Royal Mencap Society - 2 Conroy Close

Royal Mencap Society - 2 Conroy Close is a care home providing personal care for up to six people with a learning disability. At the time of our inspection six people lived at the service.

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

People living at Royal Mencap Society - 2 Conroy Close were happy and received person centred care and support from experienced and trained staff. Staff were recruited safely and understood the principles of keeping people safe. Medicines were managed safely, and risks were assessed.

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. People’s health was well managed, and the service worked with other health and social care professionals and followed best practice guidance.

Staff were kind and caring towards people. People told us the staff were always available to support their needs. Staff had clear knowledge of people’s diverse needs and it was clear that trusting relationships had been formed. People were treated with respect, dignity, and to maintain their independence.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People were supported to make links in the wider community and were prevented from becoming socially isolated. Staff understood their roles clearly and knew what was expected of them to promote people’s wellbeing.

The provider, registered manager and staff had a strong ethos of person-centred care and placed

people's wellbeing at the heart of their work. Quality assurance systems in place, monitored the service effectively and drove improvements when they were needed. Lessons learnt were used as learning opportunities to continuously develop the service.

We have made a recommendation about the effective use of governance systems in place at the service as these failed to identify the recording issues we found in one care plan or the equipment and flooring that required in attention in the bathroom

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 05 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 30 January and 03 February 2016 the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 Safe care and treatment; Regulation 18 Staffing; and Regulation 17 Good Governance. Notifications had not been submitted, which meant that the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009.

2 Conroy Close is registered to support people living with a learning disability. It does not provide nursing care. When we inspected on 13 April 2017 there were six people living there.

The service had a registered manager who had been in post since 2016. 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.

Risks assessments had been reviewed and updated to ensure any potential risks were identified and that these were minimised without placing any undue restrictions on people who used the service. Care plans described the actions staff needed to take in the event of an emergency including a medical emergency and we found staff followed these in practice to keep people safe.

Improvements had taken place in relation to the staffing arrangements. People could be confident that they would receive support from a flexible, consistent workforce.

Medicine administration was managed and carried out appropriately and staff had received medicine training. In the main, the storage and administration of medicines was safe. We have made a recommendation in relation to the storage of controlled drugs.

Staff had received on-going training and support to fulfil their roles effectively and provide consistent, safe care. Appropriate arrangements were in place to ensure staff had supervision and annual appraisal in line with the provider’s policy.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported with their nutritional needs and with their general health needs. We saw adaptations such as cutlery,ceiling tracking and flooring helped to promote people’s dignity, safety and independence.

Our observations were that the care people received was compassionate and that staff were respectful and kind. People’s relatives gave us positive feedback about the service and were happy with the care and support they received. They told us they felt they were listened to.

Care plans were clear and detailed, and these were person centred. Care plans were regularly reviewed to make sure they remained up to date and reflected people’s changing care needs.

Overall we found that the service demonstrated an open, transparent and person centred culture. Effective management systems were in place to monitor the quality of the service and we saw these had resulted in significant improvements across all areas of the service provided.

2 Conroy Close is a purpose built service. The service is registered to support people with a learning disability. It does not provide nursing care. There were 6 people living there at the time of this inspection.

The service had a registered manager who had been in post since 2012. 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.

Staff had been trained to recognise and respond to any safeguarding issues although for some staff this training had been over four years ago. Staff knowledge and understanding of safeguarding was good. The service acted appropriately in reporting such issues to the local safeguarding adults unit although they had not notified the Commission in relation to safeguarding concerns and absence of the manager. We will write to the provider about this. People told us they felt safe when their support workers were providing them with support.

Risks to people were assessed, and risk assessments gave sufficient information to ensure that people could be supported safely by staff. These were not always reviewed consistently. Some accidents and incidents were recorded but these had not been recorded consistently or analysed by the registered manager, to see if any lessons could be learned. Plans were in place to keep people safe in the event of an emergency.

There were a large amount of staff vacancies which resulted in daily use of agency staff, although regular and consistent staff from the agency were used. There were currently 200 hours per week vacancies that required recruiting too. Staff files showed that recruitment was professional and robust to ensure suitable applicants were employed.

Medicine administration was managed and carried out appropriately although not all staff had received recent training. Medicine storage was safe and appropriate.

Staff had received some training to enable them to meet people’s needs but this needed reviewing and updating as there were gaps in various areas. Staff were also observed by management carrying out tasks such as medicine administration and moving and handling and these checks were recorded. Staff had supervision and annual appraisal although this was not as frequent as the providers own policy seen during the inspection stated. Records of supervision did not always demonstrate two way conversations between staff and the registered manager. People told us they felt staff had the skills they needed.

People were asked to give their consent to their care. Where people were not able to give informed consent, their rights under the Mental Capacity Act 2005 were monitored. Staff knowledge of mental capacity and deprivation of liberty was inconsistent.

People were supported with their nutritional needs and with their general health needs.

People and their families gave us positive feedback about the service and all were very happy with the care and support they received. People told us that staff were caring and knew them well. Relatives felt that their family members were cared for very well and were happy with all aspects of their care with the only issue raised being the staff vacancies and use of agency staff.

Care plans were clear and detailed, and reflected people’s preferences. They were extremely personalised and demonstrated the person and families input. Some reviews and updates needed to be recorded more clearly within the documentation being used.

The environment was in good condition with only some minor repairs and redecoration required. Infection control was well managed and staff demonstrated an understanding of ways to minimise the risk of infection. However, we did find excessive hot water temperatures recorded for three taps, and a lack of action taken being clear in documentation. We could not find recent records of legionella testing in the house. We raised this with the registered manager during the inspection and they updated us that action was taken to address these issues two days after the inspection.

There was regular engagement with families for both individual input to the person’s support as well as development of the service. A residents, families and professionals day had been held in order to gain feedback on what the service did well and the improvements that were required.

The registered manager was open to improvements needed to the service. There were some systems in place to monitor the performance of the service but these were not being used in order to be effective or result in improvements across all areas of the service provided. People told us they felt they were listened to.

We found breaches of the Health and Social Care Act (Regulated Activities) Regulations 2010 in relation to safe care and treatment, staffing and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

The inspector visited the service and the information they collected helped answer two of five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

We found that support plans had been reviewed and updated. Measures were in place to record any changes made to the plan and these were signed and dated by the key worker. Dates for future reviews of support plans were in the office diary. The manager had introduced the use of the code at the bottom of the medical administration sheet (MAR) to be used when medication was administered away from where the medication was stored.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable.

Is the service responsive?

Not applicable.

Is the service well-led?

The manager had introduced the use of a walk-in store cupboard where all daily logs, handover file and care plans were now stored. Minutes of team meetings were filed and accessible to staff. Confidential documentation relating to a person who used to live in the service was stored in an envelope clearly marked confidential in a locked filing cabinet. We were unable to look at any staff records as they were stored on the computer system and the computer had been broken. On the day of the inspection the hard drive had been taken away for repair. Following the inspection, we requested that the manager send us copies of supervision and appraisal records once the hard drive from the computer had been returned. These have now been received and the manager confirmed that these will be printed off and stored in staff files.

On the day of the inspection we met all five people living at the service. We talked with two people about their experience of care and we subsequently spoke with the relative of one person. We talked with four staff and looked at records. We met the general practitioner (GP) who was visiting the home. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. We found that not all care plans had been reviewed and updated to reflect the changing needs of people living in the service. Staffing levels were appropriate to meet the needs of the service and were reviewed and adjusted to address any changing needs. Medication was managed and administered safely. We did see evidence of staff not completing the recording of medication.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Staff spoke with pride about the progress that individual people had made whilst they had been living in the service. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives. One person told us, " They are very, very good and kind, [the person] likes it there, I've no complaints."

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included visiting local places of interest and shopping. One person regularly attended The Boot Shop where they took part in activities. People knew how to make a complaint if they were unhappy and two people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything. There was evidence that staff responded flexibly to the changing needs of people using the service to ensure that they were cared for in a way that they preferred.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. When we spoke with a visiting GP they told us that they believed that the care provided by the staff was good and medication was well managed.

The service had a quality assurance system which included planned audits. We found that some records were not up to date and had not been signed. We found that some records were not stored securely.

We used a number of different methods to help us understand the experiences of people using because some people using the service had complex needs which meant they were not able to tell us their experiences. We spent time talking visitors, staff and observing the care provided.

We spent time with people and we observed staff being friendly and warm towards people. We observed that staff and service users had positive relationships and people appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in.

We found the arrangements for providing meals and snacks was good. People were involved in planning menus, shopping and cooking.

People received safe, appropriate care and The service had effectives systems in place to ensure people were protected from harm and their health and wellbeing were protected at all times.

There were sufficient staff available to met people's needs and staff received appropriate induction and training to provide them with the skills and knowledge required.

There was a complaints procedure in place which included an easy read accessible format for people with communication difficulties.

One person told us 'I like living here with my friends.' Another person said 'the staff are really kind and help me, I really like to go out and I do that quiet a lot.'