Brighton & Hove City Council - 21 Ferndale Road

21 Ferndale Road provides tailored support packages for two people with a learning disability or autistic spectrum disorder. This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection two people were living in the service. People have their own bedroom and shared the communal facilities. The service is situated in a residential area with easy access to local amenities and transport links.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Observations, a relative and visiting health and social care professionals consistently told us how the service was exceptionally personalised to meet people's individual needs. Staff spoke with pride and passion about the way people were cared for. Management and staff continuously looked for ways to improve people's care so they received positive experiences and led fulfilling lives at the service. Staff had achieved a ‘Gold’ award for ‘Total Communication Charter Standards,’ which was an externally rated and reviewed award. The ‘Total Communication Charter’ is a set of 10 standards to help support people with learning disabilities and their carers to communicate as effectively as possible and is supported and followed by local statutory authorities in the city. This is the term used to describe the use of pictures, objects, signs, gestures and spoken word to enable people to express themselves and understand what is being said. Staff spoke of ways they had been creative and innovative to achieve and maintain this level of award and how they had supported staff from the other provider’s services to achieve this award and work towards ‘Gold’ status. The registered manager told us, “Through the high standard of communication implemented in the service we supported the service users to communicate through speech, Makaton (A specific visual signing technique was used, as was pictorial representations), symbols and pictures.” Staff from the providers other services working towards the award had also visited the service for ideas, support and guidance.

The culture of the service was open and inclusive and encouraged staff to see beyond each person's support needs. The provider had clear values which the registered manager and staff promoted. The registered manager showed outstanding drive and passion, ensuring the service was continually improving and striving to be outstanding, with people at the heart of the service.

Systems had been maintained to keep people safe. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had received supervision, and continued to be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Care staff had the knowledge and skills to provide the care and support that people needed.

Care and support provided was personalised and based on the identified needs of each person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent. A relative/advocate told us they very happy with the care and support provided. People continued to be supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to increase their independence and access a range of social activities.

The provider continued to have arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health. People were protected by the infection control procedures in place.

A relative/advocate, visiting health and social care professionals and staff told us the service continued to be well led. Staff told us the registered manager was always approachable and had an open door policy if they required some advice or needed to discuss something. One member of staff told us, “I love it here. We have done such a lot of work with (People’s names) and they have come such a long way. I like what we do here. I like the support here. This place keeps me going. I enjoy getting stuck in here and we all help each other out.” The registered manager carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided through reviews, tenants meetings and by using quality assurance questionnaires.

21 Ferndale Road is a supported living scheme where people live in their own home under a tenancy agreement, and is registered to provide personal care. People received personal care or social support in order to promote their independence. The support provided was tailored to meet people’s individual needs and enable the person to be as autonomous and independent as possible. 21 Ferndale Road had two people with a learning disability living in the service, whose behaviour can be complex. People have single bedroom accommodation and a range of communal facilities they can use. The service is situated in a residential area with easy access to local amenities, transport links and the city centre.

The service had a registered manager, who was present throughout the inspection, who has been in their current post for a number of years and knew the service well. 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 was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Care staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively.

Relatives told us people were safe in the service. People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were up-to-date, were detailed and reviewed regularly.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff were aware of the appropriate action to arrange meetings to make a decision within their best interests.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans. There were procedures in place to ensure the safe administration of medicines.

People were supported by kind caring staff. There were sufficient numbers of suitable staff to keep people safe and meet their care and support needs. The number of staff on duty had enabled people to be supported to attend social activities.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the registered manager, who they described as very approachable.

Relatives, staff and a visiting healthcare professional told us the service was well led. People representatives were asked to complete a satisfaction questionnaire to help identify any improvements to the care provided. The registered manager told us that staff carried out a range of internal audits to review the quality of the care provided, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

Below is a summary of what we have found. The summary is based on our observations during the inspection. There were two people who used the service. We used a number of different methods to help us understand the views of these people, who had complex needs which meant they were not able to tell us about their experiences. We observed the care provided, looked at supporting care documentation, staff records and records relating to the management of the service. The registered manager had left the service. A new manager had been appointed who showed us an application had been submitted to the CQC to register a new manager. We spoke with the manager, two care workers (one of whom was one of the providers bank staff), a relative for one of the people who used the service,and an advocate for the other.

Is the service safe?

People were treated with respect and dignity by the care workers. People told us their relative or friend was safe in the service. One commented, 'Definitely.' Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people's best interests. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were being safeguarded as required.

There was a system in place to make sure that the provider, manager and care workers learnt from events such as incidents and accidents, complaints, and concerns.

Staff had been provided with training to undertake their roles in the service, systems developed and recording and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.

A staff rota was in place, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs had been reviewed and where possible people and their representatives had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and behavioural support needs had been identified and guidance for staff to follow was in place. People were able to move around the service freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and offered encouragement when supporting people. The relative and advocate we spoke with told us, '*** (name) likes routine. They manage this well,' 'I like the way *** (name) is treated. I am very happy with the care there,' and ' We can't really fault the service.'

The relative and advocate told us had they been involved with the service and had been asked to complete quality assurance satisfaction surveys.

People's preferences, interests, aspirations and diverse needs had been recorded. Both the relative and advocate told us care and support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside of the service.

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. No complaints had been received since the last inspection. The relative and advocate told us they had not had to raise any concerns. They were aware who to speak with if they had any concerns and they felt they would be listened to. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

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

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

There were two people who used the service. We used a number of different methods to help us understand the views of these people, who had complex needs which meant they were not able to tell us about their experiences. We observed the care provided, looked at supporting care documentation, medication records, staff records and records relating to the management of the service. We spoke with the manager, two care workers, and a relative for one of the people who used the service, and an advocate for the other.

This told us people who used the service or their representatives had been involved in making decisions about their care, and where they were able to gave consent to the care. Peoples' care needs had been assessed and care had been planned and delivered in line with their individual care plan.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

People's care had been provided by care workers who understood their care needs. There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service.

Systems were in place to review and monitor the quality of the care provided.