Number Residential Care Home

Number Residential Care Home is a residential care home which provides accommodation and personal care to up to 10 people with mental health needs and learning disabilities. At the time of the inspection 10 people were living at the service. Number Residential Care Home is a care home set up in an adapted residential building over 2 floors.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support.

People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were encouraged to make choices and decisions in accordance with their level of understanding.

People and relatives told us they felt safe at the service. People were protected from the risk of abuse or harm because staff knew the action to take should they suspect or witness any abuse. Risks to people were assessed and appropriately managed to ensure people received safe care. Appropriate infection control practices were followed by staff. Recruitment checks were carried out to ensure staff employed were safe to work with people. We found some areas for improvement were required in relation to recruitment records. Systems were in place to report and learn from any incidents where restrictive practices were used.

People were cared for and supported by staff who were suitably trained and supported to effectively perform their roles and responsibilities.

Right care

Care was person-centred and promoted people’s dignity, privacy and human rights. Relatives told us staff were kind and caring towards their relative and treated them with dignity and respect. Relatives confirmed they were included in decision making about their relative’s care. People were supported to maintain their privacy, dignity and independence by staff who knew them well.

People had their communication needs met and information was shared in a way that could be understood.

People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and well. Staffing levels were determined by the level of individual care required for people using the service and funding arrangements.

Right culture

The ethos, values, attitudes and behaviours of management and care staff promoted a service which was inclusive, empowered and encouraged good outcomes for people who used the service. We found some rooms lacked personalisation, the registered manager told us this was due to people who expressed anxiety and anxiousness. Relatives and staff spoke positively of the managers, including the registered manager. The deputy managers ensured that staff had relevant training, supervision and appraisal. Governance systems ensured people were kept safe and received high quality care and support in line with their personal needs. Staff worked with other services and professionals to improve outcomes for people.

Relatives told us they were able to speak to management any time and were listened to. The management team was described as approachable and took action to resolve issues where needed. Staff told us they were well supported by the registered manager and were listened to and encouraged to discuss their views about the service.

Systems for monitoring the quality of the service were in place and regular audits took place. Continuous learning took place to improve the quality of the service provided to people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was rated good (published 14 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the provider in relation to the management of the service, staffing levels, recruitment and medicines management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Number Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Number Residential Care Home is a ‘care home’ for people who have mental health needs and who may also have additional disabilities. People in care homes receive accommodation and 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 service accommodates a maximum of 10 people. At the time of our inspection there were 10 women living in the home. Most of the people using the service had been living at the home for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the manager and deputy manager.

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 understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

We have made a recommendation relating to notifying the Commission about certain changes, events and incidents that affect services or the people who use it.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs people had.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements.

All parts of the home, including the kitchen, were clean and no malodours were detected.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

At the time of our inspection there were ten women living at the service. The service is located in two adjoining terraced houses, on two floors with access to a front and back garden. We previously inspected the service on 6 August 2014 and the service was found to be meeting the regulations inspected.

Number Residential Care Home had a registered manager at 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.

People using the service informed us that they were happy with the care and services provided. During the inspection we saw staff were caring, kind and compassionate and treated people with dignity and respect.

Care records were individualised, contained people’s personal histories and reflected their choices, likes and dislikes, and arrangements were in place to ensure that these were responded to. Care plans provided detailed information about people’s mental health needs which were closely monitored. Risk assessments had been carried out and updated regularly. These contained guidance for staff about protecting people. Staff were able to tell us about the needs of people they cared for and were aware of the most effective way of supporting them with their mental health needs.

People were supported to maintain good health through regular access to healthcare professionals, such as the local mental health team and GPs. We saw people had access to opticians and dentists on a regular basis.

People’s cultural and religious needs were facilitated by staff.

People had their medicines managed safely, and they received their medicines as prescribed. Storage and management of medicines was safe with clear systems in place.

Staff had been carefully recruited and provided with training to enable them to care effectively for people. Staff felt supported and there was evidence of regular supervision taking place in recent months. Staff knew how to recognise and report any concerns or allegations of abuse and were able to tell us what action they would take to protect people against harm. Staff knew what whistleblowing was and were able to tell us what they would do if they were concerned about the quality of the service.

There were enough staff to meet people's needs and management of money for people using the service was safe.

We found the premises were clean and tidy, and measures were in place for infection control. There was a record of essential services such as gas and electricity being checked, with fire drills taking place regularly. There was clear documentation relating to complaints and incidents.

Staff told us the management was a visible presence within the home, and the staff we met were

caring, kind and compassionate.

There was a wide age range of people living at the service. The provider focused on the compatibility of people living at the service and prioritised this when considering new admissions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

At the time of the inspection there were nine people living in the home. We spoke with five of them, two did not wish to talk with us, and two were out during the inspection visit.

Is the service safe?

People told us that they felt safe at the home. Clear records were maintained of people's property held for safekeeping and risk assessments had been undertaken with care plans in place to keep people safe from known risks.

Staff had undertaken first aid training and safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home environment appeared safe, clean and hygienic.

Recruitment records for staff indicated that appropriate checks had been undertaken to ensure their fitness to work with vulnerable people.

Is the service effective?

People told us that they were happy with the care and support provided to them. They had consented to any restrictions to their freedom, and where they were unable to do so, the appropriate action had been taken to safeguard their rights.

They told us that they engaged in a range of activities within and outside of the home. One person noted 'I'm taking a course at the library,' others advised 'I go to church,' 'I go out for lunch with staff,' and ' I go out to feed the birds.' Within the home activities included yoga classes, beauty therapy, and jewellery making.

People's health and social care needs were assessed with them, and they were involved in writing their care plans which were reviewed regularly to ensure that staff met people's needs consistently.

Staff received appropriate support and supervision to enable them to deliver care and support to people to an appropriate standard.

Is the service caring?

People we spoke with told us that staff were responsive to their needs and treated them with respect. We observed staff knocking on people's bedroom doors, and waiting for a response. They were sensitive and patient when supporting people. People's preferences and interests, goals and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

People using the service, and visitors to the home had completed an annual satisfaction survey indicating that they were happy with the support provided at the home.

Is the service responsive?

We saw that staff had identified people's cultural and religious needs, and people were supported to attend places of worship and have cultural foods. Some people living at the home said that they were being supported to develop daily living skills to move onto more independent accommodation.

There were records in place to indicate that people's consent had been obtained in relation to any restrictions placed upon them within the home. Where this was not possible Deprivation of Liberty Safeguards had been applied for as appropriate. People told us that they were satisfied with the choices available to them including choices about the food, and activities provided. One person told us that the food had improved recently noting 'It's more healthy.'

Is the service well-led?

People we spoke with were happy with the home's management. Staff spoke positively about training, supervision and support provided to them.

We reviewed several monthly audits that took place and the most recent quality assurance survey. Staff told us they were clear about their roles and responsibilities, and demonstrated an understanding of the needs of the individual people they cared for.

Records were clear, well organised, and had been reviewed up to date. Where improvements were recommended following a particular incident, we noted that the manager had implemented these promptly.

At this inspection we found that the provider had taken action to meet the requirements of regulation. We found that all prescribed medicines were available, medicines were stored safely and at the correct temperatures. We found that accurate and up-to-date records were kept of medicines received, administered to people and returned. Therefore medicines were now being managed safely for the protection of people who use the service.

People using the service told us that they liked the home and felt that it provided good care. They told us that they liked the homely environment that was provided. We received the following comments about the home:

'I like it here.'

'It is nice. It is well run.'

'It is good here.'

'There are two cats. They are nice.'

We found that people's privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had a system to regularly assess and monitor the quality of service that people receive.