Archived: Ciderstone House

Ciderstone House is a residential care home providing personal care and support for up to six adults with learning disabilities and autism. At the time of the inspection, six people were being supported.

Ciderstone House accommodates four people in one building and two people in self-contained annexes attached to the building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The registered manager and provider were not providing consistent leadership and support at Ciderstone House. Staff felt unsupported and felt their views were not respected or valued. Management had not demonstrated the principles of good quality assurance and therefore systems and processes to provide an overview of the service were unclear and confusing leading to risk.

People’s safety was not always optimised. Relatives did not feel fully confident that family members supported at the service were always safe. Staff did not always have the level of experience necessary to work with people with complex needs. We found improvements needed in respect of staff training in safeguarding and other aspects of safety such as infection control and food safety. This training had not been completed as per the provider’s policy. Therefore, staff did not have the relevant learning to support people effectively and safely. Not all staff we heard from were confident about raising concerns internally with the provider. Information about risks associated with people’s needs were not clear and readily accessible. The management of medicines needed improvement. The provider acknowledged that lessons had been learnt in the acquisition of the service and provided assurance that areas of improvement were being worked upon.

People’s needs had not been reviewed to ensure best practice guidance was used to achieve effective outcomes. Staff did not have the support in place to ensure they felt confident to deliver care to people with complex needs. People’s health need requirements, such as specialist health appointments, were not always known about so that the provider and registered manager had a good overview to manage people’s health conditions. People’s nutritional needs were not always being met to ensure their diet was healthy and adequate to maintain good health.

People were not always supported to have maximum choice and control of their lives and supported in the least restrictive way possible. We have made a recommendation about ensuring the principles of the Mental Capacity Act 2005 are consulted.

People were supported by staff that cared for them. However, the provider had not ensured that people were supported with consistent staffing in relation to their autism. This meant that people were not always supported by staff that had the time to get to know them well and understand their care and support needs, wishes, choices and any associated risks.

People’s care needs were not regularly reviewed. Care plans were muddled and incomplete which meant staff could not always access all information about people. People did not always have opportunities to pursue their interests and hobbies.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. People using the service did not receive consistent, planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The provider was actively addressing the issues that had been raised during the inspection and demonstrated a willingness to work transparently and openly with all relevant external stakeholders and agencies.

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 27 May 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. However, just prior to the inspection we received information of concern from anonymous sources. These included, people not being supported by sufficiently experienced staff as training had not taken place. There was also concerns expressed about unsafe medicines management

We have identified four breaches in relation to person centred care, safe care and treatment, staffing and good governance at this inspection. We have made one recommendation in relation to the Mental Capacity Act 2005.

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

Follow up:

Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded. 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 ethos of Autism Care Wiltshire Limited is to recognise people as individuals and to put together bespoke packages of care to ensure that each person has their needs met. This included learning about the way each person communicates, routines they follow that were important to them and looking at creative ways to support people to live their lives safely. Where required they worked in partnership with other health and social care professionals to provide additional guidance and advice to the staff team. This included psychologists, occupational therapists and specialist nurses.

This inspection took place on 9 May 2017 and was announced. The provider was given short notice because people living in the home can become unsettled by the presence of an unannounced visitor. This gave the provider an opportunity to plan our visit with the people using the service. The inspection was carried out by one inspector. The service registered in December 2015 and had not been previously inspected.

A registered manager was employed by the service who was present throughout the inspection. 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 supported by kind and caring staff. We observed staff developed extremely positive caring and compassionate relationships with people. People were treated with dignity and respect and were encouraged to maintain their independence and make choices. Staff knew each person as an individual and were patient and caring in their approach when offering support. Throughout the day we observed staff supporting people in a kind and respectful manner, offering reassurance to people where required. Relatives spoke extremely highly of the care and support their family member received.

People received a personalised service which was responsive to their individual needs. Care plans contained extensive essential information on people’s preferences and life experiences to help ensure people received person centred care in their preferred way.

There were safe administration systems in place and people received their medicines when required. Medicines were stored securely and disposed of safely. People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

Staff were aware of people’s dietary requirements. Where required people had access to specialist diets and guidance was in place to ensure staff met these needs accordingly.

People were protected from the risk of harm and abuse. Staff had received safeguarding vulnerable adults training and were aware of their responsibility to report any concerns. Policies and procedures were in place to advise staff on what they should do if they had concerns. Risks were assessed and reviewed regularly and control measures were put in place to minimise the risks to people. There were effective pre-employment checks for the safe recruitment of staff, including criminal records checks and obtaining character references.

There were sufficient staff on duty to ensure people’s needs were met. We observed throughout the inspection that staff were unhurried and spent time engaging with people. People received care from staff who had the skills, knowledge and understanding needed to carry out their roles. New staff members received a comprehensive induction. Training records confirmed staff received training in a range of core subjects required by the provider.

People received a high standard of care because the management team led by example and set high expectations of staff about the standards of care people should receive. There was an effective quality assurance system in place to ensure any improvements needed within the service were identified and the necessary action was taken to implement change.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent to care was sought in line with legislation and guidance. Mental capacity assessments had been completed and where people had been assessed as not having capacity, best interest decision meetings had taken place.