Archived: Royal Mencap Society - 12 Wales Street

Royal Mencap Society – 12 Wales Street is registered to provide support to four adults with learning disabilities and physical health needs. At the time of our inspection, two people were receiving support from the service.

At our last inspection on the 24 February 2016, we rated the service “Good.” At this inspection we found that the service ‘Required Improvement’.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

The quality assurance processes in place to monitor the quality and safety of the service and drive improvement required strengthening. Audits had not resulted in sufficient action to mitigate risks to people’s health and safety. Health and safety checks had not been carried out as scheduled and staff did not consistently adhere to environmental fire safety measures. Records relating to medicines stock levels were incomplete and did not allow this aspect of medicines to be audited effectively.

The provider had recognised that the environment at 12 Wales Street was no longer suitable to meet people’s needs. People, their relatives and staff had been consulted and people were due to move to alternative accommodation in June 2018. The provider informed us that they would then apply to remove 12 Wales Street from their registration.

Staff understood their responsibilities to keep people safe from harm. Safeguarding procedures were in place and staff understood their duty to report potential risks to people’s safety. Staffing levels ensured that people's care and support needs were safely met. Safe recruitment practices were in place.

People received their medicines as prescribed and risk assessments were in place to manage risks within people’s lives. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff had regular one to one supervisions.

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 demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care.

People were encouraged to make decisions about how their care was provided and staff had a good understanding of people's needs and preferences. Staff treated people with kindness, dignity and respect and had spent time getting to know them and their specific needs and wishes.

Staff supported people to access healthcare professionals, and encouraged them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement. The provider had a process in place, which ensured people could raise any complaints or concerns.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

The home provides care and support for people with learning and physical disabilities who had limited communication. At the time of the inspection there were 4 people living at the home.

At the time of the inspection there was no 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. There was a manager in post who was in the process of applying to become the registered manager.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. There was enough staff deployed to support the individual needs of people.

Staff undertook training which focussed on helping them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People received support and care from staff that were friendly, kind and respected them as individuals. Staff had taken time to understand peoples likes, dislikes and enabled people to participate in activities. This was evident in the way staff spoke to people and the activities they encouraged and supported individuals with. Relatives spoke positively about the care and support their relative was receiving and felt that they could approach management and staff to discuss any issues or concerns they had.

The manager was approachable and open to feedback; actively enabling staff to look at ways to improve and develop the service. There were a variety of audits in place to ensure people were receiving a good service and action was taken to address any shortfalls.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Care plans and risk assessments were in place which identified any specific risks for people who used the service and the actions staff should take to minimise the risk. Staff were knowledgeable about the needs and risks for each person who used the service, and the actions they should take to reduce the risk.

Staff received training in safeguarding vulnerable adults and understood their responsibilities for reporting any concerns about the treatment of people.

Is the service effective?

People's health and care needs were assessed and plans of care developed according to their needs. Information about how people communicated their needs and wishes was clearly identified in care plans which helped staff to provide appropriate care. From our observations and discussions with staff, we concluded that staff had a good knowledge of each person's care needs and preferences. This meant that most of the time staff were able to support people effectively. However, staff shortages sometimes meant that people were not always able to take part in their chosen activity, or access the community.

Is the service caring?

We saw that people were treated with dignity and respect by the staff. People who used the service were relaxed in the presence of staff and responded positively to them. People who used the service told us that they liked the staff and we heard staff talk about people in a caring manner.

Is the service responsive?

We saw that staff were kind and responsive to people's needs. Staff understood the importance of obtaining consent from people who used the service and responded to individual needs. For example, when someone refused food, staff respected the person's decision, however continued to offer encouragement and alternatives.

Is the service well-led?

We found that overall the service was well managed. The registered manager also managed another small home fifteen miles away. They told us that they divided their time between the two services and head office. The manager was not present when we arrived, and staff did not know which days the manager would be at the service; however they were able to contact the manager.

Contact details for senior managers were also available to staff. Staff told us that management support was also available out of office hours, although due to some recent changes, another member of staff was the first point of contact. This meant that management support was available to staff.

Effective systems were in place to assess and monitor the quality of care. Regular checks on all aspects of the service were carried out by an area manager and where necessary improvements made.

We spoke with a relative who confirmed that the service was very good: 'I have always been happy with the service. Staff are excellent'.

This was a largely a positive inspection. Everyone we spoke with said that care that staff supplied was good. We saw positive, friendly interaction from staff towards people. The standards we inspected, except one, were compliant.

They were issues that needed to be dealt with; consistently promoting a person's nutritional needs, always having enough staff on duty to be fully able to meet people's needs, additional staff training to include training in people's health conditions, and locks to bedroom doors need to be reviewed to ensure that people cannot be locked in their bedrooms.

We spoke with two relatives. They all told us that staff had provided high quality care to their relatives.

One relative said: 'Staff could not be better. They are kind and professional'. Another relative said: 'Care is very good '.

This was a positive inspection. The person we spoke with was satisfied with their care. People's relatives praised the service. We saw staff providing friendly, patient and helpful care. There were a small number of suggestions; for the organisation to recognise the quality of work that staff were doing, and to ensure detailed training for staff on issues such as dementia, autism and challenging behaviour.