Background to this inspection
Updated
14 August 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was undertaken by one inspector, due to the small size of the service and the need not to cause undue disruption to people who lived there.
We spoke with inspectors who had carried out previous inspections at the home. We checked the information we held about the service and the provider. We reviewed notifications that had been sent by the provider as required by the Care Quality Commission (CQC).
Before an inspection, we can ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We had not requested that the provider completed a PIR and we took this into account when we made the judgements in this report.
During our inspection we spoke with the registered manager and one member of staff on duty. We spoke by telephone with a second member of staff on a different day when they were on duty. We spoke with people who lived at the service. One person was able to speak with us. They chose not to engage with the inspection process, however they did talk with us and answer some questions whilst they were preparing a meal in the kitchen. We used observations and talked with staff to better understand people's needs. We made informal observations of care when people returned home, to help us understand the experience of people who could not talk with us.
We looked at one care plan. One person said they did not want us to look at their care plans. The registered manager said the person took time to build up trust with different professionals who visited the service. We respected the person’s right to privacy. We looked at three staff recruitment files and records relating to the management of the service, including quality audits. After the inspection we spoke with a quality monitoring officer at the local authority to obtain their feedback about the service.
Updated
14 August 2015
This inspection took place on 7 and 13 May 2015. To ensure we met staff and the people that lived in the house, we gave short notice of our inspection to the service.
This location is registered to provide accommodation and personal care to a maximum of three people with learning disabilities. Two people lived at the service at the time of our inspection.
People who lived in the house were younger adults below the age of sixty five. People had different communication needs. Some people were able to communicate verbally, and other people used gestures and body language. We talked directly with people and used observations to better understand people's needs.
The home had a registered manager. 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.
Our inspection on 21 May 2014 found that the provider was in breach of Regulation 20 of the Health and Social Care Act 2008 (HSCA) which relates to records. This was because some records were not always well maintained. For example, weight checks had not been recorded in line with people’s needs and monthly keyworker reviews had not been consistently completed. A keyworker is a member of care staff with key responsibility to support an individual, to meet their support and care needs.
The provider sent us an action plan to show how they intended to improve the records they kept by October 2014. During this inspection we found that improvements to record keeping had been made and fully embedded into common practice by the registered manager.
People and staff were encouraged to comment on the service provided and their feedback was used to identify service improvements. There were audit processes in place to monitor the quality of the service. Maintenance systems were not always sufficiently robust to ensure low priority repairs and maintenance tasks were completed in a timely manner.
We recommend that the service explores relevant guidance from reputable websites about quality monitoring and action planning to improve the maintenance audit system and ensures effective communication of this with staff
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Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.
Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed and were continually reviewed.
Staff were competent to meet people’s needs. Staff received on-going training and supervision to monitor their performance and professional development. Staff were supported to undertake a professional qualification in social care to develop their skills and competence.
The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One person was subject to a DoLS, we found that the registered manager understood when an application should be made and how to assess whether a person needed a DoLS.
The service provided meals and supported people to make meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.
Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People were satisfied about how their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.
People were involved in their day to day care and support. People’s care plans were reviewed with their participation and relatives were invited to attend the reviews and contribute.
People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People were involved in planning activities of their choice.
People received care that responded to their individual care and support needs. People felt confident they could make a complaint and that the registered manager would address concerns.
There was an open culture that put people at the centre of their care and support. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.