Shining Star

Shining Star is a residential care home which was providing personal care to three people at the time of our inspection. All people living at the service were autistic or had learning disabilities. The service can support up to four people in one adapted building over two floors.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Their model of care was person centred, placing people at the heart of the care. People’s choices were what motivated staff in their roles and the provider wanted people to live empowered lives.

People were kept safe. Medicines were managed in a safe way; people’s medicines folders were up to date and audited correctly. Infection control practice had improved since our last inspection; the service followed national guidance and sought to keep people safe from infection. There were systems in place to protect people from abuse. People’s risks were assessed and monitored. There were enough staff working at the service and recruitment processes were robust. Lessons were learned when things went wrong as incidents were recorded and actions completed to keep people safe.

The service worked effectively. People were supported to eat, drink and maintain healthy diets. People were 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. Deprivation of Liberties Safeguard documentation was up to date. People’s choices were respected, and decisions made in their best interests. People’s needs were assessed in line with the law, so the service knew whether they could meet their needs. Staff received induction and training, so they knew how to work effectively with people. Staff were supported in their role through one to one supervision. Staff communicated effectively with other agencies to ensure people received good care, this included health care. The provider had adapted the building to ensure it met people’s needs and people could decorate their rooms as they saw fit.

The service was caring. A relative told us staff were caring. People were supported to express their views in key work sessions. People’s privacy and dignity were respected, and their independence promoted.

The service was responsive. Care plans were person-centred focusing on people’s needs and preferences. People’s communication needs were met. People were able to take part in activities they could enjoy. There was a complaint process where people or relatives could complain and when they did, the provider responded appropriately. People’s end of life wishes were recorded.

The service was well led. Record keeping at the service had improved since our last inspection and documents we viewed were up to date. Quality assurance measures were appropriate and working to ensure care remained good and people were safe. The manager was thought of highly by staff, as well as the relative and advocate we spoke to. The manager understood duty of candour and fulfilled the service’s regulatory requirements. People, relatives and staff were able to be engaged with the service should they choose to be. The service worked with other agencies to the benefit of people using the service.

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 requires improvement published (29 March 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Shining Star is a residential service providing care and accommodation to people with learning disabilities and or autism. Shining star accommodates up to four people in one building. At the time of our inspection three people were living there, all of whom communicated non-verbally.

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

Medicines were not always managed safely. There was out of date paperwork in one person’s medicine folder and some poor medicine administration recording practice. We have signposted the service in respect to improving their infection control measures. There was no signage in bathrooms around the donning, doffing and disposal of PPE. People’s temperatures were not being recorded in line with the provider’s guidance for supporting people during an outbreak of Covid-19. Food hygiene was not always practiced. We found out of date and unlabelled food in the fridge.

Risks to people were assessed and monitored. There were systems in place to support safeguard people from abuse. Lessons were learned when things went wrong.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service had not applied for Deprivation of Liberties Safeguards (DoLS) for people and thereby was depriving them of their liberty without lawful authority. Although this was the case the service was working in people’s best interests and to the principles of the Mental Capacity Act (MCA).

Relatives had mixed views on staff training. Staff completed training and were competency checked in their roles.

Relatives had mixed views on the provider’s responses to complaints and concerns. We saw complaints were responded to appropriately and the provider worked to address relatives’ concerns. People’s care plans were personalised and detailed. People were supported with their communication needs.

The provider had not picked up on the issues we found at inspection through their quality assurance measures. They were also unable to provide us with some of their quality assurance documentation because the registered manager was unavailable.

The service worked in line with the provider’s values and sought to listen to people, relatives and staff. The service worked in partnership with other agencies to support people.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. There were sufficient staff who were trained to provide person centred care. The provider’s values, including being inclusive and caring, were embedded in the service, being discussed regularly at staff meetings and promptly displayed on the walls of the office.

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

Rating at last inspection

The last rating for this service was good (published 17 December 2019).

Why we inspected

The inspection was prompted in part due to the death of a service user by choking. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not seek to inspect them, though we found information about them through the course of our inspection activity. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to safe care and treatment of people, safeguarding people from abuse and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Shining Star is a residential service providing care and accommodation to people with learning disabilities and or autism. Shining star accommodates up to four people in one building. At the time of our inspection four people were living there, all of whom communicated non-verbally.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

There were safeguarding procedures to keep people safe from abuse. Risk assessments were used to monitor risks to people and keep them safe from harm. There were enough staff at the service. Suitable staff were recruited to work with people. Medicines were managed safely. Staff understood how to prevent infection. The service analysed incidents and accidents to learn lessons when things went wrong and where possible, worked to ensure they didn’t happen again.

People’s needs were assessed before moving into the service. Staff were trained how to do their jobs and were supervised in their roles. People were supported to eat and drink healthily. People were supported to access health and social care professionals as and when necessary. 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.

Relatives told us staff were caring towards people. People and their relatives were involved with people's care decisions. People’s privacy was respected, and their independence promoted.

People’s care plans recorded their needs and preferences. People were supported to do activities they liked to do. The provider understood people’s communication needs and sought to ensure their voice was heard. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. The service investigated and responded to complaints. The service recorded people’s end of life wishes if people wanted them to be.

The service promoted person centred care. Relatives were happy with the management of the service. The provider used quality assurance measures to drive improvement in the service. Staff understood their roles and responsibilities. People, relatives and staff were involved with the service through meetings and feedback provision. The service had links with other agencies to the benefit of people using the service.

Rating at last inspection

The last rating for this service was good (published 28 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Shining Star is a four bedded service providing support and accommodation to people with a learning disability. It is a large house in a residential area close to public transport and other services. The house does not have any special adaptations. A ground floor bathroom and shower are available, which can meet the needs of a person with limited mobility.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Systems were in place to minimise risk and to ensure that people were as safe as possible. Staff were aware of their responsibilities to ensure people were safe and knew what action to take if they had any concerns. They were confident that the registered manager would address any concerns.

People were protected by the provider’s recruitment process which ensured that staff were suitable to work with people who need support.

The staff team worked with other professionals to ensure that people were supported to receive the healthcare that they needed. People received their prescribed medicines safely.

Staff received the support and training they needed to give them the necessary skills and knowledge to meet people’s needs. Staffing levels were sufficient to meet people’s assessed needs.

People were supported to be as independent as possible and to make choices about what they did. Systems were in place to ensure that their human rights were protected.

People were treated with respect and their privacy and dignity was maintained. They were supported by a consistent staff team who knew them well.

The registered manager and the provider monitored the quality of service provided to ensure that people received a safe and effective service that met their needs.

People lived in a safe environment that was suitable for their needs.

People chose what they wanted to eat and drink. They were supported to eat and drink enough to meet their needs.

Systems were in place to respond to any concerns or issues that affected people who used the service.

We saw in practice that consent was sought before an activity was undertaken. Staff understood the importance of getting consent before they delivered care.

Each person had their own bedroom which allowed privacy. Care plans demonstrated that people's individual needs, likes and dislikes were addressed and met where possible. We observed one person being supported in getting ready to go out for the day in a way that was appropriate to their needs.

We found that the people who were using the service were protected from abuse as the provider had procedures in place for the staff to follow if the suspected anyone was at risk from abuse and staff told us that they understood theses policies and procedures. We were shown the protocols and systems for the safe storage and supply of medicines, which were all followed and records were complete. This demonstrated that there were processes in place designed to keep people safe from harm.

There were systems and procedures in place for monitoring and improving quality and we saw examples of improvements made. There was a comprehensive complaints procedure in place.

People were treated with respect and their care and welfare needs were met. A relative told us 'they are good at getting my relative the healthcare that they need.' People were supported to be as independent as possible and to use community facilities. Staff received the training and support that they needed to meet people's needs. There were systems in place to ensure that people received their prescribed medication appropriately. Following medication errors the provider had taken appropriate action to make the procedure more robust to ensure that people received their prescribed medication as safely as possible.