Blakesley

Blakesley is a residential care home providing personal care to up to 6 people in one adapted building. The service provides support to people with a learning disability. At the time of our inspection there were 7 people using the service, including 2 people who stay part of the week at the service and part with their families. Blakesley is a family sized house in a residential area, similar in appearance to the other houses in the street.

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: People received exceptionally personalised care and support from dedicated staff who had formed positive, mutually respectful close relationships with them . With the right support people flourished in all aspects of their lives, growing in self-confidence, developing skills and being enabled to maximise opportunities that would not otherwise be available to them. People were supported to achieve their aspirations and goals. People were supported holistically and enabled to access specialist health and social care support when this was needed. People played an active role in maintaining and improving their health and wellbeing.

People were supported to have maximum autonomy, 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 living at Blakesley received highly individualised care and support which promoted their dignity, privacy and human rights. People were supported to develop skills and independence at their individual level, varying from growing in confidence with completing their own personal care to learning household tasks. People received care and support from exceptionally kind and compassionate staff. Staff were extremely vigilant, responded to people's individual needs and focused upon supporting them to achieve a full and enriching quality of life.

Right Culture: There was an embedded culture of people being at the heart of the service. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. People received support based on transparency, respect and inclusivity. The registered manager and staff worked hard to instil a culture of care and good teamwork. Everyone valued and promoted people's individuality, protected their rights and enabled them to develop and flourish.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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.

The inspection was prompted in part due to concerns received about bathroom facilities. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from requires improvement to outstanding based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blakesley 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.

Blakesley is a residential care home providing personal care to six younger adults with learning disability and autism. The service can support up to six people in one adapted building. Blakesley is a family sized house in a residential area, similar in appearance to the other houses in the street.

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

Health and safety audits were not always completed in line with best practice guidance. Several maintenance tasks were not completed in line with the provider’s policies.

Quality control systems were not always effective and did not always identify issues within the service. When issues were identified during audits, this did not always result in the provider developing effective action plans to improve care and drive continuous learning.

Medicines were safely managed. Medicines administration record (MAR) charts were accurately completed, medicines were safely administrated and when people received their medicines ‘as and when required’ (PRN) the correct PRN protocols were in place.

The provider had enough staff with the right skills deployed to provide people with their commissioned care.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around medication, mobility, behaviour and personal care.

Comprehensive cleaning schedules were in place which supported staff to prevent and control infection.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

The provider and management team had good links with the local communities within which people lived.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

The service ensured that people can live as full a life as possible and achieve the best possible outcomes by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.

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 outstanding (published 10 August 2018).

Why we inspected

We received concerns in relation to staffing levels, staff training, medicines errors and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The model of care is based on the Rudolf Steiner principles of providing a spiritually oriented community, supporting people with learning disabilities to continually develop, regardless of disability. Blakesley accommodates up to six people in an adapted two storey building in the centre of a village.

At the time of the inspection there were six people living there. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We had previously inspected this service in June 2016, at that inspection the service was rated ‘Good’. This inspection took place on the 12, 14 and 15 June 2018. The service had remained ‘Good’ and we found that there were areas which had continued to be improved and have rated the service overall as ‘Outstanding.’

The service demonstrated an excellent commitment to providing outstanding care which put people at the heart of everything. The provider and registered manager led and inspired the staff to deliver person- centred care which had achieved consistently outstanding outcomes for people.

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

Staff continuously went the ‘extra mile’ to ensure that people lived as fulfilled and enriched lives as possible. They respected people’s individuality and enabled people to express their wishes and make choices for themselves. Positive therapeutic relationships had been developed and staff were proud of the support that they had provided to people and the positive outcomes they had observed.

People who demonstrated behaviour that may challenge services received care that was based upon best practice guidelines that met their individual needs and successfully reduced incidents within the home and community.

Staff demonstrated the provider's values of offering person - centred care that respected people as individuals in all their interactions with people. People, their relatives and the professionals involved in people's care consistently told us that the service provided ‘exceptional care’ to people. People could be assured that they would be supported by sufficient numbers of staff. Records showed that people received their care in the way they needed to maintain their safety.

People were supported to use communication aids and information was provided to people in an accessible format to enable them to make decisions about their care and support.

People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet. People experienced caring relationships with staff and good interaction was evident.

Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns. Care plans contained risk assessments which gave detailed instructions to staff as to how to mitigate risks; these enabled and empowered people to live as independent a life as possible safely.

There was a very effective system of quality assurance led by the provider and registered manager that ensured people consistently received exceptional care and support. The people living at Blakesley had an enhanced sense of well-being and quality of life because staff worked innovatively to enable people to have meaningful experiences and to become active members of the local community.

The provider ensured that the service kept up to date with the current best practices and innovative ways to support people through membership of relevant organisations and working with various professionals and agencies. The registered manager and provider continuously looked at ways to improve the service and enhance people’s lives. The feedback from the people, relatives and professionals was consistently positive.

A registered manager was in post. 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 were safe and protected from harm. The staff had a good understanding of what abuse meant and the safeguarding procedures to follow to report abuse.

Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare. Systems were in place to monitor accidents and incidents so that preventative action could be taken to reduce the number of occurrences.

Robust staff and volunteer recruitment systems ensured that staff were safe to work with people living at the service. The staffing arrangements ensured that people received one to one staff support to meet their care and support needs.

Robust arrangements were in place for ordering, storing and administering medicines.

Staff had comprehensive induction training and on-going training, which ensured that they had the knowledge and skills to meet the needs of all people living at the service.

Staff supervision and annual appraisal systems enabled them to reflect on their work practice and continually plan their learning and development needs.

The staff treated people with dignity and respect and ensured their rights were upheld. Consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were fully met.

People had a choice of healthy, nutritious food. Healthy eating was integral to promoting well-being. Appropriate referrals were made to health professionals where any health concerns were identified.

The staff were highly motivated and inspired to offer care that was kind, caring and compassionate. They worked in partnership with relatives, who felt informed and involved in their family members care and treatment.

People had individualised care plans in place that clearly detailed and reflected their needs and choices about how they preferred their care and support to be provided. The staff were observant to people's moods and behaviours and were proactive in following individual strategies to minimise people's anxiety. They followed the advice and support from other health professionals to minimise the risks of poor health.

People were encouraged and supported to engage in purposeful social, occupational and recreational activities to enhance well-being.

There were regular meetings for staff which gave them an opportunity to share ideas, and give information about possible areas for improvements to the registered manager.

People were encouraged to raise any concerns they had about the quality of the service they received and complaints were taken seriously and responded to immediately. There was an emphasis on the service continually striving to improve.

The vision and values of the service were person-centred and made sure people living at the service and their representatives were fully consulted, involved and in control of their care.

Robust quality assurance systems were carried out to assess and monitor the quality of the service. The views of people living at the service and their representatives were sought about the quality of the service and acted upon to make positive changes.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The staff on duty had a good understanding of how to meet the needs of people who used the service. We saw that people felt safe and comfortable in the presence of staff. Staff received regular training and support which helped them to provide safe care. Relatives we spoke with told us that their family member was well looked after and they were in a safe place.

We saw that health and safety information was kept up to date. People and staff were involved in fire drill training so they knew what to do if there was a fire at the service. Health and safety checks were carried out to make sure the premises and people using the service were kept safe. Risk assessments were in place which identified any specific hazards for people who used the service.

Is the service effective?

People's health and care needs were assessed and plans of care were put in place to meet their needs. Information about how people communicated their needs and wishes were clearly identified in care plans which helped ensure that all staff were able to provide appropriate care. We saw that care plans were being updated by staff when people's needs changed. This ensured staff had information about people's new needs.

Is the service caring?

People were treated with dignity and respect by the staff. We saw staff approached people who used the service in a caring manner. People's preferences, interests, and needs had been recorded and care and support had been provided accordingly. All the people we spoke with told us that the staff were very 'caring' and they liked them. The relatives we spoke with told us that the staff spoke to people in a respectful manner and were very caring. One relative told us that they raised a concern with the staff and staff made them feel comfortable and listened to and sorted their concern straight away. They told us that their family member was very happy at the service and they liked the staff and enjoyed the food and the activities. They said my relative 'sees this place as their home'.

Is the service responsive?

Staff had good understanding of people's needs. One person told us if they were not happy, they told the staff and they listened and supported them to meet their needs. We saw people had individualised care plans and they had been involved in discussing how they wanted their care to be provided. Relatives we spoke with told us that the staff kept them updated about their family members care needs. They also told us that the staff had good skills and knowledge and met their family member's needs well. One relative told us that they attended their family members review meetings and staff had 'listened to us and acted on our opinions'.

Is the service well-led?

We found that the service was being well managed by the provider and there were systems in place to identify and make improvements where necessary. Staff received training, supervision and support from management, which helped them to provide safe and effective care.

The provider had monitoring systems in place to ensure that medication administration records were fully completed. Staff training records and people's care plans were updated to meet their current needs. We saw that health and safety checks were also undertaken regularly to ensure all systems were up to date and kept people safe.

We spoke with a relative of a person that used the service who told us they were happy with the care their relative received. They told us 'We are extremely happy with the care (our relative) receives'. They also told us 'The service is excellent'.

We spoke with three staff members who all told us they felt well supported in their roles. One staff member told us 'We work with people at their pace'.

We found that people's needs were assessed and care and support plans were put in place to ensure their needs were met. We saw that work placements and activities were arranged that met people's needs and promoted their well-being. We found that appropriate checks were carried out on equipment to ensure people's safety. We found that pre-employment checks were carried out on staff to ensure people were supported by suitable staff.

However, we found concerns relating to the management of medication at the service.

We spoke with two relatives of people who lived at Blakesley. They told us "the care is wonderful, the staff are all very friendly and very professional" and "it's a brilliant place for our son, it suits him down to the ground".

We spoke with one staff member who told us that they felt that the care that people receive is fantastic and that people who use the service got a lot of choices as they got one to one support. Another staff member told us "it's one of the best care environments for young people that I've been involved in".

We found that people who used the service had detailed care and support plans and that care was provided in line with these. People were involved in a wide range of community activities and people's own beliefs were respected. We found that staff felt well supported and the provider assessed and monitored the service.