Community Places

About the service

Community Places provides care and support to people with a learning disability or autistic people. Community Places is home to 12 people. At the time of inspection 10 people live in the main building and 2 people live in the bungalow. The service can support up to 16 people.

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

Right Support:

Not all risks were assessed to keep people safe and we asked the manager to complete risk assessments for window restrictors and a profiling bed with bed rails immediately after the inspection. There were enough staff available to support people with their daily routines and activities.

Right Care:

Medicines were not managed safely and there were errors in administration of medication, stock counts and MAR sheets. Infection prevention and control was not managed effectively. Staff had training on how to recognise and report abuse and how to protect people from poor care. The service worked well with other agencies to keep people safe.

Right Culture:

Staff did not always talk with people effectively to find out what activities they might want to do. Accident and Incident forms were not reviewed in a timely manner and common themes from these forms did not improve or change practice. The service was working within the principles of the Mental Capacity Act. The manager and the provider had a clear vision for the development of the service so that people can achieve the best outcomes possible.

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 3 October 2018).

Why we inspected

We received concerns in relation to people being secluded which prompted us to carry out a focused inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. We found no evidence that seclusion had ever been used in this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken action to mitigate the identified risks and we have requested regular updates on these actions from the provider.

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

Enforcement and Recommendations

We have identified breaches in relation to management of medicines, assessment of risks and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Places is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is in Barnsley and provides accommodation for up to 16 people with learning disabilities or mental health needs who require varying levels of care and support. Accommodation is spread over two floors each with its own living space including a kitchen and lounge. The home has 13 bedrooms with en suite facilities. Some of the bedrooms have been converted to provide people with their own private living area and one person had a self-contained apartment. There is also a two-bedroom bungalow.

At the time of our inspection six people were living at Community Places. There were two people using the service for respite care.

The care service has been developed 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.

There was a registered manager in post. 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.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was spacious, well decorated, clean and tidy. All the bedrooms were single occupancy.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Community Places is a 16-bed service for people with a learning disability or mental health needs. The home is in a residential area in the village of Great Houghton. The home comprises of 13 bedrooms with en suite facilities. Some of the bedrooms have been converted to provide people with their own private living area and one person had a self-contained apartment. At the time of our inspection eight people were living at the service and eight people were using the service occasionally for respite care. One person lived in a bungalow nearby. The service has a purpose built resource centre with an IT suite and an independent kitchen facility which has been specially designed for teaching.

The service did not have a registered manager. 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 told us they felt safe. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Effective recruitment and selection processes were in place and medicines were managed in a safe way for people.

There were enough staff to provide a good level of interaction. Staff had received an induction, occasional supervision, appraisal and role specific training. This ensured staff had the knowledge and skills to support people who used the service.

People’s mental capacity was not always considered when decisions needed to be made and evidence of best interest processes was not always available. This meant people’s rights were not always protected in line with legislation and guidance. This was a breach of Regulation11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s nutritional needs were met and they had access to a range of health professionals to maintain their health and well-being.

Staff were caring and supported people in a way that maintained their dignity and privacy. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of detailed personalised care plans and risk assessments. Some people’s annual person centred reviews were being planned to set more long term goals.

People and their representatives were involved in care planning and reviews. People’s needs were reviewed as soon as their situation changed.

People engaged in social activities which were person centred. Care plans illustrated consideration of people’s social life which included measures to protect them from social isolation.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were always approachable.

People told us the management of the service had been inconsistent in recent times; however, this had now been addressed. The company directors and management team were visible in the service and knew the needs of people who used the service. The culture of the organisation was open and transparent.

People who used the service, their representatives and staff were asked for their views about the service and they were acted on.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met but this system had not identified and addressed some of the concerns we found.

Comments from relatives included,'My son is very happy and content at the home' and "Community Places has helped turn my son's life around.'

We sat with people in the lounge and resource centre and observed the support offered by staff and saw how staff interacted with people. We saw that staff treated people in a kind, considerate and empathic manner.

During this time we observed that the body language of people was positive and their facial expressions and actions conveyed contentment.

We found that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

We found that people's needs were identified in care plans. Records showed that people had been involved in the care planning process. People told us that they had regular access to healthcare professionals.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

The provider had a satisfactory recruitment and selection procedure in place to ensure that staff were appropriately employed.

The provider had an effective complaints system available. All of the people we spoke with said they had no complaints or concerns about the home.