From 23 September to 13 November 2015
During a routine inspection
This announced inspection took place from 23 September to 13 November 2015.
At the time of our inspection the service supported 73 adults and 12 children who required care for complex health needs, including care of tracheostomies and the use of ventilators for 22 people.
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 ethos of the service was that staff supported people to lead their lives by goal setting and enabling. All of the processes within the organisation were geared towards this ethos, from recruitment, training, local management to staff providing the care.
People were protected from harm arising from poor practice or ill treatment as there were clear safeguarding procedures in place for care staff to follow in practice if they were concerned about people’s safety.
All the people receiving care had complex health needs. Nurses monitored the clinical progress of people and linked with external healthcare services to ensure appointments were made and information was shared to maintain the stability of each person’s health.
People were assessed for their risks and plans of care were made to mitigate these risks. People had specific risk assessments and care plans relating to the provision of their medicines. People’s risks were managed in order to protect them whilst respecting their freedom. There were robust procedures and protocols for each person’s individual needs in an emergency and staff were trained to respond to people’s needs in an emergency.
Recruitment systems ensured that people were protected from the risks associated with the recruitment of new staff. Staff were employed specifically to meet individual people’s needs. The provider had a system to match people with care staff to find compatibility and people and their families were involved in the recruitment process.
The provider matched the needs of the people receiving care to the skills and competencies of their staff team. When staff were on leave or unplanned absences, the provider had systems in place to provide alternative competent staff. People described how the relationships with their staff teams were therapeutic and provided them with the confidence to be independent and achieve their goals.
People received care from staff that had undergone a period of induction which enabled them to acquire the skills and knowledge they required to provide safe care. Staff received regular training and updates, and their competencies were checked.
Staff received supervision from nurses and managers for their respective teams. Good team work and practice was recognised by the provider in the form of awards.
Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA 2005) and applied that knowledge appropriately. There was a Mental Capacity Act policy and procedure for staff to follow to assess whether people had the capacity to make decisions for themselves.
People were regularly assessed for their risk of not eating or drinking enough to maintain their health and well-being. Staff followed detailed care plans that mitigated identified risks and followed health professionals advice and guidance.
People were involved in planning their care. People’s care needs were detailed in care plans which were reviewed and updated regularly or when their needs changed. The care plans provided care staff with the information they required to manage people’s complex medical needs.
People had the opportunity to feedback about the quality of their care in regular meetings with the locality managers, during contact with nurses and formally through surveys.
People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.
There was effective management and leadership of the service. The registered manager had management qualifications and experience in providing care and support to people with complex needs. The management promoted an open and honest culture within the organisation.
The service was a learning organisation; they took every opportunity to learn from problems, situations and complaints to learn and improve the service.
The provider had a comprehensive governance structure which drove improvement of the quality and safety of the service.
The provider had forged closer working relationships with healthcare organisations and by supporting their clinical leads to take an active part in national initiatives.
The service provided care for people throughout England, they had a good working relationship with over 20 different clinical commissioning groups and six local councils.