Cambrian

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service met 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 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

Staffing levels had not been calculated to meet people's dependencies and packages of care. Following the inspection, the registered manager submitted evidence of peoples level of care to demonstrate they had suitable numbers of staff on duty.

We found that some processes needed improvement to evidence more effective quality assurance systems. Governance checks had not identified issues raised during the inspection with regards to managing staffing levels, reviewing the model of support within a communal environment and management of notifications. Following, the inspection the registered manager submitted appropriate updates to CQC.

We received positive feedback from people being supported. They told us staff were supportive and always consulted them about their support plans.

Support plans provided person-centred information, which included people's preferences and choices. We found that people were supported to maintain as much independence as possible.

People were protected from the risk of abuse or neglect. Staff were well trained in safeguarding vulnerable adults. Staff were skilled and knowledgeable. Systems and processes were in place to reduce the risk of harm. Thorough recruitment practices were in place to provide safe systems to ensure new staff were suited to working with vulnerable people. Staff recorded incidents and accidents in sufficient detail to aid analysis and reduce risk.

Medicines were well-managed and regularly audited to provide safe checks and support. Some people were supported to self-administer their medication.

We found that staff had received training in the Mental Capacity Act 2005 (MCA). People were supported to make their own decisions whenever possible.

The service was well-led. People knew who the registered manager was and felt able to raise any concerns with her. Staff told us that they felt well supported

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 24 January 2017)

Why we inspected

This was a planned inspection following the service's last rating of their inspection.

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.

At the time of our inspection, the service was supporting 11 people was personal care needs. These people lived within a supported living setting at Cambrian House. Supported living describes the arrangement whereby people are supported to live independently with their own tenancies.

There was a registered manager 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.

We found that people were very positive and complimentary about the service they received. People using the service told us they felt safe and the relatives we spoke with also agreed people were safe. We found that people were protected from the risk of harm and abuse. All staff spoken with had a good understanding of safeguarding, the signs of abuse, and how to report it. However, we found that the registered manager had not always notified The Care Quality Commission (CQC) as legally required to do so about safeguarding concerns. We also found that the recording of safeguarding outcomes could be improved.

People’s medicines were administered safely. Some people were supported to self-administer medication. However, we found that some medication records were confusing and could be improved.

Staff were skilled and knowledgeable. We found that staff completed an induction prior to starting work in the service and received regular and on-going robust training.

We found that staff had awareness of and had received training in the Mental Capacity Act 2005 (MCA). People told us that staff sought their consent for any care tasks. People were supported to make their own decisions whenever possible.

Staff were kind, caring and compassionate. People told us that staff treated them with dignity and respect. We found that staff had developed effective caring relationships with people.

Support plans were in place. They provided sufficient details and were regularly reviewed and updated. The care plans and risk assessments provided person centred information, which included people’s preferences and choices. We found that people were supported to maintain as much independence as possible.

People were encouraged to give feedback to the service and people knew how they could complain. Complaints were taken seriously and responded to.

The service was well-led. People knew who the registered manager was and felt able to raise any concerns with her. Staff told us that they felt well supported. We saw that regular household and staff meetings were held, as well as supervision meetings to support staff.

There were systems in place to monitor the care provided and people's views and opinions were sought regularly about the quality of the service.

We talked with seven people who used the service and with four members of staff. We looked at various paper records including five care plans and five staff files.

Below is a summary of what we found. The summary describes what people using the service and the 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.

Is the service safe?

There were enough staff on duty to meet the needs of the people living in the accommodation and a member of the management team was available or on call in case of emergencies.

Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked.

Staff were trained in Safeguarding principles and procedures. The home had a safeguarding policy which was regularly monitored.

Appropriate risk assessments had been carried out and action plans put into place for safe practice. A person using the service told us, 'I feel safe here'.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people they supported. One person using the service told us, "Staff are very approachable and understand mental health'. Another said, 'This is the best thing that's happened to me'.

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Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'Staff are brilliant, absolutely superb'.

People had been involved in the creation of their care plans and continued to be involved throughout their use of the agency. We noted that people's preferences about, for example, activities, were respected by the staff. The people were supported, where necessary, to make these choices and decisions. One person told us, 'If we need space, we can go to our flats and staff understand and respect this'.

Is the service responsive?

People's needs had been assessed before they received a service. We saw that all care plans and documents were routinely reviewed every six to twelve months.

People had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other workers, such as mental health professionals, were involved in peoples care when necessary.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the service and and had supported people to ensure their homes were safe. Various safety checks and other audits had taken place since the service was registered late last year. We saw there were safety and quality assurance processes were in place. We noted that there were prepared documents to complete annual audits and to get feedback from people using the service and other interested parties.

The provider supported about 28 people at the time of our inspection. The manager was able to demonstrate effective knowledge of the management systems used in the organisation and of the people who used the service. She showed us that she had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications. One person said, 'I am doing a course and staff and the manager always support and motivate me'.