Archived: Whitstable Road

Whitstable Road is a residential care home that accommodates up to six people with a learning disability. At the time of the inspection there were six people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People's outcomes were consistently good and feedback about the service confirmed this.

People were supported by a core team of consistent staff, who knew people well and trusting relationships had been developed. Staff were available to support people when they needed it. Staff understood the importance of being on hand to assist people to promote people’s independence. 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 treated people with dignity and kindness. They understood changes in people’s body language and how to communicate with people who had limited verbal communication. Staff received effective support from the management team and were motivated to provide personalised care.

People could be assured that staff understood their health, social and personal care needs. People continued to receive their medicines when they were needed. Advice from health care professionals was sought when it was needed. Risks to people’s well-being and in the environment continued to be effectively managed.

People were given informed choices about how to spend their time. They joined in local events and activities and kept in contact with family members and people who were important to them. People’s relatives were kept up to date with their well-being.

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

Rating at last inspection: Good (last report published 27 October 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

The service provides care and support for up to seven people with a learning disability and/or autism. At the time of our inspection there were five people using the service, one of whom was developing dementia. The accommodation was provided in a large house over two floors. People’s communication styles varied, some were able to tell us about their experiences and others used body language, mood and behaviours to communicate.

A registered manager was not employed at the service. 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. However, the provider had appointed a manager who intended to apply to register with the Care Quality Commission.

People were supported by staff to keep their home clean. However, some parts of the premises needed additional cleaning and consistent measures to prevent the spread of infection.

We have made a recommendation about this.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. The manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The manager ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were maintained to promote safety. However, it was not clear if people could easily escape from the garden, for example during a fire.

We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The manager and care staff used their experience and knowledge of caring for people with learning disabilities and autism effectively. Staff assessed people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed within the service, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy and diabetes.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

We observed people being consulted about their care and staff being flexible to requests made by people to change routines and activities at short notice.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. The manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. People could involve relatives or others who were important to them when they chose the care they wanted. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The registered manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities. New staff and existing staff were given extensive induction and on-going training which included information specific to learning disability services.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills. Staffing levels were kept under constant review as people’s needs changed. The manager ensured that they employed enough staff to meet people’s assessed needs.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. Staff advised people about healthy eating and dietary support had been provided.

Information about how to complain was in pictorial formats to help those with poor communication skills to understand how to complain. This included people being asked frequently if they were unhappy about anything in the service. If people complained, they were listened to and the manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The manager and the deputy manager demonstrated a desire to deliver a good quality service to people by constantly listening to people and improving how the service was delivered. People and staff felt that the service was well led. They told us that managers were approachable and listened to their views. The manager of the service and other senior managers provided good leadership. The provider and manager developed business plans to improve the service.

The home had ensured that changes had been made to the dispensing of medicines by the pharmacy. This meant that each medicine was contained in an individual pot which contained the name of the person, the name and dosage of the medicine and the time of day that it should be administered. Therefore, there were effective systems in place for the safe storage and administration of medicines.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and people using the service. We also looked at records.

If you want to see the evidence supporting our summary, please read our full report.

Is the service safe?

The service had systems in place to ensure that equipment relating to the environment and health and safety was regularly maintained.

Recruitment practice was safe and through. People did not start work at the home until all relevant checks had been carried out.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home manager told us that some applications for DoLs needed to be submitted and that further advice would be sought to ensure this was done correctly.

The home used a monitored dosage system for administrating medicines. A number of medicine tablets were contained in one pot, but there was not a comprehensive guide in place to identify each medicine. This meant that there was a risk that staff did not know which medicine they were giving each person. We have asked the provider to tell us what they are going to do ensure that medication administration is safe in the home.

Is the service effective?

People's health and care needs were assessed with them or their relatives and they were involved in the development of their plans of care. Care plans were up to date and reflected people's current needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs. Staff knew how to communicate with people according to their individual needs.

Is the service caring?

People were supported by staff who took time to explain things clearly to them and to listen to their responses. They were able to do things at their own pace and were not rushed.

One relative who had completed a satisfaction survey was positive about the support that was provided at the home.

Is the service responsive?

Records confirmed people's preferences, interests, goals and spiritual needs had been recorded and care and support had been provided in accordance with people's wishes. One person told us that they went to see a local football club. People met with their key worker to discuss what was important to them.

People had access to activities outside the home, but were limited in activity choices within the home.

Is the service well-led?

The service had a quality assurance system and records showed that it had identified most actions that needed to be taken.

The service was not always proactive in seeking people's views as it had sought limited feedback from relatives and other representatives of people who used the service.

Staff were clear about their roles and responsibilities and said that the management team were approachable.

We observed that overall people who used the service had positive experiences and the staff used a person focused approach when providing support. People who used the service were encouraged to make choices and were supported to engage in activities of daily living in a positive and effective manner.

People had their own bedrooms which they had been encouraged to personalise making them into their own private spaces.

We saw that people were being encouraged to be as independent as possible and were being supported to access the community.

However, we found that some of the arrangements used to assess the special needs of people who lacked capacity to consent to decisions were not robust. This had resulted in some people not fully being supported by family representatives or advocates to make informed decisions that were in their best interests.