Archived: 23 Barncroft Street

At our last inspection on 09 February 2015 the service was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver personal care to four people. People who live there may have a learning disability or associated need. On the day four people lived at the home.

The manager was not registered with us as is required by law. However, they had applied for registration to address this. 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.

Medicine systems did not always demonstrate safety or confirm that people had been given their medicines as they had been prescribed. Staff were available to keep people safe, to allow care and support to be provided flexibly and to meet all people’s needs. Staff knew the procedures they should follow to ensure the risk of harm and/or abuse was reduced. Recruitment processes ensured that unsuitable staff were not employed.

Documents had not been completed to ensure that external professionals would have all of the information they required to meet people’s needs safely or in their preferred way. Staff had received the training they required to give them the knowledge they needed to support people safely. Staff knew that people must receive care in line with their best interests and not be unlawfully restricted. People were encouraged to make decisions about their care. Meal options were offered to ensure that people’s food and drink preferences were catered for. Input from external healthcare professionals was secured to meet people’s healthcare needs.

The provider ensured a homely friendly atmosphere within the service. People were supported by staff who were kind and caring. People were treated with dignity and respect. People were encouraged to make decisions about their care and support and their independence was promoted. People could see their family when they wished to.

People were involved in their pre-admission assessment of need and follow on reviews. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to. People could attend religious services of their choice if they wished to. People accessed leisure activities on a regular basis that they enjoyed.

Although people felt that the quality of service was good a consistent manager had not been available. The manager and provider undertook regular audits but these had not always determined shortfalls that could have an impact on people’s safety. People were aware of who the new manager and deputy manager were and were relaxed in their company. The provider had made money available to enhance some areas of the premises.

No one knew we would be visiting as our inspection was unannounced. Two people lived at the home at the time of our inspection. We spoke with both of the people who lived there. We spent time sitting in communal areas to observe the care that people received.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that systems had been put into place to promote learning from events such as previous non-compliance and incidents that had occurred between the people who lived at the home. This reduced potential harm to the people who lived there.

People told us they felt safe. People we asked told us that they had not seen anything of concern. One person told us, 'The staff would not do anything I do not like'. I would not stay here if they did'. Staff we spoke with knew of the Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. All staff we spoke with told us that there was no need at that time to impose any restrictions on the people who lived at the home. This showed that systems were in place to keep people safe.

We found that people's mobility and other needs had been assessed and were generally met. We found that the management of day to day risks and safety was adequate which prevented people having falls, accidents, or suffering from untoward incidents.

We determined that staffing levels were adequate and flexible to ensure that people were not being placed at risk of harm through inadequate supervision and care provision.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

One person who lived at the home said, 'It is good here'. The other person was smiling and raising their thumb which indicated that they were happy.

People's health and care needs were assessed and they were included in their care plans. For example, care plans highlighted what action staff should take to reduce risks to people who had specific health conditions. This meant that care plans supported staff to meet people's needs. One person told us, 'My needs are met here and my care plans are good'.

We found that staff had good knowledge of people's needs and risks. One staff member said, 'At the start of our shifts we have to have a handover. That way we have up to date information about people's needs and risks. It is a good system'.

We saw that staff gave people their full attention throughout our inspection. We also saw that staff attended to people's needs as they should have. We saw that staff had time to sit and chat with people, to give them support and reassurance.

We found that people's needs had been assessed by a range of health professionals including; specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met.

Systems regarding menu planning and the main mealtime experience process were effective. People told us that the meals were good and that there was plenty of variety. One person told us, 'The food is nice'.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was effective.

Is the service caring?

Overall we determined that staff showed people respect and promoted their dignity.

We observed good interactions between the staff and people who lived at the home and we saw that people were given choices. We saw that people were at ease with the staff. We saw that staff showed patience when supporting people. One person said, 'The staff are good, they are kind'.

People's preferences and interests had been recorded so that care and support could be provided in accordance with their wishes.

We found that day to day activity provision was appropriate and met people's needs. One person told us, 'I do what I want every day'. This meant that people were fulfilled and did not experience boredom.

People who lived there were given the opportunity to give their views on the care and service provided. By listening to the views of the people who lived at the home the provider would know when improvement was needed.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was caring.

Is the service responsive?

Following our previous inspection the provider acknowledged that changes should be made and that systems should be improved. They made changes and reassessed the service provided to engender improvement. This demonstrated some responsiveness.

People who lived there told us that if they wanted to do something or go somewhere they told the staff and they made the arrangements or supported them to do so. This showed that staff were responsive to people's needs and acted to meet them. One person said, 'I only have to ask the staff and they quickly do what I want'.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was responsive.

Is the service well-led?

We found that significant improvements had been made since our previous inspection. Staff told us that new systems had been put into place and that they had received instruction on how to use the new systems.

Records we saw during our inspection were generally adequately completed. Staff told us that they had received training and that care records were audited on a regular basis. This showed that staff had undertaken tasks as they should which gave assurance that the service was well led.

Staff reported high morale. We found that staff had opportunities to receive supervision regularly and get support when it was needed. One staff member said, 'I love working here and I feel totally supported'.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was well led.

Because some of the people living at the home had complex needs, not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people which included observation. We spent time sitting in communal areas to observe the care that people received. We saw good interactions between the staff and people who live at the home and we saw that people were given choices. We saw that people were at ease with the staff.

We observed that due to low staffing levels people's privacy and dignity needs were not consistently being met.

We saw that people's needs had been assessed by a range of health professionals including; specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met. However, because staffing levels were low we found that safety needs were not being consistently met which was placing people at risk of injury.

We found that the premises were safe and maintained which made the home a pleasant place for people to live in.

We determined that staffing levels were inadequate and in need of improvement to make sure that people were not being placed at risk of harm through inadequate supervision and care provision.

We saw that complaints processes were in place and were accessible to people to use if they were not happy with the service provided.