The service was last inspected on 24 September 2014 where there were two breaches of Regulations 12 and 17 related to safety and governance of the service. At that time there were no checks on small electrical appliances, and window restrictors were not fitted to first floor rooms. The provider was not carrying out formal audits of the quality and safety of the service. At a follow up focused inspection on 18 December 2015 we found that these regulations were now being met. 11&12 Third Row is one of two 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 three people with a learning disability, who require assistance with personal care and support. At the time of the inspection there were three people living at the home. There was no registered manager in post at the time of the inspection but plans were in place to appoint a registered manager to the service. A general manager was in day to day charge of the service.
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.
We checked the management of medicines and found that appropriate procedures were in place for the ordering, receipt and administration of medicines. Medicine audits were carried out daily to ensure medicines had been given as prescribed. A competency checklist used to assess staff competency was basic, and records of when to give as required medicines could have been more detailed. We have made a recommendation about this.
Risk assessments and safety checks on the premises and equipment were carried out including electrical, legionella, and the oil tank storage. Fire procedures were in place. Staff received fire safety training and alarms and equipment were tested regularly.
Individual risks to the safety of people had been assessed and mitigated. Records of accidents and incidents were maintained and appropriate action taken where possible to prevent reoccurrence.
There were suitable numbers of staff on duty. People's needs were responded to in a timely manner and staffing took into account people's needs such as the requirement of two staff to go out. A manager was on call 24 hours a day to support staff.
Recruitment practices were appropriate and the suitability of applicants to work with vulnerable adults were carried out prior to employment. This helped to ensure that people were protected from abuse. Staff had received training in the safeguarding of vulnerable adults and knew what to do in the event of concerns. There were no concerns of a safeguarding nature at the time of the inspection.
Staff received regular training including related to the specific needs of people who used the service. Appraisals were carried out, and a system of staff supervision was in place. There were some gaps in supervision records and the general manager told us they had a plan in place to address these. Staff told us they felt well supported. Due to the small size of the service and number of staff employed the general manager had contact with staff on a regular basis.
People had access to a range of health professionals, including their GP, nurses and chiropodist. The health needs of people were responded to in a timely manner.
People were supported with eating and drinking. A menu was in place which had been reviewed and amended. People were offered a range of choices and healthy options were promoted. Some people had limited preferences of food choices and these were catered for by staff. Daily records of food and fluid intake were maintained and people's weights were monitored.
The premises were homely and generally well maintained. There was a rolling programme of redecoration and refurbishment. New carpets, a new handrail and improvements to the garden had been made since the last inspection. A lounge area had also been redecorated.
We observed kind and caring interactions between staff and people throughout the inspection. Staff knew people well and often responded to their needs through their interpretation of non-verbal cues from people who had difficulty communicating verbally. There had been a reduction in behavioural disturbance of one person which was partly attributed to the skilled approach and consistency of the staff team. The privacy and dignity of people was maintained.
The individual needs of people were responded to promptly, including a decline in physical health. People were supported to transition to the home from another service and relatives and care managers told us that people had settled well into their new surroundings.
Person centred care plans were in place which were up to date and regularly reviewed. Plans were in place to support people exhibiting behavioural disturbance or distress.
People took part in a variety of activities in line with their personal wishes and preferences. Staff were prepared to be flexible with activity plans based on people's wishes at the time. Routines met the needs of people who used the service.
A general manager was in day to day charge of the service. They carried out regular checks on the quality and safety of the service including on a daily basis and spot checks out of hours. A daily handover sheet had been introduced which recorded care and other safety checks. This was signed by staff and gave staff additional responsibility and accountability. Monthly audits had been introduced following the last comprehensive inspection, and we found some gaps in these at this inspection. We have made a recommendation about this.
Staff told us they felt well supported by the general manager and relatives also told us they were approachable and helpful. The general manager told us they were looking forward to the new registered manager providing greater oversight and support to strengthen the current management systems in place.
At this inspection we found one breach of Regulation 13 Safeguarding service users from abuse and improper treatment. This was because applications to deprive people of their liberty had not been submitted to the local authority of authorisation in line with legal requirements. You can see what action we told the provider to take at the back of the full version of the report.