times included information that was opposing. Staff knew the likes and dislikes of people and recognised developing relationships with people was important.

On the day of our inspection we found a calm atmosphere. People gave us their opinion of the service and we saw them communicate well with staff. The views of people was gathered during house meetings but their suggestions for activities had not been actioned.

Staff said there were shortages of staff and people told us activities were restricted when staffing levels were reduced. The registered manager said the service was fully staffed and the focus for improvements was staff attendance.

Where staff administered medicines, the medication administration records (MAR) charts were signed to indicate the medicines administered. Protocols were not devised for all when required medicines (also known as PRN). This meant members of staff were not given guidance on consistently administering PRN medicines. Subsequent to the inspection, protocols were devised for PRN medicines.

People were supported with their ongoing healthcare conditions. People had access to health and social care professionals which meant they had specialist support from these professionals.

Staff told us there was training courses which they had to attend and included understanding autism, safeguarding of vulnerable adults, Mental Capacity Act (MCA) and infection control. Staff had opportunities to discuss their personal development during their one to one meetings with their line manager.

People said they mostly felt safe with each other and the staff made them feel safe. Members of staff said they attended safeguarding from abuse training. These members of staff were able to describe the procedure including the types of abuse and the actions they must take for suspected abuse.

Risks management systems were in place. The staff knew the types of risk associated with each person and risk assessments were in place on how to minimise the risk.

People at the service were able to make daily living decisions and were not subject to continuous supervision. People were given individual food budgets and there was an expectation they prepare meals and their refreshments.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. During the inspection four people were living at the home and two of these people were willing to speak with us briefly about the home during the inspection. We also spoke with two relatives of people living at the home.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw that there were procedures in place in the event of a fire and that emergency contact numbers were clearly displayed.

In some cases equipment was damaged and required replacing or repair.

The premises had not been suitably maintained in line with recommendations and regulations. This meant that people were not protected from the risks of premises that were not adequately maintained.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People were not detained under Deprivation of Liberty Safeguards. Relevant staff were involved with conducting assessing mental capacity where appropriate. We saw evidence in people's files that consent was sought before care or treatment was provided. People at the home were supported to leave the home when they wished, either independently or with staff support if required.

Is the service effective?

We saw that people living at the home had care assessments and plans to identify their needs. Staff told us that care plans and daily records gave them enough information about how to support people. One relative said that staff ensured that a person living at the home had medicines and had appointments with external professionals such as doctors. One person living at the home told us, 'They take me to the doctor.' This meant that people living at the home were supported with their healthcare needs.

People were supported to participate in activities of their choice. One person living at the home said, 'Staff take me to my allotment'. Another said, 'We have just been to the beach.' One relative told us how staff took a person to a club. This showed that the service was effective in providing people with opportunities for leisure pursuits and interests.

Staff told us that they felt well supported and that they received adequate supervision, training, and appraisal. One staff member said, 'We do get enough support.' Another staff member told us how they received online and face to face training. This meant that staff received sufficient guidance and training to enable them to meet people's needs.

Is the service caring?

We observed that interactions between staff and people living at the home were caring and friendly. We saw staff talking with people about topics of interest. One relative said, 'Generally speaking staff are caring, helpful, and polite, and friendly.' This meant that staff at the home supported people in a caring way.

Is the service responsive ?

Systems were in place to make sure that managers and staff learnt from complaints, concerns, accidents, incidents, and audits. People living at the home said that they felt that they could discuss any concerns with staff members. One person told us that they had been encouraged by staff to talk through any concerns that they had. One relative said, 'I can talk to staff and discuss any issues.' They then described a situation where they had made a suggestions and this had been listened to and implemented.

Is the service well led?

The provider had an effective system to assess and monitor the quality of service that people receive. We saw that the home had sought the views of people living at the home and staff members, and had implemented changes following this. Audits of the home had also been carried out relating to training and staff support and steps were being taken to improve on the service following these. Incidents, accidents, complaints, and concerns were monitored and this information was used to improve the service. This meant that the provider had taken some steps to reduce the risk of inappropriate care and treatment through monitoring the quality of the service.

We spoke with staff who demonstrated they understood the individual needs of all five people. Staff told us this helped them to present information in meaningful ways that enabled the person to make choices and decisions. We observed staff supported people with activities of their choosing. For example, with shopping, meals and trips out.

We spoke with staff and looked at care records to see how the provider cooperated with other services to ensure appropriate and safe care for people. We saw individual needs and goals were identified and people had been supported to access and obtain a range of health and social care services.

We spoke with people and staff about medicines. We observed people needed different levels of support and staff told us they had clear processes to follow in order to support people appropriately. We saw medicines were stored safely and medicine records had been signed. We saw staff were in date with medicine training and we saw other records which showed medicine audits were regularly completed.

We spoke with the manager and looked at records to see if the provider had effective recruitment procedures. We saw records which showed the provider followed a process. This included completing relevant checks to ensure prospective staff were mentally and physically fit for care work.

We spoke people and staff about complaints. One person said 'I had a complaint, I write it down and then staff talk to me. I'd talk to staff if I had any issues.' All the people we spoke with told us they felt staff or the manager would listen to anything they had to say. Staff told us they knew how to access the complaints policy and would be comfortable making a complaint.

We looked at different records to see how people were protected against the risks of unsafe or inappropriate care. We looked at people's care records and saw each person had an individual support plan and risk assessments. We looked at other records which identified what actions staff should take in the event of an emergency. These included gas, fire and electrical emergencies. We saw records were stored safely and accessibly.

We were told 'staff leave me to get on with what I want.' Another person said 'the staff are good' People were supported to maintain and develop their independence. People were involved in the community and attended a range of activities which reflected their personal likes and preferences.

People were supported to shop and cook based on their own weekly menu plan. Staff were aware when people were not eating healthily and supported them to make the appropriate dietary choices.

Staff were confident in their understanding of safeguarding adults and how to report concerns.

There were enough staff on duty to meet people's needs.