Archived: Foxglove Care Limited- 33 Main Street

Foxglove Care Limited –33 Main Street, is a care home providing personal care for one person who has a learning disability and/or autism. At the time of our inspection one person lived at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

Care and support at this service was tailored to support that person’s specific needs and preferences. Their relatives were fully involved in developing and updating their planned care. The person was supported with activities and interests to suit them. Relative’s provided positive feedback about the staff and their caring nature.

The person was supported with their communication needs and staff demonstrated effective skills in communication. Recruitment checks were in place to ensure staff were suitable to work at the service. Staff had received training and support to enable them to carry out their role. We made a recommendation regarding updating training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff had positive links with health care professionals, which promoted the persons health and wellbeing. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks. The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness safety and how to minimise risks.

The registered manager led by example to ensure the person received a good service. Relatives and staff told us the registered manager was approachable and listened to them when they had any concerns. Feedback was used to make continuous improvements to the service.

The outcomes for the person using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. The persons support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected this location on 15 November 2015. At that time the home was rated overall as requires improvement. We identified a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17(2) Good governance in Well Led. This was because there was no effective system in place to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. The service did not evaluate and improve their practice effectively. At this inspection we checked and found the registered provider had implemented a quality assurance and audit programme and had met with the identified breach.

During our previous inspection we advised the registered provider to make improvements on the recording and storage temperature for people’s medicines. At this inspection our checks confirmed the registered provider had systems and processes in place to ensure medicines were managed and administered safely in line with guidance and people’s prescription. This included appropriate procedures that ensured medicines were stored at the correct temperature.

During our previous inspection we advised the registered provider to make improvements on the recording and completion of pre-employment checks for care workers. At this inspection we found all care workers had completed an application form, interview and that two references from recent employers had been obtained along with checks with the Disclosure Barring Service (DBS) before they started their role as care workers with people. These measures helped to ensure only suitable care workers were employed to work with vulnerable people.

During our previous inspection there was a manager in post but they had not registered with the Care Quality Commission (CQC). At this inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

33 Main Street is a house in the residential area of Wawne, on the outskirts of the city of Hull. It has two bedrooms, a lounge with a dining area and a kitchen. It provides a service to a maximum of 1 younger adult with learning disabilities or autistic spectrum disorder, physical disability or sensory impairment.

People were supported by care workers who understood the importance of protecting them from harm and abuse. The registered provider had a safeguarding adult’s policy and procedure and care workers had received training in how to identify abuse and report this to the appropriate authorities.

The registered provider had completed assessments of risks for people, the home and the environment. Along with associated support plans these measures helped people to remain safe and helped care workers to provide people with safe care and support, in line with their needs and with minimal restrictions in place.

Systems and processes were in place to record, evaluate and implement actions and outcomes in a timely manner for any accidents or incidents that occurred. This helped to help prevent re-occurrence.

Care workers completed an induction to the home, their job role and to people they supported. Care workers received training to support them with the skills required to meet the needs of people and this was recorded electronically. Systems and processes to support care workers had been reviewed to ensure supervisions and annual appraisals were robustly recorded and these were scheduled for all care workers.

People were supported to remain healthy. People’s dietary and nutritional needs were monitored and people had a choice of food at meal times. The registered provider worked with other health professionals to provide people with holistic support to meet their individual needs.

Care workers and management understood and followed legislation under the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care workers had a good understanding of people’s needs and were kind and caring. They understood the importance of respecting people’s dignity and upholding their right to privacy.

People were supported to enjoy a wide range of activities of their choosing and the service continually reviewed and improved this support.

People and their relatives were supported to complain and guidance was available in and around the home.

People had a care plan in place that was tailored to their individual needs and this was reviewed. The registered provider was in the process of updating the format of care plans and this had resulted in some duplication of recorded information. The registered manager assured us all duplicated information would be removed once the updates had been completed. We saw this process was managed as part of the quality assurance programme in place.

Regular audits were carried out to ensure the service was safe and well run and quality assurance meant the service was evaluated and improved for people.

People who used the service, and those who had an interest in their welfare and well-being, were asked for their views about how the service was run.

Everybody spoke highly of the organisational structure including care workers and the registered manager and employees had a clear understanding of their roles and responsibilities. Best practice and knowledge shared at staff meetings ensured care workers were kept up to date with changes both in the organisation and with people’s individual needs.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The person was treated with respect and dignity and we observed caring and compassionate care by the staff. The person had their own care file and these contained person centred information for example 'how I communicate with you' and 'how you communicate with me'. This was in pictorial format and also included Makaton signs relating to feelings, dislikes and likes. This contained information about the way each person should be supported and cared for. Additional information included risk assessments to ensure the person remained safe from harm.

There were activities for the person to be involved in to give them stimulation and a choice about their welfare for example shopping, swimming, visits to the seaside, music, visiting the caf' and a weekly stay at a relative's house and a shopping day.

We saw that the service had appropriate controls in place for the safeguarding of the person. Records we looked at included personalised plans to ensure the person who used the service was appropriately safeguarded. Records included for example plans for neglect, institutional abuse, physical abuse, and emotional abuse.

The service and communal areas were pleasant, clean and hygienic. All areas of the property were free from clutter and obstructions which meant that the person was protected from trip hazards and self-harm. The overall building maintenance was kept to a generally high standard.

Is the service effective?

We reviewed records for incidents and accidents and found that they were appropriately recorded and acted on. However, we found four records not to be dated. We spoke to the manager about this and they assured us that they would update these records immediately. Staff we spoke with were clear about the incident process and the procedure for recording when incidents occurred.

Visiting relatives told us, 'Staff listen to our views and they ask us a lot of questions and we get a lot of input with XXX's support. Staff even contact us to ask if they can get XXX a new jumper or cut her hair.'

Is the service caring?

The person's care was planned and delivered in a way that was intended to ensure their safety and welfare. We saw that the person had risk assessments in place. These were up to date and covered areas such as: behaviour which challenged, being out in the community, mealtimes, personal care, bathing and travelling in the car.

We spoke with visiting relatives of the person that used the service and they told us, 'The staff here are absolutely superb. They have offered for us to come to tea with XXX. We have not done this yet, but we will soon' and 'XXX's mobility was quite bad before she came here but now she is even walking on her own. We have seen three things improve over the last few months which are mobility, nutrition and handling her behaviour. We are very confident that the staff know how to handle XXX's behaviour and we are so pleased XXX is here.'

Is the service responsive?

We observed positive interactions between staff and the person living in the home. We saw that staff offered the person choices in how care was to be delivered and that they took their time to explain care tasks to the person. We saw that the person was encouraged and supported to maintain their independence where they were able to.

Records we looked at confirmed that the head office on behalf of all its services had sent out a quality performance survey to all of the people who used the service, their relatives and other healthcare professionals. We saw that 35 surveys were sent out in November 2013. Records we looked at showed that the provider had monitored the survey returns of; three from healthcare professionals, two from social care, eight from relatives and three from people who used the service.

Is the service well-led?

The service had an effective quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Records we looked at included a monthly check of the persons care plan for the purposes of accuracy for example; diary notes, behaviour monitoring charts, bowel chart, body maps and support plans. Following the evaluation the monthly check was signed by the team leader.

The staff we spoke with knew about their involvement with team meetings and supervisors and the manager observing their care activity. This meant that staff were confident and clear about their roles and their responsibilities. Staff told us, 'We have staff meetings every month to discuss any issues about the service but we also have a key worker meeting to discuss more person centred things. The meetings are really useful to resolve any potential issues that may be arising and they always get resolved quickly.'