Station House

Station House provides care and support to up to 10 people with learning disabilities, and autistic people. The service is provided in a house, with an annex and a separate bungalow. At the time of our inspection there were 8 people using the service. The service also provides personal care to 1 person living in their own home .

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The model of care and setting maximised people’s choice, control and independence. We received positive feedback from people and their relatives about the opportunities to engage in activities and interests. 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

The care and support was person-centred and promoted people’s dignity, privacy and human rights. People's care plans and risk assessments had been reviewed and updated to include the necessary detail. Day to day records reflected the personalised care, support and treatment people received.

Right Culture

The ethos, values, attitudes and behaviours of leaders and care staff helped to make sure people using the service led confident, inclusive and empowered lives. People and members of their staff team told us various refurbishment and building work had taken place and further work was planned, to improve and personalise people’s environment. However, we identified shortfalls in cleanliness in some areas and some radiators were not covered. The provider’s quality assurance processes had not identified these shortfalls.

We have also made recommendations to the provider regarding medicines management, staff recruitment and radiator covers.

The provider acted quickly to put measures in place to make the necessary improvements.

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 9 October 2019).

Why we inspected

We received concerns in relation to the management and planning in relation to people’s personal care needs. 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.

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 Station House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches of regulation in relation to safe care and treatment and good governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We have received an action plan from the provider to indicate 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.

Station House is registered to provide personal care and support for up to 10 people living with a learning disability and/or autistic spectrum disorder. Some people also had long-term health conditions and complex communication needs. The service is provided in a house with additional annex and a separate bungalow. The service was adapted to provide en-suite bedrooms, communal lounge, dining rooms and a pleasant garden. At the time of this inspection seven people were living at Station House.

People's experience of using this service:

The service worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could 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 over their own lives, choice, and independence.

People felt safe and happy living at Station House. Staff had received safeguarding training and knew when and how to raise concerns.

People were protected from risks. There were various risk assessments in place for each person giving guidance to staff to reduce the risks identified. Risk assessments were reviewed regularly or when people's needs changed.

There was sufficient and adequately trained staff to support people safely.

Medicines were administered, stored and managed safely. Audits identified no errors in the months preceding the inspection.

Station House was clean, tidy and homely and suited to the needs of people living there. People had individualised rooms with their personal items and favourite colours and décor.

People's needs were thoroughly assessed by a multi-disciplinary team of specialist professionals within the learning disabilities service. People had access to health care and hospital treatment when needed.

Staff were trained in all of the provider's mandatory areas and had the ability to access on line, face to face or group training. New staff had a robust and supported induction period. Some formal one to one supervision and appraisals were behind schedule but the new manager had recognised this as an area of immediate attention.

The staff were caring and knew people, their preferences likes and dislikes well. Staff took pride in the standard of care they provided. We received good feedback from people about the quality of care they received.

Care plans were person centred and were regularly reviewed and updated. When people's needs changed appropriate referrals were made to re-assess and devise new strategies to support them effectively. The staff had regular meetings and discussions with health and social care professionals to ensure the right care was being provided.

There was a clear and supportive management structure in place. Quality assurance, audits and monitoring were regularly undertaken. This meant that areas identified for improvement were acted upon in a timely manner.

Rating at last inspection: Requires Improvement (report published 11 July 2018).

At our last inspection in November 2016 we rated Station House as good overall, although the well led domain was rated as requires improvement. This was because we identified that improvements in the monitoring systems were required to make sure audits undertaken were more robust and that where improvements were required these were identified with appropriate and timely action taken to address these.

The home caters for up to ten adults with learning disabilities and autistic spectrum disorder in two separate buildings. The provider also operates a domiciliary care agency from the same location. However, no-one was receiving personal care from the domiciliary care agency at the time of our inspection.

Station House is required to have a registered manager and there was one 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls to ensure that improvements would be made.

Staff were able to recognise signs of abuse should they occur and knew how to report concerns if they suspected a person was at risk of harm. There was a complaints procedure available in the service for people and relatives to raise concerns.

People received appropriate care from staff to meet their needs although not all staff training was up to date to develop their skills and knowledge. Staff monitored people's health and well-being. People had access to healthcare professionals according to their needs.

People were cared for by staff who were observant and ensured people were comfortable. People told us, and we saw, that staff were kind and caring.

Staff knew the needs and preferences of the people they cared for and promoted people's rights to privacy, dignity and independence.

We found that where people lacked capacity, there was no evidence that decisions had been made in accordance with the Mental Capacity Act 2005 (MCA) Code of Conduct.

People's diversity was respected and staff responded to people's social and emotional needs. People’s care needs were met because they were supported and cared for in accordance with their wishes and choices. People and staff were positive about the culture of the service. People felt the staff team were approachable and polite.

People gave positive views about the food they received and experienced pleasant mealtimes. There were activities for people and people were supported to take part in these, although their preferred, documented routines were not always carried out.

During this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Station House' on our website at www.cqc.org.uk'

At this inspection we found improvements had been made, and the provider had achieved compliance with the breaches found at the last inspection, but further development was needed to embed and improve the systems in place.

Station House is a care home situated on the outskirts of the village of Laughton Common. There are local facilities close by and good public transport links. The home caters for up to ten younger adults with learning disabilities and autistic spectrum disorder in two separate buildings. The provider also operates a domiciliary care agency from the same location. However, no-one was receiving personal care from the domiciliary care agency at the time of our inspection.

At the time of our inspection there were six people living at the home. To gain people’s opinion about how the service operated we spoke with two people who used the service and three relatives. They told us they felt there had been improvements made over recent months and they were happy with the service provision.

The service did not have a registered manager in post at the time of our inspection. An acting manager had been appointed in July 2016. They told us they had begun the process to register with the Commission to become the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. People we spoke with told us they were pleased with the new management team saying they were approachable, listened to their opinions and ideas.

People told us they felt safe living and working at the home. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified any potential risks to people and plans were in place to ensure people’s safety.

Improvements had been made to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role.

We saw a structured recruitment process was in place to help make sure staff were suitable to work with vulnerable people. Overall staff had been recruited robustly; however we found a few documents missing from staff files. This was addressed within the week of the inspection, but more robust checks would be beneficial to ensure consistency in the future.

There was sufficient staff available to meet people’s needs. The use of agency staff had been reduced since the last inspection, which helped to make sure people received consistent care and support.

Staff had access to a varied training programme. However, training records did not evidence that all staff had completed refresher training in a timely manner. Staff told us they felt they had received sufficient training to carry out their roles, and further training had been planned. Staff support sessions had taken place, but not as regularly as outlined in the company policy. The management team told us how they were addressing this, and the staff we spoke with said they felt well supported.

The service had a policy in place for monitoring and assessing if the service was working within the Mental Capacity Act and they were following local authority advice on this topic. Staff had completed training regarding the Act and the procedures to follow should someone lack the capacity to give consent. The provider had worked with the local authority to ensure decisions made in people’s best interest were applicable, and applications under the Deprivation of Liberties Safeguards were made as necessary.

We saw people received a well-balanced diet and were involved in choosing, shopping for and helping to prepare what they ate. People’s comments indicated they were happy with the meals provided. We saw specialist dietary needs had been assessed and catered for.

People were supported to maintain good health and received access to healthcare support from appropriate healthcare professionals when required.

People were supported to maintain friendships. We saw care plans contained information about their family, friends and people who were important to them. People had access to an activity programme that was tailored to their individual needs and interests. People told us they enjoyed the activities they took part in.

The people we spoke with said they had been involved in formulating and reviewing care plans. Care records we looked at contained information about people’s needs, preferences and risks associated with their care. However, not all documents were fully completed in one of the files we checked. The manager told us work was on-going in improving the information in care files.

We saw the complaints policy was available to people using and visiting the service. The people we spoke with told us they would feel comfortable speaking to any of the staff if they had any concerns. We saw where concerns had been raised these had been appropriately recorded and addressed.

The provider had a system in place to enable people to share their opinion of the service provided and the general facilities at the home. This included surveys, one to one meetings and care reviews.

We found the quality assurance system which monitored how the home was operating and staffs’ performance had been improved. We saw checks had been consistently completed and areas for improvement identified, but further development would be beneficial to make sure audits undertaken within the home, and by external auditors, were more robust.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

The provider also operates a domiciliary care agency from the care home premises; this supports a small number of people who live in the community and have minimal personal care needs. As part of this inspection we checked how this service was operating and spoke with the people using the service, as well as staff providing personal care.

Is the service safe?

We found people were encouraged to express their views and were involved in making decisions about their care and treatment. The people we spoke with told us they were happy with the way staff supported them. One person commented, 'I have no complaints, I am happy with everything.'

Care and treatment was planned and delivered in a way that helped to ensure people's safety and welfare. In most cases records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The company had policies and procedures in place to help protect people who used the service from abuse. We found the majority of staff had received training in relation to safeguarding vulnerable people from abuse. However, staff had not always reported incidents where one person using the service had acted inappropriately to another person using the service, for example hitting them. The manager told us in future any such incidents would be consistently reported.

Is the service effective?

People's health and care needs were assessed on a regular basis. People who used the service and two relatives we spoke with said they were involved in formulating and reviewing plans of care.

Most staff had received appropriate professional development. We saw they had access to a varied training programme that helped them meet the needs of the people they supported, but updates had not always been arranged in a timely manner.

In the past staff had not always received regular support sessions or an annual appraisal of their work. However, records and staff comments indicated formal staff support sessions had begun and plans were in place for annual appraisals to take place.

People told us they completed a menu each week with support from staff. The menus we sampled, and people's comments, showed they could choose what they liked, and if they were able to they also shopped for, and prepared the food.

Is the service caring?

People were supported by knowledgeable, caring and responsive staff. We saw staff interacting with people positively. They encouraged them to be as independent as they were able to be while providing support as needed. Two relatives spoke positively about the care and support provided to their relative.

We saw people looked well-presented and cared for. The five we spoke with who used the service, and two relatives, said they were happy with the care provided and complimented the staff for the way they supported people. One person told us the staff were, 'Okay' adding 'I am happy here and we are going to Whitby at the weekend.'

People's preferences, interests and individual needs were recorded in the care plans we checked. This meant staff had adequate information to enable them to meet people's individual needs.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs outside agencies had been involved to make sure they received the correct care and support.

People told us they were involved in a variety of social activities. This included attending day centres and social evenings as well as going horse riding, swimming, and carrying out day to day living skills, such as cooking.

The home has a complaints procedure which was available to people using and visiting the service. We saw when complaints had been made the provider had taken appropriate action to investigate and resolve the issue. The people we spoke with raised no concerns.

Is the service well-led?

The registered manager has been in post for less than a year and a new deputy manager had recently been appointed. Work had been started to improve the way the service operates but new systems were still being embedded at the time of the inspection.

There was a quality assurance system in place to assess how the service was operating. This included regular meetings and periodic surveys. We saw various checks had been completed to monitor if staff were following policies and records were being maintained correctly.

Staff were clear about their roles and responsibilities. We saw they had access to policies and procedures. These had either been reviewed, or were in the process of being reviewed, to make sure they reflected how the service operated.

At this visit we found the provider had addressed the shortfalls we identified at our last visit. We saw they had completed thorough background checks on new staff before they started to work at the home to make sure they were suitable to work with vulnerable people. They had also introduced appropriate systems and equipment to monitor and minimise the risk of infection.

On this occasion we did not speak with people who used the service. However their experiences were captured through checking records and speaking with the provider and staff.

People's comments indicated they received the care and support they needed and they were happy with how staff supported them. We saw people were involved in a variety of social activities in the community and carried out daily living skills, such as cleaning their room and food shopping.

The systems in place to reduce the risk and spread of infection were ineffective.

There were systems in place to make sure people received their medications safely and we saw staff had completed training in this subject.

Recruitment and selection procedures were in place but had not always been followed. We saw not all staff had two written references on file to show they were suitable to work with vulnerable people.

There were systems in place to gain people's views and check if staff were following company policies. When we asked people if there was anything they would like to improve they said they were very happy with the support provided. One person commented, 'I like living here.' While speaking about social activities with a visitor they told us, 'It's a marvellous place. If something is cancelled they put something else in place straight away.'

People told us they received the care and support they needed and they were happy with how staff delivered their care. We saw people were encouraged to be independent, but support was available when required. They were also involved in social activities, attended day centres and carried out day to day living skills, such as cooking and cleaning their rooms.

The premises were in a good state of repair and were clean and fresh. One person told us how they had chosen what to have in their room and said, 'It's always nice and tidy." We saw that regular checks were made to make sure the home was safe and maintained to a satisfactory standard.

People who used the service and the staff we spoke with said there were enough staff on duty to meet people's needs. We saw people received the support they needed in a timely manner from staff who were competent in their role.

We saw the complaints procedure was available to people who used and visited the service. People told us they felt comfortable taking any concerns to any of the staff.