Archived: Royal Mencap Society - 5 Saunton Gardens

At the time of inspection three people were living at the home. The service is located in a residential home that has been developed and adapted in line with values that underpin the Registering the Right Support and other best guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can lead as ordinary life as any citizen.

The home had a registered manager. 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 and associated Regulations about how the service is run.

This comprehensive inspection took place on 5 and 9 July 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our last inspection in November 2016 we found the provider was required to improve the management of people’s prescribed medicines. At this inspection we found the provider had made the required improvements and people’s prescribed medicines were managed safely.

People were protected from avoidable harm, neglect, abuse and discrimination by staff who understood their responsibilities to safeguard people. Risks to people had been assessed and plans minimised potential risks, whilst promoting people’s independence.

Prospective staff underwent robust pre-employment checks to ensure they were suitable support people who lived with autism or a learning disability.

There were always enough staff deployed with the right experience and skills mix, to provide effective care and support to meet people’s needs. Staff were enabled to develop and maintain the necessary skills to meet people’s needs.

Staff applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in their day to day care practice. For example, people were involved in best interests decisions about their care, to ensure their human and legal rights were protected.

The registered manager had developed effective partnerships with relevant professionals and quickly referred people to external services such as GPs, neurologists, dieticians, chiropodists, opticians and dentists, when required to maintain their health.

Staff supported people to maintain high standards of cleanliness and hygiene in the home, which reduced the risk of infection. Staff followed required standards of food safety and hygiene, when preparing or handling food. People were supported to have eat healthy balanced diet of their choice.

The home environment was personalised to meet people's individual needs and preferences.

People’s needs had been assessed and regularly reviewed to ensure staff had the most current information required to meet their needs. Detailed care plans promoted their independence and opportunities to maximise their potential.

People were supported by regular staff who were kind and caring, which had a positive impact on their mental wellbeing. There was a warm and positive atmosphere within the service, where people were relaxed and reassured by the presence of staff.

Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. People were encouraged and enabled to be involved as much as possible in making decisions about how their support needs were met.

Staff demonstrated a real empathy for the people they cared for and one another. Staff spoke passionately about people, recognising their talents and achievements, which demonstrated how they valued them as individuals.

The service was responsive and involved people and their relatives in developing their support plans, which were detailed and personalised to ensure their individual preferences were known.

Staff consistently demonstrated in their day to day support of people, that respect for privacy and dignity was at the heart of the home’s culture and values. People were supported to take part in activities that they enjoyed and to maintain relationships with their families and those that mattered to them. This helped to protect them from the risk of social isolation.

The registered manager sought the views of people and their relatives and used these to drive improvement in the home. There had been no complaints since the last inspection. However, people and relatives were confident that the staff would listen to them if they had any concerns and would take the necessary action to deal with them.

The service was well led. The vision, values and culture of the service were understood and delivered by staff whilst supporting people. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement in the service.

The service 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.

The registered manager is also registered to manage another Royal Mencap Society service in another town a short drive away. The registered manager told us they spend two days each week in each service and another day each week at the provider’s local office base.

The service is a detached house in a residential area between Farnborough and Frimley towns. Each person had their own room either on the ground floor or first floor and shared a communal lounge / dining room, kitchen, bathroom or shower room and garden.

People were safe because staff understood their role in protecting people, had been trained to recognise signs of abuse and how to report any concerns.

Risks to people had been identified and action had been taken to reduce any risks. For example, robust processes were in place to minimise the risk of financial abuse which we saw in practice.

Although there was a small staff team, sufficient numbers of staff were available to meet people’s needs including their social and leisure needs.

People’s medicines within the service were not always managed safely. One person’s medicine which may be needed in an emergency situation was not always taken with them when they went out and some staff had not been trained to administer it. This meant the person may not receive the medicine when it was urgently required. The stock of some topical medicines was not used in the order of supply which risked them becoming out of date or deteriorating.

Staff had undertaken a range of training to enable them to carry out their role in supporting people. This included first aid, fire safety, medicines and safeguarding of people at risk. Training to meet people’s specific needs such as awareness of epilepsy and autism had also been undertaken to enable staff to provide effective support.

People’s consent to support and care was obtained in line with guidance about the Mental Capacity Act 2005 and the law. Staff offered people assistance when needed and waited for the person to respond with their choice or decision. People’s choices were respected.

Support was provided to enable people to have a balanced diet and to have enough to eat and drink. People and staff planned weekly menus together and pictures of food or meals were used to support some people’s understanding and to help them make choices.

People were supported to access a range of healthcare services to promote their health and in response to any changes in their health. These included GP’s, dentists, opticians and hospital specialists.

There was a friendly, family style atmosphere in the service and people were relaxed and comfortable in the company of staff. People had access to all areas of their home including the study / office and one person made frequent visits to the study to speak with the registered manager or whoever was using the room.

Some of the people using the service were able to express their views about the support they received or would prefer. Other people were more reliant on staff understanding their method of communication, such as their facial expressions or their body language and we saw this in practice.

People’s privacy and dignity was respected by staff. Staff did not enter people’s rooms unless invited and always knocked before entering. Staff promoted people’s privacy by encouraging people to change their clothes in the privacy of their bedroom or the bathroom for example.

Support was provided in a way that met people’s needs, including their changing needs. When one person’s mobility needs changed for example, they were provided with a downstairs bedroom to safeguard them from having to use the stairs.

The registered manager told us that the service had not received any complaints, and the provider organisation did have a feedback and complaints management system if needed. The registered manager said that she and the staff had regular communication with relatives of people using the service and would discuss and address any issues then if they arose.

It was clear that the registered manager and staff created an open, inclusive culture within the service which put people who use the service first. Staff told us they did whatever they could to ensure consistent support for people, including occasionally working on their day off, to cover if a staff member was unexpectedly absent.

The service was well led and managed by an experienced registered manager who empowered their staff to manage the service effectively in their absence on the days they did not work in the service.

The quality of the service provided was monitored by the provider through regular visits by an area operations manager, annual audits by a member of the provider quality team and annual financial audits. Quality assurance surveys had also been supplied to people and their supporters and many positive responses had been received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We gathered information based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We spoke with three people who used the service and a relative of one of the people who used the service.

We looked at four people's care records. We spoke one member of staff and looked at two staff records. We spoke with three agency staff who were working on the day of our inspection and one of the provider's assistant service managers who was visiting. In addition we spoke with the person in charge of the service when they were available in the afternoon.

This is a summary of what we found:

At the time of the inspection the service was providing care and support to four people. The person in charge had recently been appointed and told us they were in the process of registering as the registered manager with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Is the service safe?

Safeguarding procedures were robust and we found staff had training in safeguarding adults. Proper policies and procedures were found to be in place. The Care Quality Commission monitors the operation of Deprivation of Liberty Safeguards which is applied to care homes and records showed us the provider had taken note of a person's capacity in their risk assessments.

Risk management plans and care records were detailed and promoted people's rights and dignity. We observed care staff signed each person's care record to state they had read and understood them. The provider may find it useful to note we found not all staff had signed all people's care records.

Systems were in place to make sure managers and staff learnt from events such as accidents/incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The person in charge told us the provider took people's care needs and preferences into account when making decisions about the numbers, skills and experience required when allocating staff. They told us that on the day of our inspection, exceptional events had meant the service had none of their own staff on duty but they used agency staff to ensure the service had the provider's agreed number of staff on duty.

The provider used agencies which met their criteria in respect of training and skills. The person in charge told us, where possible the provider used agency staff who were familiar with the service.

We sampled the duty rota for the past five weeks. Records showed us the service had used a high number of agency workers. The person in charge told us the provider had recruited two new staff which meant the provider's guidelines for staffing in this service would be met by their own staff.

Recruitment practice was safe and thorough in respect of the provider obtaining required employment checks.

Is the service effective?

Care plans reflected people's current needs, choice and preferences and were reviewed regularly. The provider may find it useful to note we found reviews of the care plans of four people had not been completed in line with the provider's timescales. The person in charge told us the provider had recruited staff to ensure their systems to review people's support plans were effective and these staff would start once they completed their induction.

People's nutritional needs were met and staff ensured people's individual dietary needs and preferences were met. People were provided with a choice of suitable and nutritious food and drink and were supported to eat and drink sufficient amounts to meet their needs. One person told us: "I choose what I want."

Is the service caring?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative told us they valued consistent and permanent staff and said: " [my relative] is 110% cared for and the three [permanent] staff are working their socks off."

Is the service responsive?

The service worked with other agencies and services to make sure people received care in a consistent way. People had access to health care professionals such as the community health team for people with a learning disability and GP which meant people were supported to keep healthy and well.

Is the service well-led?

The service had quality assurance systems in place to identify problems and enable changes to improve the service.

The person in charge told us there had been a management change in the service and they had applied to register with the CQC as the registered manager.

The provider had a business continuity plan to deal with foreseeable emergencies. Staff told us they were clear about their roles and responsibilities and would speak with the person in charge if they had any concerns.

People told us that they and their relatives had been involved in planning and reviewing the support that they received. We found that reviews included a pictorial report on activities and any milestones or achievements. A member of staff told us, 'The residents get to lead very fulfilling and active lives here'. We found that people were provided with opportunities to pursue interests and hobbies at the service and in the community.

We found that the premises were suitable in design and layout for the purpose. The service appeared clean and comfortable and was well maintained. This meant that the building and garden provided a safe environment for the people who used the service and staff.

We found that staff were adequately trained to enable them to perform their role and that their professional development was supported.

Effective systems for monitoring the performance service were in place and we saw evidence that changes were made in response. The person in charge said, 'There is no point in recording accidents and then doing nothing to reduce the risk of them happening again'.

We also spoke with relatives who told us that families were included in the support planning and delivery process. Also, that support plans were tailored to meet the needs of the individual. We saw evidence to confirm this.

One relative told us, 'My relative had been living here happily for over 10 years. This place is very safe. If we thought otherwise then they wouldn't be here'.

One person told us, 'Yes, I really love it here and I wouldn't change anything. I go to the day centre three days a week, out to the town one day and we go on holiday'.

The manager told us that many areas of the service were managed using the Continuous Compliance Tool (CCT). This was a computer programme which warned the manager when important matters such as building and equipment safety checks and staff training were due for renewal.

We examined the staff rota saw that there were sufficient trained, experienced staff on duty to meet the needs of the people using the service.

We saw that the service had published a Statement of Purpose specifying the nature of the service that was being provided.

We saw that an effective complaints system was in place and that people's comments and complaints were responded to appropriately.