Archived: Royal Mencap Society - 7 Eggars Close

7 Eggars Close is a residential care home providing accommodation and support for four people with learning disabilities in a residential area of Alton in Hampshire. At the time of our inspection four people were using the service.

The home had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

People’s relatives told us that they felt their loved ones were safe at the home. People were supported by staff who had been trained in safeguarding and were able to recognise signs of abuse. The provider ensured that safeguarding policies and procedures were in place and kept up to date.

Risks affecting individuals had been identified, and measures put into place to protect them from harm. People’s risks were assessed and regularly evaluated by people’s key workers to ensure they remained current. A key worker is a named member of staff that is responsible for ensuring people’s care needs are met. Environmental risks were regularly reviewed and documented and personal evacuation plans were in place to ensure that people were kept safe in the event of an adverse incident such as a fire. Equipment and utilities were serviced regularly, and internal health and safety checks protected people and others from potential risks in the home.

There were enough staff to meet the needs of the people living at the home. Recruitment procedures were in place to ensure that people were protected from the risk of employment of unsuitable staff. New staff undertook a period of induction which included mandatory training. This was followed by a period of working alongside more experienced staff and observation from the registered manager, to ensure that they had the necessary skills and confidence to fulfil their role.

People were protected from the unsafe administration of medicines because staff had received training to ensure that medicines were administered, stored and disposed of correctly. Staff had their competency to administer and manage medicines assessed by the registered manager annually.

The provider had a programme of mandatory training to support staff to fulfil their roles and responsibilities safely and effectively. The registered manager kept an overview of when this was due to be refreshed for each member of staff, to ensure it was kept up to date. The registered manager carried out observations to ensure that she was satisfied with people’s skills in certain areas and ensured they had further training if necessary. Permanent staff were supported in their roles through regular supervision and appraisal, while they and the registered manager provided guidance and support to bank relief and agency staff.

People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

People, where possible, were supported to make decisions about their care and treatment. Where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider had made the appropriate DoLS applications to the local authority. Staff had a good understanding of the Mental Capacity Act 2005 and were able to talk about it in the context of the people living at the home. Records confirmed that procedures had been followed to ensure that decisions about people’s care had been made in their best interests.

People were supported to have enough to eat and drink and staff encouraged people to have healthy diets. People were offered choices and made their own decisions about what they wanted to eat and drink and looked forward to and enjoyed mealtimes.

People were well supported to maintain good health and have access to healthcare services. Staff were observant and quick to identify potential concerns, promptly engaging with other healthcare agencies and professionals to ensure people received the support they needed.

Staff demonstrated that they knew and understood people's wishes and preferences. People and their relatives were happy with the care provided and we observed interactions between staff and people which were warm and encouraging. Time and effort was invested by staff to build close relationships with people and to understand their needs. In turn, people were relaxed and comfortable in the company of staff.

People’s independence was promoted and they had their own individual goals and steps to achieve them, which were regularly reviewed. This helped ensure that people had continuous opportunities to develop new or existing skills. Staff were proactive in seeking out opportunities for social activities which people would enjoy. When people didn’t want to take part in things, their wishes were respected. People were encouraged to lead full, active and rewarding lives and to make choices for themselves, such as what they wanted to eat, what they wanted to wear and how they wanted to spend their day. Staff were able to identify and discuss the importance of maintaining people's respect and privacy and described how they ensured these.

People had thorough care and support plans which were individualised to them. In addition to outlining people’s support needs, they gave a detailed account of their personal history, their likes and dislikes, their interests and goals and their behaviours and routines. They enabled support workers to have the information they would need in order to support a person effectively. They were regularly reviewed by the person and their key worker to ensure that they remained current and relevant.

People were encouraged and supported to lead active social lives and to follow their interests and enjoyed being part of the local community.

Staff, people and their relatives knew how to raise concerns and were confident in doing so. Staff and residents' meetings were held regularly and provided opportunities for feedback on the quality of the service. Procedures were in place to record, investigate and respond to complaints effectively. Annual stakeholder surveys enabled the provider to keep an overview of people’s views of the service and to respond accordingly.

Both relatives and staff told us that the registered manager provided positive management and leadership. They felt able to talk to the registered manager if they had concerns and had confidence that she would do her best to resolve issues. The culture of the service was one of personalised individual care. It had a focus on promoting independence where possible and providing people with opportunities to live happy and fulfilled lives.

The service was led by a capable registered manager who was competent and understood her responsibilities. Staff were confident, worked hard and were inspired to do their best for the people living at the home. Staff told us that they felt well supported by the registered manager, and that the team worked well together and were supportive of each other.

The provider carried out effective monitoring to assess the quality of the service being delivered and to identify and drive improvements required.

At this inspection we found evidence to demonstrate the provider was compliant in relation to management of medicines.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had effective systems in place in order to safeguard people from possible abuse. Records showed that care workers received training in safeguarding of vulnerable adults. Care workers were knowledgeable about the safeguarding policy and the whistleblowing procedure, and told us they were confident the registered manager would act appropriately regarding any concerns raised about abuse. Records demonstrated the provider communicated effectively with the local authority, and that care plans and risk assessments were updated to reflect any changes in support delivery.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

Care workers we spoke with had good understanding of people's needs and told us they felt the care plans and risk assessments in place were effective. We found the provider had an effective system in place to check and reassess the suitability of care workers to work with vulnerable people. One relative told us their family member had received care from Mencap for almost 20 years. They said: "They have always been great. She (family member) has progressed so much with her personal care and dealing with anxiety".

Is the service caring?

People's life style choices, preferences, interests, and different needs had been written in their plans and care and support had been provided to make sure these were upheld. A relative said: "The support workers are really caring, they really are great".

Is the service responsive?

People's needs had been assessed before they received care.This included involving them in regular care reviews and keeping them or their relatives informed of changes, if appropriate. We saw that people's health needs were monitored and if necessary the support of health care professionals obtained.This helped to ensure that the delivery of care was responsive to people's needs and based on up to date information and guidance. The records showed that any concerns were followed up and relevant action was taken

Is the service well led?

There were clear lines of accountability within the service. We saw evidence that regular audits of the quality and safety of the service were carried out. For example, there were audits of the care plans and care workers training records.

We found people's care and support were effective and based on thorough assessments and detailed plans. Care and support were delivered effectively and in a caring manner. People consented to their care, and staff were aware of the procedures to follow if people did not have capacity to make decisions. Staff took suitable precautions to maintain standards of cleanliness and hygiene and to protect people from the risk of the spread of infection. However the provider was not following all Department of Health guidance on management systems to protect people from the risk of the spread of infection.

People received their medicines when they needed them. However we found the provider was not following published best practice guidance on the storage and recording of medicines. Controlled drugs were not managed appropriately and over the counter remedies were not disposed of when they reached their expiry date.