14 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 23 March and 3 April 2018 and was announced. One inspector carried out the inspection. We gave the service 48 hours’ notice of the inspection, because Tabs @42 is a small residential care home and we needed to be sure the management, staff and people using the service would be in. On the first day of our inspection, we visited the service and on the second day, we spoke with relatives on the telephone.
Before the inspection, we reviewed the information we held about the service. This included a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at information provided by the local authority to obtain their views of the service.
We also reviewed the provider’s statement of purpose and the notifications we had been sent. A statement of purpose is a document which includes a standard required set of information about a service. Notifications are changes, events or incidents that providers must tell us about. We also spoke with the local authority who told us they had no concerns about the service.
There was one person at the service on the day of our visit. They were unable to engage in conversation with us about their care so we observed them being supported by staff. We also spoke with two relatives and six staff that included the manager, a team leader, an acting team leader, two care and support staff and the housekeeper. In addition, we spoke with a care manager who was involved in the care for one person using the service and a health professional.
We reviewed records relating to the care of the two people using the service and examined their care plans, risk assessments and medicines records. We also looked at records in relation to the management and quality assurance. This included three staff recruitment records, staff training and supervision records, staff rota, quality audits and complaint records.
14 June 2018
We carried out this announced inspection on 23 March and 03 April 2018. At our last inspection, on 25 February 2016 the service was rated Good. At this inspection, we found the service remained Good in Safe, Effective and Caring. The service had progressed to Outstanding in Responsive and Well-led giving it an overall rating of Outstanding.
Tabs @ 42 is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service provides accommodation and personal care for up to five adults. People living at the service have complex needs that include Autism spectrum disorder, learning and physical disabilities. It is situated in Northampton and the premises had been adapted to provide people with individual flats. The service also has a secluded garden.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.’
At the time of our inspection, two people were using the service.
The home has a registered manager. This 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 management team were highly committed to ensuring people lived fulfilling lives. The whole focus of peoples care was person centred and focused on promoting their independence and social inclusion. Staff and the management team were exceptional at empowering people to have as much control over their lives as possible and to achieve their maximum potential. The staff were passionate about the person-centred approach of the service and it was clear it was run with and for people. It was obvious that the culture within the service valued the uniqueness of all individuals.
The service had taken inventive steps to meet people’s communication needs and we saw extensive communication plans and tools that were in use. These had been tailored to each individual and ensured effective communication took place. Staff empowered people with complex needs and behaviours to feel a part of their community, and to achieve their goals. People took part in activities at the service and in the wider community. Each person had a personalised pictorial activity plan and were supported to take part in activities of their choosing. Staff supported people by responding to their communication methods and body language to understand if they were unhappy or dissatisfied with any elements of the service.
We found a progressive and highly positive staff team that placed people and their relatives firmly at the heart of their care. The service was led by a dedicated and passionate management team who had embedded a culture and ethos within the service that was open, encouraging and empowering. Staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the management team were very committed to their work and faced up to any challenges and used these to improve the support for people using the service.
Staff attended a variety of meetings that gave them an opportunity to share ideas, and exchange information about possible areas for improvements. Ideas for change were welcomed, and used to drive improvements and make positive changes for people. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement and identify where action needed to be taken. All staff, irrespective of their role, wanted standards of care to remain high and so used the outcome of audit checks and quality questionnaires to enable them to provide excellent quality care.
People continued to receive safe care. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff understood how to prevent and manage behaviours that the service may find challenging. Effective recruitment processes were in place and followed by the service and there were enough staff to meet people’s needs. People received their medicines safely and as prescribed.
Staff were trained in infection control, and had the appropriate personal protective equipment to perform their roles safely. The service was clean and tidy, and regular cleaning took place to ensure the prevention of the spread of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service
People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. The care that people received continued to be effective and meet their needs. There were sufficient staff, with the correct skill mix, on duty to support people with their care. Staff received an induction process when they first commenced work at the service. In addition, they also received specialist on-going training to ensure they were able to provide care based on current practice when supporting people.
People received enough to eat and drink and staff gave support when required. People were supported by staff to use and access a wide variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.
Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care. People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff were caring and had built open and honest relationships with people and their relatives. They were knowledgeable about how best to communicate with people and to advocate for them and ensure their views were heard. Relatives spoke of the family atmosphere at the service and the genuine interest staff took in their family members. There was a strong culture within the service of treating people with dignity and respect and staff spent time getting to know people and their specific needs before they provided them with care and support.