Littlecroft

The service Littlecroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service was not registered to provide nursing care. The service provides accommodation for up to nine people who have learning disabilities. There were five people living at the service at the time of the inspection. The service Littlecroft is a residential care home located in New Romney and consists of two neighbouring chalet bungalows in a residential area.

At the last Care Quality Commission (CQC) inspection on 05 and 06 October 2016, the service was rated ‘Good’ in the Caring and Responsive domains: ‘Requires improvement’ in Safe, Effective and Well Led domains. The overall judgement rating for the service was ‘Requires Improvement’ and there were five breaches of regulation. There were areas that required improvement. These included, personal emergency evacuation plans that were not in place for people to inform staff about the support they would need to leave the service in the event of an emergency; fire drills had not been completed as required; maximum hot water temperatures, set by the Health and Safety Executive were marginally exceeded. Although checks had identified this, action had not been taken to rectify it; local authority safeguarding protocols had not always been followed; some 'as and when needed' medicines were administered, staff had not always recorded the quantity given; applications to meet the requirements of the Deprivation of Liberty Safeguards had not been made as needed., and quality monitoring systems were in place, but were not effective enough to enable the service to highlight the issues raised at the last inspection.

At this inspection, we found that improvements have been made.

Systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service and these were being followed.

Effective procedures were in place to keep people safe from abuse and mistreatment.

The registered manager had applied the principles of MCA 2005 within the service in a person centred manner which involved people in decisions about meeting their needs effectively.

Medicines were managed safely and people received them as prescribed, including as and when required medicines.

Each care plan now contained information of an individual Personal Emergency Evacuation Plan (PEEP). The fire safety procedures had been reviewed and were regularly monitored in line with the provider’s policy. A water management plan was in place to reduce the risks

This service had a registered manager in post. 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. The registered manager was also responsible for looking after other services owned by the same provider. Although always in contact with staff, when the registered manager was not present at the Littlecroft sites, team leaders oversaw the running of the service.

Most people were able to indicate to us they liked living in the services, they appeared happy, relaxed and contented in a comfortable living environment, interacting readily with staff and without hesitation.

There were enough staff to keep people safe. The registered manager continued to have appropriate arrangements in place to ensure there were always enough staff on shift.

Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for.

Staff received regular training and supervision to help them to meet people's needs effectively.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

People were supported to eat and drink enough to meet their needs.

Staff treated people with kindness and respect for their privacy and dignity. Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people's preferences were respected.

Independence was encouraged so that people were able to help themselves as much as possible.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the home continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focused on people experiencing good quality care and support.

The provider had a set of values, which included treating everyone as an individual, working together as an inclusive team and respecting each other. Staff were aware of these and they were followed through into practice.

Littlecroft provides accommodation and personal care for up to nine people who have learning disabilities. The service consists of two neighbouring chalet bungalows in a residential area.

There were eight people using the service at the time of our inspection who had a range of health and support needs. These included learning disabilities, very limited or nonverbal communication and some mobility difficulties. Some people had additional conditions such as epilepsy, autism and cerebral palsy. At the time of inspection four people lived in each bungalow. We met and spoke with each person. Most people were able to indicate to us they liked living in the services, they appeared happy, relaxed and contented in a comfortable living environment, interacting readily with staff and without hesitation.

This service had a registered manager in post. 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. The registered manager was also responsible for looking after other services owned by the same provider. Although always in contact with staff, when the registered manager was not present at the Littlecroft sites, team leaders oversaw the running of the service.

Our inspection found that whilst the service offered people a homely environment and their care needs were being supported; there were shortfalls in some areas that required improvement.

Personal emergency evacuation plans were not in place for people to inform staff about the support they would need to leave the service in the event of an emergency; fire drills had not been completed as required.

Maximum hot water temperatures, set by the Health and Safety Executive were marginally exceeded; although checks identified this, action had not been taken to rectify it.

Local authority safeguarding protocols require some events to be reported to them. The service did not have a copy of the protocols and had not recognised or reported an incident warranting this action.

When some ‘as and when needed’ medicines were administered, staff did not always record the quantity given.

Applications to meet the requirements of the Deprivation of Liberty Safeguards were not made when needed.

A quality monitoring system was in place, but was not effective enough to enable the service to highlight the issues raised within this inspection.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

Staff treated people with kindness and respect for their privacy and dignity. Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people's preferences were respected.

Independence was encouraged so that people were able to help themselves as much as possible.

The provider had a set of values, which included treating everyone as an individual, working together as an inclusive team and respecting each other. Staff were aware of these and they were followed through into practice.

We found a number of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

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

Is the service safe?

We found that all aspects of the service were safe. People said or indicated that they felt safe. We saw that people had the right support at the right time from staff. People's needs had been monitored, and the service developed to meet these needs. There was a whistle blowing and complaints policy in place.

Some restrictions were in place that prevented people from leaving the home without staff accompanying them. This was done in the spirit of safety and restrictions were adjusted to have as minimal impact on people as possible. Because it was unclear if people had capacity to consent to these arrangements, the managers were assessing people's capacity to consent to these restrictions.

Is the service effective?

Others who knew people well were also involved in assessment and care planning. Relatives or care managers were involved in helping people have a say. People's support and activities were reviewed regularly.

Regular environmental checks for the safety of the premises were taking place and there was a system for staff to report any concerns. Any maintenance issues were resolved quickly. People were able to choose what meals to have and the provider kept records to assess people had sufficient nutrition.

Is the service caring?

The registered manager and the staff team knew the people living at the home very well. People were observed to be treated respectfully, and given support without delay. Where people had special requirements in their living arrangements, the service had made adjustments to meet these needs.

Is the service responsive?

People's needs had been assessed before they moved into the home. People's likes and dislikes were noted, and as they changed, the records were updated. We observed that the staff listened to people, and took appropriate action to support them in their daily routines. We saw staff responded promptly to people's requests. Where people's social or health needs had changed, the service was quick to seek advice from people who could help.

Is the service well led?

The people we observed appeared happy, mostly relaxed and confident in their well-maintained home. Systems were in place to keep on top of important checks, and mostly these were up to date. The registered manager had assessed that quality assurance processes needed to improve and had arranged a process of independent checks and balances across the organisation.

At the time of our inspection, there were seven people who lived at the service. We spoke with one person and met with six other people who used the service. We spoke with five members of staff and the provider.

We found that people were supported to make choices and to express their preferences about what they wanted to do. We saw that staff supported people in a respectful and dignified manner.

We found that care plans contained details about people's health care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that the service had arrangements in place to protect people from the risk of abuse and that people appeared comfortable and relaxed when interacting with the staff.

We found that the staff had the appropriate skills to support people's needs safely. We observed the staff supporting people in different ways and according to their individual needs. One member of staff told us 'I definitely feel supported; there is lots of training'.

We found that the service kept records that identified people's needs and stored them safely and appropriately, to ensure people's details and information was protected.

People were supported to take part in a range of social activities that met their interests. They were given the support they needed to stay in contact with their family.

People were kept safe from harm because staff knew how to recognise and report signs of abuse. There was a new training programme in place for staff to complete within the next three months and staff we spoke with showed that they had the skills to care for people safely. Staff treated people with respect and we saw that they provided care in a way that promoted people's dignity.

There were systems in place to monitor the quality and the safety of the service. The provider had recently developed a quality improvement plan for the service.