This inspection took place on 07 and 12 May 2015. This was due to the need to talk to people when they returned from activities outside the home and to staff who were working at the service on different days. To ensure we met staff and the people that lived in the house, we gave short notice of our inspection to the service.
This location is registered to provide accommodation and personal care for a maximum of three people with learning disabilities. Three people lived at the service at the time of our inspection.
People who lived in the house were younger adults below the age of sixty five years old. People had different communication needs. Some people were able to communicate verbally, and other people used gestures and body language. We talked directly with people and used observations to better understand people's needs.
Our inspection on 21 May 2014 found that the provider was in breach of regulation 20 of the Health and Social Care Act 2008 (HSCA) which relates to records. This was because some records were not always well maintained. For example, weight checks had not been recorded in line with people’s needs and monthly key worker reviews had not been consistently completed. A keyworker is a member of care staff with key responsibility to support an individual, to meet their support and care needs.The provider sent us an action plan to show how they intended to improve the records they kept by October 2014. They intended to review all risk assessments and care plans and introduce a monthly keyworker report system. They intended to introduce a new quality monitoring process to monitor and analyse care plans and key worker report records to ensure they were up-to-date and met people’s needs.
During this inspection we found that improvements to record keeping had been made and fully embedded into common practice by the provider.
The home had a registered manager. 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.
People and staff were encouraged to comment on the service provided and their feedback was used to identify service improvements. There were audit processes in place to monitor the quality of the service. Maintenance systems were not always sufficiently robust to ensure low priority repairs and maintenance tasks were completed in a timely manner.
We recommend that the service explores relevant guidance from reputable websites about quality monitoring and action planning to improve the maintenance audit system and ensures effective communication of this with staff
.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Risk assessments took account of people’s right to make their own decisions.
Accidents and incidents were recorded and monitored to identify how the risks of re-occurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed and were continually reviewed.
Staff were competent to meet people’s needs. Staff received on-going training and supervision to monitor their performance and professional development. Staff were supported to undertake a professional qualification in social care to develop their skills and competence.
The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no one living at the home was currently subject to a DoLS, we found that the registered manager understood when an application should be made and how to submit one.
The service provided meals and supported people to make meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.
Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People were satisfied about how their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.
People were involved in their day to day care and support. People’s care plans were reviewed with their participation and relatives were invited to attend the reviews and contribute.
People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People were involved in planning activities of their choice.
People received care that responded to their individual care and support needs. People felt confident they could make a complaint and that the registered manager would address concerns.
There was an open culture that put people at the centre of everything that took place. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.