Archived: 146 Lower Robin Hood Lane

146 Lower Robin Hood Lane is a residential care home that accommodates up to five people with a physical disability and learning disability. People had complex communication needs and limited vision. The accommodation provided is a bungalow. Some people were not able to communicate using speech and used body language, signs and facial expressions to let staff know how they were feeling. At the time of the inspection there were four people living at the service.

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.

People’s experience of using this service:

People's experiences were consistently good, and this was confirmed by feedback about the service.

People were supported by staff, who knew people well and trusting relationships had been developed. Staff were available to support people when they needed it. 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 continued to treat people with dignity and kindness and to put people at the heart of the service. Staff and managers had championed on people’s behalf in situations when professionals had not shown people equal respect.

Staff understood changes in people’s body language and how to communicate with people who had limited vision and verbal communication. Despite changes in the management team, staff felt well supported and were motivated to provide personalised care.

People could be assured that staff understood their health, social and personal care needs. Strong partnerships had been developed with a range of health care professionals. Everyone worked together to find the best outcome for the person. People continued to receive their medicines when they were needed. Risks to people’s well-being and in the environment continued to be effectively managed.

People were given informed choices about how to spend their time. They took part in regular sensory activities which met their individual needs. People’s relatives were assured that people were safe and well cared for and they were kept up to date with their loved one’s well-being.

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

Rating at last inspection: Good (last report published 25 October 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

146 Lower Robin Hood Lane provides accommodation for people who require personal care. The accommodation is a large bungalow providing support for up to five people with learning and physical disabilities and complex communication needs. Some people were not able to communicate using speech and used body language, signs and facial expressions to let staff know how they were feeling. At the time of the inspection there were four people living at the service receiving support.

At the time of out inspection the manager had been in post since the previous registered manager had left the service to manage another of the provider’s homes in January 2016. The manager had applied to the Care Quality Commission to become the 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the manager had not applied for DoLS authorisations for people living at the service, however they had planned to and they had spoken to their line manager about this. People living at the service were under constant supervision from staff to keep them safe. We have made a recommendation about this.

The manager and the management team understood their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments and decisions made in people’s best interest were recorded. People were asked their consent before any care or support was given.

People told us they felt safe and observations showed that staff knew people well and understood their communication needs. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Systems were in place to ensure people were protected from the risk of financial abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure the safety of people, staff and visitors. The fire risk assessment had not been reviewed by a qualified and competent person. We have made a recommendation about this.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. Medicine audits were regularly carried out by the manager and the assistant team leader.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff received the appropriate training to fulfil their role and provide the appropriate support. Staff were supported by the management team who they saw on a regular basis. Staff worked well as a team and felt supported by one another. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. People’s individual care and support plans were person centred and gave staff the information and guidance they required to give people the right support. Detailed guidance was available for staff to follow to support people who displayed any behaviour which caused a risk to themselves or others. People had clear communication plans and guidance in place to ensure staff were able to communicate effectively with them.

People had access to the food that they enjoyed. People’s nutrition and hydration needs had been assessed and recorded. People were encouraged and supported to be as independent as possible. People were supported to remain as healthy as possible with the support of healthcare professionals.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and their loved ones and reviewed to make sure people continued to have the support they needed. Detailed guidance was provided to staff about how to meet people’s needs including any specialist support needs. Innovative ways were used to ensure people were able to maintain contact with people that mattered to them.

People participated in activities of their choice within the service and the local community. There were enough staff to support people to participate in the activities they chose.

Processes were in place to monitor and improve the quality of the service being provided to people. The provider had a vision and set of values which were followed and implemented by the staff team.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We spoke with one person who used the service about their experience of living in the home. The person commented, "Yes, I like living here'. 'I am happy here' and 'I like my friend X to visit me regularly here'.

People were not protected from the risk of infection because appropriate guidance had not been followed.

There were effective recruitment and selection processes in place.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Staff records and other records relevant to the management of the service were accurate and fit for purpose.

We observed the staff were kind and respectful to the people. In our discussions with staff they demonstrated a thorough knowledge of the people living at the service and how to focus care around their specific needs.

Care records were out of date and recorded in inappropriate ways. We could not be sure that the care records reflected a good standard of care was being provided, though we observed the care and interaction to be respectful and kind. We found that staff obtained verbal consent but there was insufficient written consent on the files.

Staff spoken with demonstrated a good understanding of how to safeguard people from harm and were confident to take appropriate action. Training records showed that staff received regular training on protecting people from abuse and the Mental Capacity Act.

We could not find evidence that the provider regularly assessed and monitored the quality of the service. We saw that the home had not had an internal audit for five months and the poor record keeping had not been identified within those audits.