Royal Mencap Society - 178 London Road

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.

What life is like for people using this service:

•People received personalised care that met their needs and preferences. Staff recognised the risks to people’s health, safety and well-being and knew how to support them safely. People received their medicines as prescribed. People were offered choice at mealtimes and specific nutritional requirements were met. People chose how to spend their day and were engaged in activities that they enjoyed. People were supported to attend healthcare appointments and were encouraged to be healthy. People were cared for by staff who were kind and caring and people’s privacy, independence and dignity were promoted.

•Staff were supported in their roles. They took part in regular training and supervision. Staff told us they enjoyed working at the service and felt well supported by the service manager.

•We found the service met the characteristics of a “Good” rating in all areas. More information is available in the full report.

Rating at last inspection:

Requires Improvement (report published 2 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: There is no required follow up to this inspection, however we will continue to monitor the service through information we receive.

We visited this service on 30 October and 3 November 2017. The inspection was unannounced and was carried out by one inspector. The inspection was carried out earlier than originally scheduled as a result of concerns received about the service.

At the time of this inspection there were two people living in the home and one person in hospital recovering from an operation.

The service had a registered manager who had been on an extended secondment since 5 October 2015 and had applied to cancel their registration in relation to this service in July 2017. Interim management arrangements were in place. A registered manager is a person who has registered with to 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.

Relatives were positive in their feedback about the service and how people were cared for.

Management systems were not always implemented effectively to ensure the quality and safety of the service.

While there were systems and processes in place to protect people from harm; medicines were not always managed to ensure people received them at appropriate times.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

There were sufficient staff deployed and the provider checked staff’s suitability for their role before they started working at the home. There was a programme of training for staff to update their knowledge and skills.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People’s nutritional and specialist dietary needs were taken into account in menu planning and choices.

People were referred to other healthcare services when their health needs changed.

Staff had developed positive caring relationships with people and respected their privacy and dignity. Staff listened to people and were responsive to their needs, choices and preferences.

Relatives knew how to complain and were comfortable to raise any concerns about the service people received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We inspected the home on 13 and 16 May 2016. The inspection was announced 24 hours in advance because the service was a small care home for younger adults who may be out during the day. There were three people living in the home at the time of our inspection.

The service had a registered manager who had been on an extended secondment since 5 October 2015. Interim management arrangements were in place. A registered manager is a person who has registered with to 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.

Due to their difficulties communicating verbally, we were not able to seek people’s views about the care and support they personally received. However, a relative we spoke with told us they felt the service provided safe care and support.

A relative we spoke with was confident their family member was safe. People were cared for by staff in ways that met their needs and maintained their dignity and respect. Staff understood how to identify, report and manage any concerns related to people’s safety and welfare. There were systems and processes in place to protect people from harm, including how medicines were managed.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People and their relatives were involved in planning and reviewing the care and support provided by the service. Staff listened to people and understood and respected their needs. Staff reflected people’s wishes and preferences in the way they delivered care. They understood the issues involved in supporting people who had lost capacity to make some decisions.

People were supported to eat and drink enough to meet their needs and to make informed choices about what they ate. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health or when their needs changed.

The service was responsive to people’s needs and staff listened to what they said. Systems were in place to help ensure concerns or complaints were responded to appropriately. People were encouraged and supported to engage in activities and events that gave them an opportunity to socialise.

There was a friendly, homely atmosphere and staff supported people in a kind and caring way that took account of their individual needs and preferences. The staff and management team shared common values about the purpose of the service. People were supported and encouraged to live as independently as possible, according to their needs and abilities.

There was an open and inclusive culture within the service, which encouraged people’s involvement and their feedback was used to drive improvements. There was a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

During this inspection we spoke with the registered manager, who has been registered with us since 2011. We checked on the care planning records and medicines management systems to see what improvements had been made since our last inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service well led?

Is the service responsive?

This is a summary of what we found-

Is the service safe?

The improvements made to the care planning process and medicines management ensured that people's needs and wishes were reflected in the records held about them. The detail meant that safe and consistent care could be provided by all staff.

Is the service effective?

We saw that the improvements to care planning and medicines management were effective in protecting people against the risks of unsafe and inappropriate care.

Is the service caring?

Care plans were written in a way that showed people's views and known preferences were taken into account and that staff understood their individual needs. The manager spoke about some recent events that affected one person using the service. They told us staff were upset and concerned for the person. Notes from a recent staff meeting about this person showed that staff had addressed the concerns in a caring and supportive way.

Is the service well led?

The manager was very open and transparent about the improvements we asked for following our last inspection. The new systems that had been put in place clearly set out what was expected of staff and they had signed to say they had read and understood them.

Is the service responsive?

The service responded immediately to our concerns in January 2014. Records showed they had addressed some of the issues the day after our inspection.

The two relatives we spoke to said they were happy with the care and support their loved ones received. One said of staff 'They are very loving and caring. They meet her individual needs, we are very happy'. Another said they had no concerns and of staff they said 'We can talk to them, they are very forthcoming'.

We saw records that showed us people had busy lives and were supported on an individual basis to choose how to spend their time. Care plans reflected people's individual needs and preferences. Not all the care plans we looked at were kept under regular review.

We observed people interacting with staff and being offered choices about their plans for the day. There was a relaxed and friendly rapport between staff and people using the service. Staff were respectful and caring and clearly knew people well and understood their individual needs.

People were safeguarded from abuse because there were suitable policies and procedures in place and staff were trained. Relatives told us they felt people were safe and they trusted the home to manage their finances.

We saw that medicines were safely stored and administered. Each person had an individual care plan for their support with their medicines. There were monitoring processes in place however we found some people had run out of certain medicines.

The home has suitable processes in place to monitor the quality of the service.

From our observations during the visit, we saw positive, friendly, and respectful interaction between staff and people living in the home. Staff were seen to be attentive to individual needs.

We spoke to two relatives. One relative told us: 'The staff are very good, very caring'. 'I am really pleased, [the person] is very happy. The staff do their very best to accommodate. I am really pleased with [the person's] room, it's very comfortable'. 'I can pop in whenever I like'. 'I couldn't ask for a better environment, I feel really lucky, they are such nice people'.

Another relative told us 'the staff are quite helpful, they are interested in what [the person] does'. 'I am happy with the staff and how it is run, when I ask a question I always get an answer straight away'. '[The person] is happy, [they] always seems to want to go back after we take [them] home'.