Archived: No 10 Fifth Row

10 Fifth Row is one of four locations owned and run by Mr J & Mrs D Cole and is situated in the village of Linton, near Ashington. It provides accommodation for up to two people with a learning disability, who require assistance with personal care and support. At the time of the inspection there were two people living at the home.

At the time of our inspection there was a registered manager in place. Our records showed she had been formally registered with the Commission since October 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was not available at the time of the inspection but we were supported by the provider’s general manager.

People who lived at the home were not always able to communicate with us or did not wish to speak with us. We asked one person if they liked living at the home and they indicated that they did. Staff had a good understanding of safeguarding issues and said they would report any concerns to the registered manager or general manager. The premises was maintained and appropriate safety certificates were in place and available for inspection.

Staffing levels were maintained to support the individual needs of people living at the home. Staff said they felt there were enough staff available to provide adequate support. Appropriate recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. Medicines were stored and disposed of safely. Records related to the safe management of medicines were up to date.

Staff said they were able to access a range of training including on-line courses and face to face sessions. Areas covered included first aid, moving and handling and food hygiene. They told us they had access to regular supervision and appraisals.

A range of food was provided at the home. Weekly menus had been devised and a range of meals were offered. The general manager told us that because of the size of the home meals could reflect people’s individual likes. We observed people had access to food and drink throughout the day.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. People living at the home had capacity to make decisions and therefore applications under the DoLS guidance were not required. Records showed that consent was sought from people and that their capacity to consent was considered and the Mental Capacity Act (2005) (MCA) was applied appropriately.

We noted the decoration of the home was in need of refreshing in some areas. The carpet on the stairs was slightly worn. The general manager confirmed refurbishment of the home was an on-going process. The outside of the property was well maintained and people had access to a secure garden area.

We observed staff treated people well and people living at the home appeared happy and relaxed. Staff had a good understanding of people’s individual needs, likes and dislikes. People had access to general practitioners, dentists and a range of other health professionals to help maintain their wellbeing. People were supported to participate in activities they liked or to go out on trips and visits.

People had individualised care plans that were detailed and addressed their identified needs and considered risks associated with the delivery of care. A new care planning system had recently been introduced. There had been no recent formal complaints.

The general manager said that because the home was small and was regularly visited, any matters that needed addressing were dealt with on an immediate basis. He had recently introduced a monthly audit process that checked that care plans were up to date and the premises were safe.

' 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 they 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 changes 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's representative 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 interventions do not deprive people of their liberty and that decisions are made in the best interests of the person). Following a recent court ruling regarding depriving people of their liberty in care settings the provider may wish to review the living arrangements of individuals, to identify where their circumstances may amount to a deprivation of liberty, according to the revised definition.

We saw there were effective systems in place to ensure people were protected against the risks associated with the unsafe use and management of medicines.

We found the house was clean and people were protected by the systems in place to reduce the risk and spread of infection. We saw staff were provided with appropriate training to equip them with the skills to meet people's needs.

Is the service effective?

There were systems in place to ensure people's health and care needs were assessed with them. We found they were involved in this process. We saw that specific care plans were in place for people with particular needs such as, skin care or intake of fluids.

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 like the staff. I get on fine with them. We all get on well.'

People's preferences, interests, and diverse needs were recorded and we saw staff were aware these during the inspection.

Is the service responsive?

We saw evidence that the care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that the care of someone with a skin condition was supported to visit the 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?

A registered manager is a person who is registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. There was a registered manager in post who had completed appropriate training and was experienced in the care of people with learning disabilities.

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. At the time of our inspection the service had not received any complaints or had to make any safeguarding referrals. One relative told us they were confident any concerns or complaints would be acted upon promptly.

We saw risk assessments for individuals and the service were in place and were regularly reviewed.

Staff had regular supervision and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. They told us they felt well supported. We saw records of staff meetings that confirmed this.

We looked at the medication administration record (MAR) sheets for both people. We found one hand written entry had not been signed to say they had been checked. Some medicines may not have been given at the correct time to be most effective and one care plan, for particular medicine, was unclear about what dose of medication should be given.

The building was well decorated, warm and provided appropriate accommodation to meet the needs of the individual. The people using the service gave us permission to look at their rooms. We saw that they was personalised with pictures, photographs and personal items.

There was a comprehensive training matrix indicating that staff had undertaken a range of training. Staff stated they had regular supervision and appraisals. We saw copies of notes from people's supervision and appraisals and noted they covered a range of topics.

Each service user had access to an easy read version of the complaints policy. Staff also told us that if a person expressed that they wanted to complain they would help them contact their care manager to discuss the situation. There had been no complaints logged this year.

We saw people were happy and relaxed with staff. We observed on several occasions people were asked their opinion and the provider acted in accordance with their wishes. We saw that there were regular reviews of care plans and that these routinely involved people's care managers and next of kin. This indicated that although people were not able to give their direct consent, someone was acting on their behalf.

We noted people had comprehensive assessments of needs. We found risk assessments had been undertaken and detailed care plans highlighted their needs. We saw care plans were reviewed yearly and were updated if people's needs had changed.

We saw there was a daily record of what people had to eat and they were provided with a choice of suitable and nutritious food and drink.

Effective systems were in place to reduce the risk of infection. We noted that the home was clean and well kept, floors and furniture were free from dirt and kitchen work surfaces and sink areas were clean. There was a valid Food Hygiene certificate displayed.

There was an effective recruitment process in place and application and interview procedures had been followed to ensure appropriate staff were employed.

We saw that people's personal records were accurate, fit for purpose and kept securely.