Archived: Royal Mencap Society - 1 Sheepfold Avenue

1 Sheepfold Avenue is a 'care home.' People in care homes receive accommodation and nursing or 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.

1 Sheepfold Avenue is registered to support up to seven people with learning disabilities or other complex needs, such as Autism or mental health. At the time of the inspection there were seven people living at the home. The home provided personal care and support to adults of various age groups and gender.

1 Sheepfold Avenue detached house with communal areas over two floors. A purpose-built lift enabled people to mobilise between floors. There was a kitchen and shared dining area which was open and accessible to people. One lounge that were used both for recreational activities. In the corridor on the first floor, was a small sitting area. A back garden was used by people who used the service. The service had been developed in line with the values that underpin the Registering the Right Support guidance 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 other citizen.

At the last inspection on 5 January 2017, the service was rated as good in the areas of Safe, Effective, Caring and Responsive. The service was rated as requires improvement in the area of well-led but the overall rating for the service was Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a manager, who had been in post since October 2017. The manager informed us that her registration as registered manager was in progress and that she had recently undertaken her registration interview.

The service had improved the management and notification of Deprivation of Liberty Safeguard authorisations.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risks had been identified and there were clear plans in place to guide staff in how to support people safely. Staff understood their responsibilities with regards to safeguarding people. Infection control measures were effective and incidents and accidents were monitored and used to inform improvements. A relative told us that they felt their family member was, “Very safe at the service”.

People were supported to have maximum choice in their lives and staff supported them in the least restrictive way possible. Staff had received training that was relevant to effective support people at the service.

People were supported to have enough to eat and drink and to meet specific nutritional requirements. People were supported to access the health care support that they needed.

Assessments and care plans were developed to support staff to provide care in a personalised way. Staff understanding of people’s communication needs was good and allowed them to support people effectively and proactively.

People's privacy was respected and staff supported people to be as independent as possible.

The service was well led and staff spoke positively about the management of the home. There were effective systems and processes in place to monitor the quality of the service including a complaints system.

1 Sheepfold Avenue is a residential care home, which provides care and support for up to seven people with a learning disability and other complex needs, including autism and mental health. At the time of our inspection there were seven people living at the home.

1 Sheepfold Avenue is a detached house with communal areas over two floors (ground and first floor). There was a kitchen and shared dining area which was open and accessible to people. A purpose built lift enabled people to move from one floor to the other. There was one lounge that were used both for down time (watching television/movies) and for activities. In the corridor on the first floor, was a small sitting area. There was a back garden and we were told that people helped with the gardening.

The service did not have a registered manager in post at the time of our visit. 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. 1 Sheepfold Avenue has not had a registered manager in post since September 2016. An employed support worker was promoted to a temporary acting manager role in October 2016 and was managing the service day to day. The acting manager told us they had previous experience of managing care services. The acting manager told us, a permanent manager had been appointed but was not due to commence until March 2017.

The acting manager had identified the need to improve the personalisation of care planning within the service. For example, whilst we found that people received appropriate care, the approach to care planning was uniform and did not always reflect the assessed individual needs of a person. The acting manager was in the process of updating the care plans and the target for completion was March 2017.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People told us they felt safe at the home

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. There were also risk assessments in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Accidents and incidents were accurately recorded and were assessed to identify patterns and triggers. Records were detailed and referred to actions taken following accidents and incidents. Reference was made to behaviours, observations and other issues that may have led to an accident or incident.

Medicines were managed safely. People were supported to take their medicines as directed by their GP. Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. There were sufficient numbers of staff to meet people's needs safely. People told us there were enough staff on duty and records and staff confirmed this.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The staff had a good understanding of their responsibilities in relation to MCA and DoLS. Staff sought people's consent about arrangements for their care. However, the provider had failed to notify the Commission of four Deprivation of Liberty Safeguards (DoLS) authorisations in accordance with the registration regulations.

Staff received training to help them meet people's needs. Staff received an induction and regular supervision including monitoring of their performance. Staff were supported to develop their skills through additional training such as National Vocational Qualification (NVQ) or care diplomas. All staff completed an induction before working unsupervised. People were well supported and said staff were knowledgeable about their care needs.

People told us the food at the home was good and they were offered a choice at mealtimes. Staff monitored people's health to ensure they had access to other health professionals when needed.

People's privacy and dignity were respected. Staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

People were involved as much as possible in planning their care. People had monthly meetings with their keyworkers to discuss all aspects of their care. The acting manager and staff were flexible and responsive to people's individual preferences and ensured people were supported in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them.

Handover meetings held between shifts enabled staff to receive updates about people and their most up to date care needs. Complaints were managed in line with the provider's policy.

There was a stable staff team who said that communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

A system of audits was in place to measure and monitor the quality of the service provided and this helped to ensure care was delivered consistently. Suggestions on improvements to the service were welcomed and people's feedback was encouraged.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

The relatives of three of the people who live in the home told us they had no concerns about the support their relative received. People's relatives told us about their satisfaction with the home and told us they felt their relative was safe. A relative told us, 'I feel quite sure my [relative] is safe.' We saw that care was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had assessment tools in place to assist staff in establishing the level of risk for people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were arrangements in place to deal with foreseeable emergencies. The service had procedures to deal with any short or long term emergencies such as loss of electrical power or loss of gas supply. The home had a contingency plan should the home become uninhabitable and people could not return to the home after an evacuation.

Is the service effective?

Each person had a plan of care and support. These explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people. The care staff we spoke with were aware of people's needs, and the preferences of people in how they wanted their care to be delivered. We saw staff offering advice and support and enabling people to make their own choices and decisions.

Is the service caring ?

We saw people being treated kindly and with dignity and respect by the care staff. Care workers spent time chatting with people and responded promptly to people's request for assistance. Staff had a good understanding of people's needs. People's relatives described their satisfaction with the home. One relative told us, "It's quite a good home; everything is OK.' Another relative told us, 'They respect my [relative] and treat them very well.'

We heard staff speaking to people appropriately and staff using people's preferred form of address. People's relatives told us the staff were kind and patient in their approach.

Is the service responsive?

Staff responded promptly to people's request for assistance. People had regular reviews of the care and support they received and care plans showed alterations that had been made to people's plans of care as people's needs had changed. We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service and their relatives were asked for their views about how the home was meeting people's needs, and any concerns or ways to improve the service were acted on.

Is the service well led?

The manager was recently appointed at the time of our visit. A relative we spoke with told us they had regular contact with the home, and said, 'The new manager invited us to a meeting. She asked us if we had anything we wanted to discuss.' People's relatives told us they were kept informed about any issues which affected their relatives.

The staff we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These included the manager and service manager conducting a number of monthly audits including inspections of the property, people's care records, and staff training.

Records we viewed confirmed the provider had effective recruitment procedures to ensure that staff were of good character and had the necessary skills for the job.

We spoke with two members of staff who were on duty. They informed us that they had received training, including induction training, that provided them with the necessary skills to deliver the care and support that people required. They also said they felt well supported by the manager in their work.

We also gathered evidence of people's experiences of the service by looking at a selection of records. This included individual care records, risk assessments and review records. We found that care records provided care staff with appropriate information to follow. This meant they knew what they were expected to do to ensure individual needs had been met.

From our own observations, we found the atmosphere throughout the visit was good. It was friendly and homely. Staff were observed to have a good relationship with the people living there. When talking to people, staff were friendly and professional. They spoke clearly to ensure they were understood and listened carefully to make sure they knew what was expected of them.