This was an unannounced inspection that took place on 1 December 2016 and was completed by an adult social care inspector. When we last visited the service on 20 February 2015 we judged that the staffing did not meet people's needs and the service was in breach of Regulation 18. Nutritional needs were not being met and the service was in breach of Regulation 14. The service was also in breach of Regulation 12 because assessment, care planning and delivery did not always meet individuals needs. The provider sent us a detailed action plan that assured us they were working on these breaches. At this visit we judged that these three breaches had been met. Floshfield is a dormer bungalow situated in a residential part of the village of Cleator. It can accommodate up to six people living with a learning disability. Accommodation is in single rooms with shared facilities. The service is operated by West House, a charitable organisation that runs other services in Cumbria for people with a learning disability
The home 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 service ensured that staff were suitably trained to identify and deal with any issues of abuse or harm. Suitable safeguarding arrangements were in place.
Risk management plans were in place for all aspects of the service. The provider had an emergency plan to deal with any potential problems. This had been put into action during the floods of 2015.
Recruitment and disciplinary matters were managed well. West House had detailed policies and procedures in place about these matters
When we last visited the service was in breach of Regulation 18, staffing, because we judged that the staffing levels did not meet peoples' needs. At this visit we saw that staffing levels were kept under constant review to reduce risk and give suitable levels of care. Staffing levels were suitable to meet needs.
Medicines were appropriately managed with staff receiving training and checks on competence. People had their medicines reviewed on a regular basis.
The home was clean and orderly when we visited. Staff were aware of the need to prevent any cross infection and took suitable action. There had been some improvements made to the environment with redecoration and new floor coverings being planned.
Staff received good levels of training, supervision and appraisal. The staff we spoke with were happy with the support they received.
The staff understood their responsibilities under the Mental Capacity Act 2005. We saw that appropriate action was taken if the registered manager thought anyone was being deprived of their liberty. Restraint had not been used in the service but staff were trained in how to manage behaviours that might challenge.
At our last visit we judged that the service did not meet Regulation 14, meeting nutrition and hydration needs. We saw at this visit that the staff team had worked on the problems and we found that people now received a balanced and wholesome diet. Suitable support was sought if anyone was underweight. People had good support from their GP, community nurses and health care specialists.
We judged that the staff team were kind and caring towards the four people who lived in the home. We had evidence to show that the staff supported people to have as much privacy as they wanted. We observed staff ensuring that people could retain their dignity. Everyone in the home had access to independent advocacy services.
We also had evidence to show that the staff team tried to support people to be as independent as possible.
We had also identified a breach in Regulation 12 when we last visited because assessment and care delivery did not always meet individual needs. At this visit we saw that staff were now supported to be fully aware of individual. New assessments and care plans were being worked on where peoples needs had changed. This had happened because good assessment of need was in place. Other plans had been updated after assessment and review. We judged that the breach in the regulation had been met.
We also looked at activities and person centred plans. These were suitable but the registered manager had identified that some more age appropriate activities might be welcomed by some people in the service. We have made a recommendation about involving people in the home and taking guidance from a reputable source so that people in the service will have access to entertainments and activities they will find appropriate.
There had been no formal complaints received but the provider had suitable policies and procedures in place.
People were given suitable support if they had to move from or into the service.
The home had a newly registered manager who was experienced in the care of people living with a learning disability and who had already led staff teams. We had evidence to show that he had started to help staff look at their practice so that people would continue to receive appropriate care.
West House had a detailed quality monitoring system in place in all the services. We saw that senior managers visited this service on a regular basis to ensure that quality standards were met. The registered manager also completed audits of all aspects of the service. Action plans were in place to deal with some of the issues that quality monitoring had highlighted. We saw that the registered manager had started to streamline the records in the home.