4 Mill Road

We found the following examples of good practice.

During an outbreak of COVID-19, people were supported to isolate in their rooms where they were able to. People who were not able to self-isolate used designated communal areas at different times. During the various lockdowns over the pandemic, staff had supported people with in-house activities such as Chair yoga via zoom, zoom quizzes, art and craft projects, themed weeks, come dine with me competition, name that tune, cooking and gardening to support individuals well-being. People were also supported to do their personal shopping online.

People had been supported to keep in contact with their loved ones throughout the pandemic. People received visits inside the home where possible. People were also supported to use video and phone calls as well as window visits.

There were personal protective equipment (PPE) stations around the home. These had been placed in areas of the home where people needed support with personal care. Each PPE station had a donning and doffing (putting on and taking off) poster for staff to follow. Staff were using PPE in line with government guidance.

Staff had worked with people to understand how to stay safe during the pandemic. People were supported to wear face masks when going out and to sanitise their hands upon return. People who went to work and visited day centres had agreed to have additional lateral flow device (LFD) tests before attending these.

The home was clean and free from clutter. The Local Authority had provided a cleaning service during the home’s outbreak period to support with deep cleaning of the home. People and staff had found this a positive experience and going forward, were looking to implement a designated cleaner at the home.

Staff had worked with people to support them to declutter their rooms and order additional storage furniture to limit infection control risks around the home. People were proud of their tidy rooms and the work they had done. People had designated home days in which they did their own laundry and cleaned their rooms with the support of staff. Staff also cleaned high touch areas three times a day. Staff cleaned communal areas at night and this was recorded. The registered manager was looking at ways to record the cleaning that people living at the home did whilst keeping a homely feel to the service.

At the previous inspection of this service in February 2017 the overall rating was requires improvement because we found improvements were needed in relation to the allocation of staff and the quality assurance system was not robust as it had not identified areas where improvements were needed. We carried out a focused inspection in June 2017 to look at ‘safe’ and found that the concerns regarding staffing continued.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm that the service now met legal requirements. We found improvements had been made, the provider had met the legal requirements and the overall rating had improved to Good.

Sedgemoor and Framley is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is one of three owned by the Eastbourne and District Mencap charity. It comprises of two houses joined by a link building and there is a separate bungalow to the rear that is used by two people.

The home provides support and accommodation for up to 23 young adults with learning disabilities, autism and mental health issues. There were 18 people living at the home during the inspection, who needed assistance with personal care and with support in the community.

The registered manager was present during the inspection. 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.

The quality assurance system had identified areas where improvements were needed and the provider had taken action to drive improvement, with regard to ensuring that records reflected the support provided and that policies and procedures were up to date. 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. With current guidelines in terms of smaller units to support people with learning disabilities, this home would be unlikely to be considered for registration as they support a large number of people.

There were sufficient staff working in the home and people were supported to be independent and enjoy their hobbies and interests. Staff were appropriately trained and assisted people to take part in activities and join in with community groups and festivals.

Staff had a good understanding of safeguarding and how to protect people from abuse and supported people to make choices and decisions about their daily lives. Feedback was consistently sought from people about the services provided and staff planned improvements based on their views.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. DoLS applications had been made when required to ensure people were safe and the registered manager was waiting for a response from local authority.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. Staff said they had not received this training, but they had a good understanding of each person’s communication abilities. We have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

The home provides support and accommodation for up to 23 young adults with learning disabilities, autism and mental health issues. There were 18 people living at the home during the inspection, who needed assistance with personal care and with support in the community.

We carried out an unannounced comprehensive inspection of this service on 10 and 13 February 2017. After that inspection we received new information of concern in relation to people's safety and insufficient numbers of experienced staff. As a result we undertook a focused inspection on 28 June 2017 to look into those concerns. This report only covers our findings in relation to whether the service is safe. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sedgemoor and Framley on our website at www.cqc.org.uk.

A registered manager had not been in place since August 2015. A manager was appointed two weeks before this inspection. They had experience of working at the home and told us they had started their application to register as the manager with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 management structure within the charity and the home had changed since the last inspection. The charity had appointed a new Chief Executive Officer (CEO) and the manager, deputy manager and a number of staff had resigned from Sedgemoor and Framley. The management were aware of the staffing issues and five new support staff had been appointed in the two weeks prior to the inspection. However, there continued to be a reliance on agency staff and new staff were working through their induction programme and were still learning about people’s support needs with the assistance of more experienced staff.

Support plans and risk assessments were not consistently up to date. Consequently the guidance for staff to follow when planning support was not in place.

Medicine procedures had been reviewed and systems were in place to ensure that people received their medicines as prescribed, by staff who were qualified to do so.

Staff had attended relevant training in safeguarding people from abuse. They demonstrated a good understanding of how to protect people and what action they would take if they had any concerns.

The atmosphere in the home was relaxed and comfortable. People were happy to talk about their day and what they planned for the evening and staff supported them to take part in activities, including those outside the home.

The home is one of three homes that are owned by the Eastbourne and District Mencap charity. It is comprised of two houses enjoined by a link building and there is a separate bungalow to the rear that is used by two people.

A registered manager had not been in place since August 2015. A manager had been appointed and an application had been made to register. 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.

This inspection took place on the 10 and 13 February 2017 and was unannounced.

At our inspection on 18, 19 and 26 November 2015 we found the provider was not meeting the regulations with regard safe care and treatment for people; assessing and monitoring the services provided and notifying the commission of events that might affect people living in the home. At this inspection we found improvements had been made and the provider had met the regulations.

However, we found that additional work was needed to ensure the improvements were embedded into practice. For example, the quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during the inspection. Such as gaps in the care plans.

The staffing levels had increased and although the provider continued to use agency staff they had an understanding of people’s support needs and how these were met. However, the allocation of staff within the home did not ensure people’s safety at all times.

There were systems in place for the management of medicines and staff completed records as they gave the medicines out. The specific protocols for giving medicines to people who were unable to verbally express how they felt were not clear, they were reviewed during the inspection and copied to CQC following the inspection.

Relevant training was provided and staff were supported to understand people’s needs and provide the support people wanted. Staff had an understanding of the Mental Capacity Act 2005 and how to support people who did not have capacity to make some decisions.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training and had an understanding of DoLS. Staff had followed current guidance by making appropriate referrals to the local authority for DoLS assessments.

Staff had attended safeguarding training and demonstrated an understanding of abuse and how to protect people.

People had access to health professionals as and when they required it. The visits were recorded in the support plans with details of any changes to support provided.

A range of activities were available for people to participate in if they wished. People were able to choose what they ate and where and, relatives said the food was very good.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and had been given in pictorial form for them to use.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications were in place at the time of inspection.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in this process and that they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person said, "My keyworker is very kind and helps me a lot". A relative told us, "The care is first class and the staff are so caring".

People living at the home and their families completed an annual satisfaction survey. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People engaged in a range of social, educational and work opportunities which were devised in conjunction with them and their families.

People knew how to make a complaint if they were unhappy though nobody had done so recently.

Is the service well-led?

The home worked well with other agencies and services to ensure that people received their care in a joined up way. The home also operated a quality assurance system which identified and addressed shortcomings. As a result, the good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were looking after and were properly trained to carry out their duties.

People told us they were very happy living in the home. One person said, 'We can decide what to do and we are well looked after'. We found evidence that people were encouraged to make choices and observed people supported by staff with respect and dignity.

We examined three care plans, and found that people living in the home and their relatives were involved in making decisions about the care provided. The care workers we spoke with demonstrated a good understanding of people's needs and how these were met.

We looked at staff rotas and staff files. Staff told us there were enough staff on duty to meet the assessed needs of people who lived in the home. Staff said that had received the training required to enable them to provide appropriate care and support for people.

A complaints procedure was in place and people were encouraged to discuss the care and support they received.