Archived: Mr & Mrs T Grimshaw - 1 Taylor Avenue

Mr & Mrs Grimshaw 1 Taylor Avenue, also known as 'Terlyn' is located close to the centre of Ashington and provides accommodation and personal care for up to four people with a learning disability.

A registered manager was 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.

The provider was a husband and wife partnership; Mr and Mrs Grimshaw. They employed a registered manager and two staff members, one of whom worked exclusively with one person on a one to one basis outside of the home. There were four people who used the service at the time of the inspection. People told us they were happy with the care they received and had no concerns. The provider and manager described the service as being like a family, and they had supported people for many years and knew them well. We observed positive interactions between the providers and people who used the service.

Safeguarding procedures were in place and staff had received training in the safeguarding of vulnerable adults. People told us they felt safe in the service. A safeguarding investigation was in progress during the inspection and we will report on the outcome once complete.

The manager and provider described in detail the steps taken to ensure the safety of people but this information was not always reflected in documentation, and risk assessments had not been completed in relation to identified risks.

We checked the administration of medicines, and found that one medicine provided by the hospital for one person, was not recorded on medicine administration records (MAR’s). Medicine competency assessments contained insufficient detail, and room temperatures were not taken where medicines were stored. These issues had been addressed by the second day of the inspection.

We inspected records related to the safety of the premises. There was no evidence that a Legionella risk assessment, electrical installations test or asbestos survey had been carried out to demonstrate the safety of the premises. There were no window restrictors on bedroom windows and no risk assessments were in place related to the absence of window restrictors. The provider contacted the local authority health and safety officer for advice. Appropriate fire safety precautions were in place.

Safe recruitment procedures were not always followed. This meant that people were not always protected from potential abuse. We have made a recommendation about this. There were suitable numbers of staff on duty.

The premises were clean and had been recently refurbished. Rooms were nicely personalised and people were involved in decisions about how the home was decorated. Cleaning schedules were in place and people were supported to clean their bedrooms or did so independently.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that capacity assessments had not been fully completed and best interests decisions including decisions related to the management of people's finances were not adequately recorded. Applications to deprive people of their liberty had not been made in line with legal requirements.

Staff had received training relevant to their role, and had received regular supervision and appraisals. There were plans in place to address any gaps in training. Staff had regular opportunities to speak with their manager about any concerns they had due to the small size of the service.

People were provided with nutritious meals and there were new kitchen facilities available. People told us they did not tend to do any cooking as they were out most of the day and one person said that they sometimes helped with cooking. Menus were available but people were able to choose what they ate on a daily basis. Special dietary requirements were recorded and catered for.

People had access to healthcare professionals and were supported to attend appointments in the community or where appropriate, they attended by themselves. People were supported to hospital appointments for reviews of their care and treatment.

People had access to a range of activities and spent most days in the community at day care services, supported employment and social activities. People told us they enjoyed the activities they attended.

A complaints procedure was in place but no complaints had been received by the service. People were encouraged to raise any concerns during house meetings or discussions with staff. The people we spoke with said they had no concerns about the service.

The manager and provider were passionate about the service they provided. There were shortfalls in a number of records including those related to care and treatment, medicines, training, MCA, and recruitment. The provider was proactive in immediately rectifying some omissions following the first day of the inspection and was considering ways in which they could improve their internal quality monitoring systems through linking with other organisations. They carried out audits of medicines and care records.

People were encouraged to be involved in the running of the service and the views of people, relatives and professionals had been sought through feedback questionnaires.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the need for consent and good governance. You can see what action we told the provider to take at the back of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We saw people's individual records had been reviewed and included risk assessments which were updated as people's needs changed. We noted that people's records were accurate and had been updated to reflect any variation in their care.

There were systems in place for dealing with complaints, safeguarding and whistle blowing procedures. One person told us they were aware of how to make a complaint and felt satisfied staff would respond appropriately.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke to the provider and saw records to confirm staff had undertaken training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). (These are safeguards to ensure care intervention does not deprive people of their liberty and that decisions are made in the best interests of the person). The manager was able to describe the process for making a referral to the local authority and was aware of the circumstances that could lead to this.

Is the service effective?

There were systems in place to ensure people's health and care needs were assessed. We found they were involved in this process. We saw that specific care plans were in place for people with particular needs such as, a special diet.

Staff training was provided that took account of the needs of the people in the house. For example, we saw training in behaviour management and administration of medicines had been provided.

Is the service caring?

We saw staff responded kindly and respectfully to requests from people. There was a relaxed atmosphere and we saw there was a good rapport between people and staff. One person said, 'I really like it here. All the staff are lovely.' People's preferences, interests and diverse needs were recorded and we saw staff were aware of these during the inspection.

Is the service responsive?

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they required. For example, there was evidence that someone who required a special diet had received appropriate support and was referred, as necessary, to their GP and had appropriate treatment provided.

People told us they were aware of the complaints procedure and the manager could describe how they would assist a person to make a complaint. We saw there were systems in place for dealing with and recording complaints.

Is the service well led?

The service had a quality assurance system in place that included the use of surveys from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

We found that people's care and support needs were appropriately planned and their individual care needs were met. People said the staff were very caring and looked after them well. Comments included, "I like it here, I've been here for about 13 years now," "I can go out when I want and decide what I want to do," and "Everything is fine here, we all get on."

The premises were clean, comfortable and suitable to meet the needs of the people who used the service. There were systems in place to ensure the premises were safe and well maintained.

Staff were well supported, they received the appropriate training for their professional development and were able to obtain further relevant qualifications.

There was an effective procedure in place for dealing with complaints. Where necessary people were given support to make a comment or complaint. People told us they knew how to complain but it had never been necessary.