St Leonards Place

St Leonards Place is a residential care home, providing accommodation and personal care to 3 people at the time of the inspection. The service can support up to 3 people. The people living in the service had a learning disability and/or autism. Some people were not able to verbally communicate and required full support from staff. One person was more independent and able to manage many areas of their day to day life, going out alone for example.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People were enabled to make their own choices and express their wishes in their own way and staff understood them. People were encouraged by staff to do the things they could do for themselves.

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

Right Care:

Although staff knew people well, they were not always provided with sufficient guidance in relation to people’s individual risks. People could not be assured staff were recruited safely as safe recruitment practices were not followed and recruitment procedures were not used effectively.

People were safe with staff as staff had received safeguarding training and recognised potential signs of abuse. Relatives told us their loved ones were safe. People’s medicines were managed safely, staff received appropriate training and had their competency checked in relation to medicines.

Right Culture:

People’s care was not always fully checked for quality and safety as monitoring processes were not robust and effective. The provider had not complied with regulations, they had not submitted notifications to CQC about people being subject to DoLS authorisations.

The provider had established a good culture within the staff team. Most staff had worked at St Leonards Place for many years and told us this was because they felt supported, and they enjoyed their job. Relatives spoke very highly of the registered manager and how well they run the service.

Relatives and staff were involved in the running of the service through surveys and meetings. The provider and manager attended forums in order to learn from other registered providers to help them look for ways to improve.

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 11January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 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.

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

Enforcement

We have identified breaches in relation to the assessment of risk, safe recruitment and good governance.

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

Follow up

We will request 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.

St Leonards Place provides accommodation, with personal care and support for three people. Accommodation is provided in a large house that has been divided into three flats. One of these can be accessed by its own entrance at the rear of the property. At this inspection, there were three people living in the home. The service is able to offer support for people who may have a learning disabilities, autistic spectrum disorder (ASD) and/or mental health issues.

A registered manager at the home is also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

At the last Care Quality Commission (CQC) inspection on the 8 and 12 October 2015 the service was rated Good overall although they were rated Requires Improvement for the Safe domain. At this inspection, we found the home was Good across all domains.

Staff had received suitable training, which was provided to reflect the individual needs of the people living in the home.

Policies and procedures were available and had been up dated for staff to view.

Staff we spoke with understood their responsibility in keeping people safe, they confirmed they had received safeguarding training. They knew who to contact if they saw or suspected abuse, and the outside agency’s to contact if their suspicions were not taken seriously.

Medication administration had been risk assessed and one person was now self-administering medicines with minimal support from staff. Staff had received relevant training and their competency had been checked. Medicine was supplied in a dosage system. Currently the staff complete a medicine administration record (MAR) which was not supplied by a pharmacy. We made a recommendation about this.

People’s needs were assessed and reviewed on a regular basis. Care plans were detailed and these had been written with the person, and their family member if appropriate. Care plans were person centred and included things that were important to people as individuals. For example, one person liked regular contact with their mother, the staff facilitated time when they could spend it together by liaising with mum and making the arrangements.

Risk assessments contained detailed information and clear guidance about all any risks to the person’s safety. The staff knew people very well and were able to describe peoples care in great detail. Changes to care plans were made when necessary with the involvement of people’s families, health professionals and the person’s funding authority when appropriate.

Recruitment procedures were followed and appropriate checks were carried out to make sure staff were suitable to work with vulnerable people. Staff received induction training and day to day support to ensure they did their job safely.

There was a very low staff turnover with most staff having been there many years. There were sufficient skilled staff employed to keep the rota covered at all times without the use of agency staff.

Most meals were homemade and took into account peoples likes and dislikes. There was no regular menu as the two people who needed support with meals chose items they liked when out shopping with staff. People’s meals were recorded and showed a varied nutritious diet.

There was a relaxed atmosphere in the home. Although the two people we observed were non-verbal there was good interactions between people and staff. Staff were considerate and respectful when speaking about and to people. Staff knew people very well, including their personal histories, hobbies and interests.

Systems were in place for people and their relatives to raise their concerns or complaints knowing they would be responded to quickly and to their satisfaction.

There were systems in place to review accident and incidents. The registered manager kept care managers informed of any changes needed to peoples care and support.

Monitoring systems were in place in order to maintain and improve the quality of the service provided to the people living at the home. The management was stable and staff felt supported by the registered manager.

During our inspection visit we spent time with two people and spoke with another person. However, all three were not able to communicate verbally and staff were able to explain the non-verbal signs used when each person was happy or when they were not. We saw that people were content in the home and there was a calm, inclusive atmosphere. We saw that staff interacted well with each person and had established effective means communication with the people who lived in the home.

Care and treatment was planned and delivered in a way that was intended to meet people's individual needs and ensured people's safety and welfare. Staff made sure that people received the medication they had been prescribed.

Staff had received the skills and knowledge they needed to support the people that lived at the home.

We saw that there were effective quality systems in place to make sure people received their care and support in a safe and consistent way.

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assisted them to make choices and maintain as much independence as possible. A member of staff told us we encourage people to do as much for themselves as possible "just as if they were in their own homes"

People who used the service told us how they were supported to maintain their independence with "independence evenings" but staff were always available if needed.

In order to protect the people who used the service, we saw that the home carried out a rigorous staff recruitment process.

We saw that staff were knowledgeable about people's needs and preferences, were observed to treat people as individuals and delivered care in a personalised way. This was particularly noted when a person who used the service was supported to have a bath in a dignified and respectful manner and at a pace directed by the person.

There were processes in place to monitor the quality of service being provided and we saw that people who used the service were involved through reviews and one to one discussions.