Evergreen

Evergreen is a care home providing personal care for up to 8 people. At the time of the inspection 6 people were living at the home.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Staff communicated with people in ways that met their needs. They focused on ensuring people lived a fulfilling and meaningful life. People were supported to achieve their aspirations and goals. Medicines were stored and administered safely. Infection prevention and control practices reflected current guidance.

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

Right Care

People received care from staff who were kind and compassionate. The staff protected and respected people's privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse.

People received person-centred care. Thorough assessments of people's needs were carried out following a multi-disciplinary team approach. The staff were skilled in supporting people when they experienced distress which may lead to risk for the person or others. People were encouraged to access activities in the community and attended social events.

Right Culture

People, relatives and staff were regularly asked to provide feedback on the care provided. Their views were listened to and acted upon. The provider and managers were passionate about continuous improvements and invested in their staff. This created an open, honest culture where staff felt valued.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. They were working to best practice guidance for supporting people with a learning disability and/or autistic people. The registered manager continuously monitored the home with in-house checks carried out. These checks identified areas for improvement.

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 25 August 2017). At this inspection the home was rated good.

Why we inspected

We undertook this focused inspection due to the length of time since the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Evergreen on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

•Some people found it very difficult to understand how to follow social distancing rules. For those people individual risk assessments were completed. These had clear actions to keep people and staff safe.

•Some people had been unable to isolate in their rooms when required. Staff had adapted other rooms in the service to enable these people to have their own spaces.

•People were well supported to keep in touch with families and other people who mattered to them. This had included visits in the garden, by windows, and in open spaces in the community. Risk assessments were completed when staff supported people to meet family members in the community.

•The registered manager told us how they were planning for one person to be admitted to the service Time was spent planning and preparing for their arrival. Regular video calls were held to help put them at ease about the home.

•Annual Christmas events were being held on live video calls. This was to help families see their loved ones and join in with activities and events.

Evergreen is acting to provide accommodation and personal care for up to eight people with mental health needs, autism and/or a learning disability. On the day of the visit, there were eight people at the home.

There was an acting manager in post. They had been in the role for two and a half months. They had put in an application with us to apply to be a registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like acting providers, they are ‘acting 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.

People were protected because the staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. There were systems in place to support staff and people to stay safe. New staff were only employed after they had been through a thorough recruitment process. Risks to people were assessed and identified. Action was then taken to keep people safe. These actions were kept to a minimum and were undertaken in ways that did not impact unnecessarily on people and their independence.

People were supported by staff who assisted them with their needs in a way that respected their privacy and encouraged them to be independent. The home had a welcoming and friendly atmosphere. People who wished to were encouraged to keep close contact with family members and people who mattered to them.

There had been a lapse in the regularity of staff supervision for staff whose records we viewed. However the acting manager had put in place a programme of staff supervisions for all of the team to address this shortfall. Staff were now being supervised and formally supported on a regular basis.

Staff had been properly trained and developed to ensure they were aware of people's needs and how to meet them. People were supported with their complex health needs by health professionals. They received the treatment and help they required to maintain optimum health.

People were able to enjoy a wide range of meals and drinks that they chose. People were well supported with their nutritional needs by the staff. The staff team understood how to support people with complex dietary needs.

People received care that was flexible to their needs. Where possible they were involved in reviews of their care needs. This was to help to ensure that staff had up to date information to support them effectively. Care and support plans were individual and promoted people’s independence. For some people where it was beneficial, picture formats were used to help them be involved in their care.

The team were positive about the management structure of the service and the organisation. They told us that the acting manager was a caring and supportive manager. They also said they were a very good role model. The acting manager was also very positive about their role and the team that they had taken over managing. Staff said the acting manager was always there for them whenever they needed advice, guidance and support.

To properly monitor the quality of care and daily life there were checking systems in place. These were to ensure the service people received was safe, suitable and personalised to their needs. Audits had picked up some matters that required action, including the shortfall in frequency of staff supervision. The acting manager was acting on these issues. There were also a range of checks and audits in place that ensured the ongoing safety and quality of the home. These had been effective at providing assurance that the service remained good, and that the service was meeting people's needs and the regulations.

Below is a summary of what we found. This is based on our visit to the home when we met with the people who used the service and with members of the staff and management team. Not everybody who used the service was able to express their views verbally and our observations in the home helped us to make judgements about the support that people received. Observations of staff interactions with people that used the service, were conducted sensitively and were in line with people's individual assessed needs.

Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person told us “staff are nice X looks after me”.

Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints, concerns, whistleblowing and investigations. Learning from any such events was cascaded to the staff team during team meetings. The provider audited such systems on a monthly basis. This reduced the risks to people and aided service improvement.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Dols. The deputy manager confirmed no one currently living in the home was subject to such safeguards. However relevant staff had been trained to understand when an application may be required. This meant that people’s rights would be upheld.

The management team set the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required to make sure that that were enough staff on duty. This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in developing their plans of care. People told us that they had been involved in the care planning process and we found care plans reflected their current needs. People had signed their care plans where possible that showed their involvement.

The deputy manager told us no one currently living in the home had specialist dietary, mobility or equipment needs. However they told us people needs would be assessed and their care plans would reflect any specialist requirements and advice would be sought. We viewed evidence in people’s care files of referrals to external professionals to gain advice as and when required.

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example, people's personal care files held information of how the home worked in partnership with family members and external professionals that ensured care and support plans were effective.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People were supported by sensitive and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. Not everyone was able to verbally tell us of their experience of living in Evergreen. The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Comments viewed were positive. Comments included: "I like the food" and "the staff are nice".

People’s preferences, interests, likes and dislikes had been recorded and in a format that supported their individual needs. Care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home has its own minibus, which helped to keep people involved with their local community, especially for some people who found using public transport difficult. People we spoke with confirmed some day trips they had recently enjoyed. One person told us “we went to Weston. I like fish and chips”.

People knew how to make a complaint if they were unhappy. A pictorial complaints policy was in place to support people and was discussed on a regular basis by the management team and support workers, during monthly care reviews and resident meetings. One person was able to tell us how they would make a complaint. We looked at previous complaints and how they had been dealt with. Complaints had been investigated and action was taken as necessary in line with the organisation’s policy.

Is the service well-led?

There was a well-established management team in place. Staff understood the ethos of the home. The deputy manager told us "We are well supported by the management team to provide the best care to people. We can always contact the manager they are always available for advice and support”.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly and reviewed by the provider. As a result the quality of the service was continuingly improving.

On the day of our visit people appeared relaxed and engaged in their own environment. Some people were not able to verbally tell us of their experiences. Therefore we observed staff interactions with people to gain a view of what it was like for them living in the home.

People were observed being supported by staff to prepare for the day’s activities. Staff were observed engaging with people in a positive way, and were heard asking people if they wanted to go out for a ride in the mini bus and what they wanted to do.

Staff were knowledgeable about the needs of people living in the home, and told us that training was sufficient and relevant to the needs of people they were supporting. Staff comments included; “we are a good stable staff team and we help each other”. “We get good support from the management team and the regional management team there is always someone to contact for support”. “Training is plentiful and we can do it at home on the computer”.

We were told by staff that they felt a good standard of care was delivered to people living in the home. Staff said they ensured people were asked their opinions and were encouraged to be as independent as possible.

On the day of our visit people appeared relaxed and engaged in their own environment. People were observed in the kitchen area being supported by staff to prepare their breakfast. Staff were observed engaging with people in a positive way, and were heard asking people what they wished to do with their day.

Staff were knowledgeable about the needs of people living in the home, and told us that training was sufficient and relevant to the needs of people they were supporting. Staff also told us they provided a good standard of care to people living in the home, and that they ensured people were asked their opinions.

A relative who was visiting the home told us "they are amazing here, I cannot fault what they do here". Another relative told us "the home has the best management team, things get done and things are organised for people". People we spoke with told us the staff team were approachable, and felt able to take any concerns to the management team if needed.