This inspection took place on 31 May 2017 and was unannounced. The service provides accommodation and personal care for up to four adults with a learning disability. At the time of our visit there were four people living at the service. There was a registered manager 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. The registered manager was also the registered manager for a sister home two doors away and as such ran both services very similarly aside from recognising and promoting the individuals who lived in each of the two homes.
We last inspected the service in January 2015. At that time we found no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 or the Health and Social Care Act 2008 (Registration) Regulations 2009. The service was rated as Good in all five key lines of enquiry and received an overall rating of Good.
At this inspection we found the service remained Good in three of the key lines of enquiry and they had improved to an Outstanding rating in Caring and Well Led. Overall the rating has changed to Outstanding
St Mary’s was part of a small organisation which also included an additional small care home accommodating 10 people in total and, a domiciliary care agency providing care and support to people in their own homes. The ethos, vision and values were provider led and, as such, applied across all three services. This included; following current best practice, innovation, plans for the future and continuous striving to be the best. It was evident that the provider and registered managers worked together effectively. However each service was additionally recognised for its individuality. They had a healthy, respectful, working relationship which encouraged each service to strive to provide the best possible care independently, based on their own merits. Two of the providers other services had received an overall outstanding rating following inspections by CQC in November 2016.
Following those inspections the provider and registered manager had continued to improve the quality of the services they provided despite having achieved outstanding status. They continued to put people who used their services at the forefront of this.
The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, action plans were in place about how to manage these, monitor and review them. Medicines were managed safely and staff followed the services policy and procedures.
People were supported by the services recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.
People moved into the service when a full assessment had been completed and the registered manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.
Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty safeguards (DoLS) were understood by staff and, appropriately implemented to ensure that people who could not make decisions for themselves were protected.
People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.
People were confident in their surroundings and with each other. The atmosphere was very pleasant and people were doing their own things to relax and pass the time of day. St Mary’s had a family atmosphere and homely feel. Staff were knowledgeable about everyone they supported and it was evident they had built up relationships based on trust and respect for each other. People experienced a lifestyle that met their individual expectations, capacity and preferences. There was an ethos of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated.
People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs.
Further information is in the detailed findings below