Livability Netteswell Rectory

Livability Netteswell Rectory is a residential care home providing accommodation and support for up to nine people living with a learning disability. Eight people were living at the service.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area.

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

Staff had received training for safeguarding and this was updated regularly. The service was well-staffed, and people received their medicines when they needed them. Risk assessments were in place to manage potential risks within people's lives, whilst also promoting their independence.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's independence and dignity was promoted. Their risk assessments and support plans were written in a positive, person-centred way. People took part in regular reviews. People were supported to have relationships with their friends and families and took part in local activities and volunteering opportunities.

Staff told us they enjoyed working at the home and felt supported by management.

Fire safety checks and drills were regularly completed. There were regular, documented safety checks and external assessments of safety and equipment. Audits and quality checks had been completed and had identified where improvements were needed.

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

The last rating for this service was good (published 27 July 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.

Since the last inspection the service had a new registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments had been completed to enable people to retain their independence and be supported with minimum risk to themselves or others. Staff were aware of their responsibilities to ensure people were safe and what to do if they had any concerns.

Recruitment processes ensured staff were suitable to work with people who needed support. There were enough staff to provide care and support to people and meet their needs.

Medicines were administered by staff who were trained and assessed as competent to do this. People were supported to maintain good health and had access to external health care professionals when required.

The staff were very caring and people had built strong relationships with people that used the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. The service was meeting the requirements of The Mental Capacity Act 2005 (MCA).

The service continued to have a friendly and homely atmosphere. Care plans provided information about what was important to people and how to support them and people were involved in activities of their choice.

There was a system of quality assurance in place overseen by the registered manager, the regional manager and provider.

The service did not have a registered manager at the time of our inspection. 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. An acting manager was in post to provider management at the service until a registered manager could be appointed.

People were safe because staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs. There were sufficient staff to provide people with the support they needed to live as full life as possible. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

Medicines were stored and administered safely, and people received their medicines as prescribed. People and their relatives thought staff were kind and responsive to people’s needs, and people’s privacy and dignity was respected.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were able to tell us about their care and said how happy they were with the staff. People told us they felt safe living at Netteswell Rectory. We saw people were well cared for and relaxed in the home. They were confident to ask staff for help and staff responded with kindness, humour and warmth. Everyone spoke positively about the staff and living at the home.

Staff knew people well and were trained, skilled and competent in meeting people’s needs. Staff were supported and supervised in their roles. People, were involved in the planning and reviewing of their care and support.

People were supported to attend health care appointments when they needed to and received healthcare that supported them to maintain their wellbeing.

People were supported to maintain relationships with friends and family so that they were not socially isolated. There was an open culture and staff were supported to provide care that was centred on the individual. The acting manager was open, approachable and available for people who used the service.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to make sure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

People who used the service were all assessed as having the mental capacity to make their own decisions. The service understood the need to formally identify when a person's mental capacity required reassessment before decisions were made on their behalf. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one.

Is the service effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with the positive feedback received from people as reported in the provider's own quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I never feel rushed by the staff that help me, they don't do everything for me and help me to do things for myself".

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The registered manager responded in an open, thorough and timely manner to complaints. Therefore people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff.

Care records were not always presented in a format which reflected the needs of the person for whom it was written. Some language used in care plans did not uphold people's dignity.

People who used the service were all assessed as having the mental capacity to make their own decisions. Their consent had been recorded in relation to various aspects of their care. The service understood the need to formally identify when a person's mental capacity required reassessment before decisions were made on their behalf.

People told us that they were happy with the care they received and that their needs were met. One person told us 'I have lived here for twenty seven years and I love it. I would not want to live anywhere else.'

Staff could describe people's needs and demonstrated a good knowledge of their preferences.

People had access to food and drink at all times and were supported to choose and prepare meals. People who required specialised diets were supported by staff who were knowledgeable and competent to meet their needs safely.

Staff received appropriate support and training to meet people's needs.

The service had a complaints policy which was available in an easy read format. A summary of the policy was on display in the service. Complaints were recorded, investigated and followed up appropriately.