Our inspection took place on 27 June 2016 and was announced. We gave the provider 48 hours notice as this is a small service where people live independently, and we needed to be sure they would be available to speak with us.27 Ledstone Avenue is a registered unit that provides rehabilitative support for up to two people with an acquired brain injury. The service is part of Daniel Yorath House, and shares staff, management and management systems with that service. At the time of our inspection there were two people using the service, which is a domestic house close to Daniel Yorath House and local amenities. 27 Ledstone Avenue is used to assess a person’s ability to live independently as part of their injury rehabilitation programme.
There was a registered manager in post when we inspected. 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.
People who used the service told us they felt safe and were confident in the care and support they received. Risks associated with people’s care were assessed well and documented, and the provider had a good approach to positive risk taking to support people’s rehabilitation goals. Staff had received training in safeguarding, could describe the signs of potential abuse and were confident the provider would react appropriately to any concerns that were raised.
The environment was well maintained. Fire safety procedures were in place and staff were confident in their ability to assist people to evacuate the building safely if required. Care plans contained personal evacuation plans to support this.
Recruitment was carried out safely. Appropriate background checks were made to ensure new staff were not barred from working with vulnerable people. People told us staffing levels were appropriate, and staff said they had access to support from colleagues working in the main service at Daniel Yorath House when they needed it.
Medicines were stored and managed safely. People were able to manage their own medicines, and we saw records were kept up to date.
People told us they thought staff were well trained, and we saw evidence of a robust induction and training programme. Some refresher training was overdue, but the registered manager had taken steps to address this. Staff had regular support through supervision meetings with senior staff and an annual appraisal at which their performance and training needs were discussed.
The provider was working within the principles of the Mental Capacity Act. People’s capacity to make specific decisions was assessed and documented, and there were appropriate systems in place to ensure decisions made on people’s behalf were made in their best interests. Care plans contained records of consents given by people for various aspects of their rehabilitation.
People were able to plan their shopping and cook their own meals according to their tastes and preferences. Staff told us they gave advice about healthier options but respected people’s decisions about what they wanted to eat.
We received good feedback about the staff and people told us they felt they were caring. People using the service said they were involved in setting their goals and the pace of their rehabilitation programme. They told us they made choices about how they spent their days and were free to have visitors or to make visits to friends and family.
Staff described how they were mindful of people’s privacy and dignity and we observed a relaxed and informal atmosphere in the service Staff were knowledgeable about people and spoke about them respectfully and with fondness.
People’s preferences for daily routines was documented in their care plans, together with the amount of prompting or assistance they required for each task.
People’s care plans were based on a thorough pre-assessment of needs and contained a number of specific care plans to support their rehabilitation. We saw people who used the service, families and healthcare professionals were involved in writing and review of care plans.
The provider had systems in place to ensure they recorded and responded to complaints appropriately. We saw the provider had not received any complaints relating to the service, and looked at the wide range of compliments received from family members of people who used the service.
We found a collaborative culture in the service, with people and staff able to contribute ideas and suggestions both formally and informally. Staff told us they felt the manager had a clear vision for the service.
There were quality assurance activities in place to monitor and drive improvement in service delivery. The registered manager had delegated some activities to appropriate staff and given them protected time to complete audits. We saw this was improving the effectiveness of the audit programme.