27 and 29 January 2015
During a routine inspection
The inspection took place on 27 and 29 January 2015 and we arrived unannounced on the first day. On the second day our arrival was expected.
The service supports approximately 30 people with learning disabilities and autism spectrum conditions, some of whom have additional needs associated with their mental health or physical disabilities. Five people were in residence during the inspection. Some people use the service for regular or occasional short breaks; others are there short-term due to a crisis situation. Some people who use the service also receive support from its outreach team. The outreach team is registered separately with the CQC so is not included in this report.
There are three units within the building, so it can operate as separate units or one larger unit. The building opens out onto a well-used garden courtyard. An additional upstairs unit is used for office and meeting space.
At the time of the inspection, staff and the people who used the service were based in a particular unit, but could move freely between them. Two units were designated for crisis care and one for short breaks, but the compatibility of individuals was taken into account alongside the reason for admission when deciding who was assigned to which unit. Therefore there could be a mix of crisis and short break care in any of the units.
A registered manager was in place. 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 service had received a short inspection in September 2014 to check that it had improved its medicines administration, as it had not met this regulation in a previous inspection in November 2013. Improvements had been made and, during this inspection, we found they had been sustained.
We found that the managers and staff were very caring towards the people who used the service. They liked and valued them as individuals. A strength of the service was the emphasis on understanding people’s communication needs. We also noted that staff were very aware of some of the risks associated with the provision of crisis or short-term care, such as people arriving without their medicines, and there were arrangements in place to deal with these issues. In addition to mandatory training, staff had access to training which was specific to the needs of the people they supported.
The management team had information to hand about accidents, incidents and safeguarding and they had analysed any trends. They intended to develop their audit systems so they focused on issues that needed to be monitored at this particular service, but this had not started at the time of inspection.
We saw that there had been a lot of work carried out to improve the service, but some of it had yet to make an impact on the quality of care. However, plans were in place to make further improvements which should benefit people who use the service. For example, extensive repairs and maintenance were planned because the premises and equipment were in a poor state of repair. This was due to a breakdown of the arrangements with a separate organisation which had only recently been resolved.
There were restrictions in place, for example, in relation to the kitchen, which helped some people to stay safe, but prevented others from exercising their rights. The provider needed to review this as it amounted to a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.
We have also made a recommendation about structuring people’s free time better, as some people had little to do and information in their care plans indicated that they were likely to find this difficult.