Salthouse Road

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:

We received positive views from relatives about the support provided to people. We observed people and staff had developed good and caring relationships built on trust and mutual respect.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People were safeguarded from harm by staff who had received the relevant training. Risks to people's safety were assessed and clear guidance was in place to explain to staff how to mitigate any known risk.

People were supported by staff who had been recruited following safe recruitment procedures. People received their medicine on time and were protected from the risk of infection. Accident and incident forms were completed, and lessons were learnt when things went wrong. People's care needs were assessed, and staff received training that enabled them to meet people's needs.

People were supported to maintain a balanced diet and had access to fluids and snacks. Where required, staff monitored people’s weights and worked with healthcare professionals to make sure people received medical attention when required. Systems were in place to ensure information was shared when necessary. For example, when accessing health care.

The building was adapted to meet people's needs and people had access to outside space.

People were treated with kindness and supported to express their opinion wherever possible. The service was working with professionals who were providing specialist training in communication for the staff team to promote effective communication within the service. People's dignity was protected, and people were encouraged to maintain their independence.

People's care was personalised to their individual needs and people had access to activities they were known to enjoy. Staff used alternative means of communication such as photographs to assist people in the exchange of information. People were supported to maintain relationships and attend family events.

Relatives and staff spoke positively about the registered manager. They felt able to raise concerns and were confident these would be addressed. Staff told us they were well supported by the registered manager and senior management team. A complaints procedure was in place.

No one was in receipt of end of life care however, staff had previous experience of supporting people with end of life care and working with healthcare professional to enable people to remain at home at this time.

Staff attended regular team meetings and updated families of up and coming events via a newsletter.

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 11 April 2017)

We undertook this unannounced inspection on 16 March 2017. At the time of our inspection there were 7 people living at the service.

At the last inspection on 5 February 2016, the overall rating for the service was ‘Requires Improvement’. This related to making improvements to medicines management, stopping the practice of wedging doors open and the safe storage of disposable gloves and aprons. Further action also needed to be taken to promote good infection control practices when washing clothing and other items. Some minor incidents between people had not been assessed and scored using the specific risk management tool provided by the local safeguarding team. Risk assessments were completed; but further detail was needed to be included for staff about recognising the signs of changing behaviours. When accidents or incidents had occurred in the service, records of actions taken to review and investigate these were not always in place.

At this inspection we found automatic closures had been fitted to doors so they were no longer wedged open. Disposable gloves were stored away from clients. Records were being maintained of all incidents and the action that had been taken following these and any referrals made to the local safeguarding team and the Care Quality Commission. Risk assessments had been updated and included information to guide staff on how to recognise potential triggers and changes in behaviour. Processes had been introduced to ensure accidents and incidents were analysed within the service by the manager, and further reviews of these were completed by the quality assurance manager and at senior management level.

There was no registered manager in post. The previous registered manager had recently left the service to take up another post within the organisation and a new manager had been appointed to the post in the last month. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their registration. 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. When a service does not have a registered manager in place the rating in well led cannot be rated any more than ‘requires improvement’. A manager had been appointed but had not been through the registration process to become the registered manager. They had been at the service for two weeks at the time of our inspection.

We found improvements were required to ensure people’s specialist dietary records were completed in more detail to reflect what people had eaten and the texture and presentation of the food.

We found further action was required to ensure that the date was recorded when topical creams were opened. Individual ‘pro re nata’ (PRN when necessary) protocols for pain relief needed to be reviewed and include the dosage of the medicine that had been prescribed. These issues were addressed by the manager during the inspection.

Relatives and professionals praised the skills of the core staff team and shared their reservations about the reliance and use of agency staff and lack of continuity of managers in the service.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved.

The environment was found to be clean and tidy throughout. Areas of the service were beginning to look tired. This had been identified by the registered provider’s internal auditing system and plans were in place for a refurbishment of the service in April 2017, which included the replacement of the kitchens.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

Staff had access to induction, training, supervision and appraisal which provided them with the relevant skills and confidence to provide care to people. This included training considered essential by the registered provider and also specific training to meet any individual needs of the people they supported.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, best interest meetings were held with relevant individuals and professionals.

We saw arrangements were in place that made sure people’s health needs were met. For example, people had access to the full range of NHS services. This included GP’s, community learning disability nurses, chiropodists, dentists, speech and language therapists, physiotherapists and occupational therapists. People received their medicines safely, as prescribed and medicines were held securely.

Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions staff followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink to maintain their health. Menus were varied and staff confirmed choices and alternatives were available for each meal: we observed drinks and snacks were served between meals. People’s weight was monitored and referrals made to dieticians when required.

We found staff had a caring approach and found ways to promote people’s independence, privacy and dignity. People who used the service received care in a person centred way with care plans describing their preferences for care and staff followed this guidance.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read risk assessments and were aware of their responsibilities and the steps to minimise risk.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on holiday. Staff supported people to stay in touch with their families and friends.

There was a complaints process and information provided to people who used the service and staff in how to raise concerns directly with senior managers. Relatives knew how to make complaints and told us they had no concerns about raising any issues with the staff team or the manager.

We undertook this unannounced inspection on the 5 February 2016. At the time of the inspection there were eight people living at the service.

The service had 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.

We found improvements were required in some areas of medicines management to ensure recording was accurate and stock control was efficient. People received their medicines as required although there had been some occasions when staff could have contacted their GPs to seek advice.

There were policies and procedures to help guide staff in how to keep people safe from the risk of harm and abuse. Staff were knowledgeable about the different types of abuse and knew how to raise concerns. We found staff recorded when incidents occurred between people who used the service and incidents were referred appropriately to the local authority safeguarding team.

People had risk assessments in place which helped to guide staff in how to minimise the reoccurrence of incidents. Staff told us they had read risk assessments for people who used the service and were aware of their responsibilities and the steps to take to minimise risk. However, we found one instance where risk assessments could be improved.

We found the environment was clean and tidy, but improvements were required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags. Further action also needed to be taken to promote good infection control practices when washing clothing and other items. Equipment used in the service was maintained.

We looked at the recruitment checks the service had carried out for new staff. These showed robust measures were in place to ensure staff were suitable to work with vulnerable people. Staff received an induction and had access to training, supervision and support to help them to develop and feel confident when caring for people and carrying out their roles.

We found people’s health care needs were met. They had access to a range of health professionals and staff were clear about how they monitored people’s health in order to seek medical attention quickly. Comments from health professionals who visited the service were positive about the staff team being helpful and receptive to their help and support.

We found staff had a caring and considerate approach towards people who used the service and found ways to promote people’s independence, privacy and dignity. Staff provided information to people and included them in decisions about their support and care.

People had assessments of their needs and plans of care were produced; these showed people and their relatives had been involved in the process. We observed people received care that was person-centred.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

Menus were varied and staff confirmed choices and alternatives were available for each meal; we observed drinks and snacks were served between meals. People’s weight was monitored and referrals to dieticians made when required.

We found staff supported people with meaningful activities including access to community facilities and keeping in touch in family and friends.

Relatives knew how to make complaints and told us they had no concerns about raising issues with the staff team or the registered manager.

A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them.

We found people were involved as much as possible in decisions about care and treatment. Decisions were made in people's best interest when they were assessed as not having capacity to make the decision. We saw staff offering assistance and communicating with people. It was clear that people consented to the practical care given.

We saw people involved in activities and they could choose what they wanted to do at any time. The staff we spoke with were well aware of people's individual care and support needs.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

The premises were in a good state of repair and were clean and fresh.

There were sufficient staff available at all times to meet people's individual needs.

People had opportunities to comment on the service through meetings and surveys.