We carried out a review of the data available to us about Viola House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Viola House, you can give feedback on this service.
About the service
Viola House provides accommodation and personal care and support for a maximum of 12 adults with a learning disability and autism. There were seven people living in the home at the time of our inspection.
People’s experience of using this service and what we found
The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.
Right support:
The service supported people to have the maximum possible choice, control and independence so they had control over their own lives. The service gave people care and support in a safe, clean, well equipped, well-furnished, and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.
Right care:
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People who had individual ways of communicating, using body language, sounds, pictures and symbols could interact comfortably with staff and others involved in their treatment because staff had the necessary skills to understand them. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
Right culture:
People received good care and support because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well. People and those important to them, including families, were involved in planning their care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
People’s relatives told us the provider had worked hard to improve care and support for people using the service. The new registered manager has a positive impact and was described in complimentary terms by staff and families.
People lived safely and free from unwarranted restrictions because the provider assessed, monitored, and managed safety well. The assessments provided information about how to support people to ensure risks were reduced but did not limit people’s right to take reasonable risks.
The service had enough staff. Pre-employment checks had been carried out. These checks helped to ensure only suitable applicants were offered work with people.
People received their medicines safely. They were supported by staff who followed systems and processes to administer, record and store medicines safely. We observed from records people received their medicines on time.
People were protected from the risks associated with poor infection control because the service used effective infection, prevention and control measures to keep people, staff and visitors were safe.
People's health needs were met. The care files we looked at included details of health action plans and management of day-to-day healthcare needs.
There was a process in place to report, monitor and learn from accidents and incidents.
Governance processes were effective and helped to assess, monitor, and check the quality of the service provided to people. Audits had been carried out on a range of areas critical to the delivery of care.
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 Good (published 4 May 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.
About the service
Viola House provides accommodation and personal care and support for a maximum of 12 adults with a learning disability and autistic people. There were seven people living in the home at the time of our inspection.
People’s experience of using this service and what we found
Right support:
The application of COVID-19 restrictive visitor policies meant some people did not always have maximum possible choice, control and independence. The service has since made adaptations to ensure restrictions are reasonable and equitable. We also observed elements of right support. Staff enabled people to access specialist health and social care support in the community. During the COVID-19 pandemic, we saw reasonable adjustments for people so they could have day centre activities at the home. The service people received was provided in two adjacent houses, which were similar to the other houses in the area. People’s rooms were clean and personalised with their belongings.
Right care:
There were elements of right care. Whilst the service could have done more to make sure restrictions were equitable, largely people’s equality and diversity were supported. Staff spoke knowledgeably about how they ensured people received care that met their diverse needs, including spiritual and cultural differences. They understood how to protect people from poor care and abuse. They had received training on how to recognise and report abuse and they knew how to apply it. People who had individual ways of communicating, using body language, sounds, pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.
Right culture:
The management did not sufficiently enable people and those important to them to work with staff to develop the service. Whilst there was evidence the provider had explored opportunities for collaborative work with local agencies, more should have been done to facilitate effective working with families and across health and social care services. We found responses to complaints and opportunities for improvements unsatisfactory. There was no clear escalation and resolution process, where there were disagreements with other agencies. This meant issues were left unresolved for a long time.
We have made two recommendations for an improved complaints, escalation and resolution process, and arrangements for learning lessons.
People lived safely because the service assessed, monitored and managed their safety well. Risks to people had been identified, assessed and reviewed. The assessments provided information about how to support people to ensure risks were reduced.
People received their medicines safely. They were supported by staff who followed systems and processes to administer, record and store medicines safely. We observed from records people received their medicines on time.
People’s health needs were met. Staff from different disciplines worked together to make sure people had no gaps in their care. The care files we looked at included details of health action plans and management of day to day healthcare needs.
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 Good (published 4 May 2018).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns about the safety and wellbeing of people using the service. A decision was made for us to inspect and examine those concerns.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Viola House provides accommodation and personal care and support for a maximum of 12 adults who have learning disabilities. There were nine people living in the home at the time of our inspection.
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.” Registering the Right Support CQC policy.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going 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.
At this inspection we found the service remained 'Good'.
People were protected from avoidable harm. There were assessments in place, which identified support needs and how care was to be delivered. People were protected by staff who knew how to recognise if a person was experiencing or at risk of abuse. Staff had been carefully recruited to make sure they were safe to work with people. We observed people were supported by sufficient staff to meet their care needs, including making sure people were supported to take their medicines as prescribed.
People's needs had been assessed and there were care plans in place to ensure they received safe and effective care. Staff received an induction and regular training so they were able to meet people's specific care needs. They supported people to access specialist health care services. People were supported to eat and drink enough to meet their needs. There were policies and procedures to ensure people had maximum choice and control of their lives and that they were not restricted unnecessarily.
People were supported to maintain relationships that were important to them. This enabled people to develop meaningful relationships with the other people and staff at the service. People were involved in making decisions about matters important to them. They were encouraged to express their views as much as they were able to. We observed people being treated with privacy, dignity and respect.
The service was responsive to people's needs and staff listened to what people had to say. Staff responded to people speedily and understood the need of respecting people's individual wishes and choices. The service ensured that people had access to information they needed in a way they could understand and which complied with the Accessible Information Standard. This showed the service had ensured people were able to communicate their needs and understood information that was given to them. People and their relatives could be confident that any concerns or complaints they raised would be dealt with.
The service was well-run and had received compliments from people and their relatives. The registered manger and the rest of senior management were aware of their regulatory responsibilities. The service monitored the quality of care people received and took action to improve how people were supported. The registered manager worked in partnership to ensure people received quick and appropriate support.
Viola House provides accommodation and personal care for a maximum of 12 people with learning disabilities. There were 9 people at the time of this inspection.
The inspection took place on the 30 June 2015 and was unannounced. At our last inspection in June 2014 we found the provider was meeting the all the regulations we inspected. .
There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.
Relatives of people receiving care felt their relatives were safe. Staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised.
Risk assessments were in place for every person receiving care. We saw these reflected current risks and ways to reduce the risk from happening.
There were appropriate arrangements for the management of people’s medicines and staff had received training in administering medicines.
Staff received an induction and training and they were supported through regular supervision and appraisal. We saw staff had received training in the Mental Capacity Act (MCA) 2005 and people’s capacity was assessed in line with the MCA.
People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.
We saw that staff were caring and promoted people’s independence. They knew people’s needs well. People were treated with dignity and respect. Relatives told us they were well looked after. They felt confident they could share any concerns and these would be acted upon.
There was a positive and open culture at the service. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. Systems were in place to monitor and improve the quality of the service.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We observed the care provided and the interaction between staff and people who used the service. We spoke with five care staff and two relatives of people who used the service.
Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
We observed that staff were constantly supervising people to ensure that they were safe. Care records contained risk assessments which provided guidance to staff on action to take to keep people safe. CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The home had proper policies and procedures in relation to the MCA and DOLs. The manager and some staff had been trained to understand when an application should be made, and in how to submit one. MCA and DOLs training had been booked for new staff. We saw from records that the provider had submitted a DOLs application for a person who used the service. This meant that people were safeguarded as required.
Is the service effective?
Comments from relatives and our observations indicated that the service was effective and responsive to the needs of people. People's likes and dislikes were documented and staff we spoke with were aware of these. There was evidence that people's needs had been attended to by healthcare professionals such as psychiatrist, dentists and their GP.
Is the service caring?
We observed that people who used the service were well cared for. We saw staff attending to people and offering them drinks. Staff were gentle and pleasant towards people. We noted that people were able to approach staff freely and came to them when they needed help. People's preferences, interests, aspirations and their diverse needs had been recorded and care and support had been provided in accordance with people's wishes. A relative told us, 'Staff do care for residents.'
Is the service responsive?
We observed that staff were attentive towards people and when people needed help or attention, staff responded immediately. We saw that the provider had responded positively to feedback from relatives. The provider may find it useful to note that feedback from one relative indicated their responses could be improved. The relative told us, 'At times they do not feedback very well. I would give feedback a low score.'
Is the service well-led?
The home did not have registered manager. The new manager had recently submitted an application to CQC for registration. The new manager and the nominated individual were knowledgeable about their roles and responsibilities. There were arrangements for monitoring the quality of care provided.
At this inspection we were satisfied that people who used the service were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We noted that there were arrangements for the recording of medication received, storage, administration and disposal of medicines. Medication administration charts (MAR) were appropriately signed by staff and there were no unexplained gaps.
Care provided was closely monitored and regular reviews of care had been carried out. People participated in various activities organised by the home and by community services. There were suitable arrangements for safeguarding people and relatives told us that people were safe in the home. We however, noted that improvements are needed in the administration of medication.
Relatives were of the opinion that the home had adequate staff to care for people. This was reiterated by staff who said they were able to take good care of people. Regular audits and checks of the service were in place. The results of a recent satisfaction survey indicated that those who responded were satisfied with the quality of care provided. An action plan had been prepared in response to issues which needed attention.
People had been kept occupied. We saw people engaging in various activities organised by the home and by community services. Activities that people had participated in were recorded in their care records. Care provided was closely monitored and regular reviews of this care had been carried out.
The relatives who spoke with us stated that people who use the service had been treated with respect and dignity. They indicated that their relatives' personal, social and healthcare needs had been attended to. They had been kept informed by staff who updated them regarding the welfare and progress of their relatives.
Relatives said the home was clean and tidy when they visited and people looked well cared for. They were happy with the quality of care provided and felt that it was of a good standard. Their views can be summarised by the following comment, 'we are absolutely delighted with the staff. They are very good.'