Inshore Support Limited - 10 Beeches Road

Inshore Support LTD – 10 Beeches Road is a residential care home providing accommodation for people who require nursing or personal care and have a diagnosis of a learning disabilities and autistic spectrum disorder. The service can support up to two people and two people were receiving support at the time of the inspection.

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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

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

Audits were not robust enough to demonstrate safety was effectively managed. There was no registered manager in post, the deputy manager was overseeing the day to day running of the home. Staff felt well supported and part of a team. Staff worked in a person-centred way.

Relatives felt their loved ones were safe. Some staff told us they did not always follow care plans. Information relating to people’s allergies was not reflected in all documentation. Medicines were not always dispensed in line with best practice guidelines. Staff understood safeguarding and how to keep people safe.

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.

Peoples dignity was not always maintained. People were encouraged to maintain their independence. Relatives felt their loved ones were treated with kindness. People information was stored securely, and confidentiality was maintained.

Peoples communication needs were met, and information was provided to people in different formats. Peoples personal preferences were identified in their care plans. People were supported to maintain relationships.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

The service applied the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service reflected the principles and values of Registering the Right Support and focused on them having as many opportunities as possible. 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.

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 29 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to failure to meet a condition of registration and good governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The provider is registered to accommodate and deliver personal care to two people who have a learning disability and autism. On the day of our inspection there were two people living at the home.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At our last inspection on 3 December 2015 we found that improvements were needed to show how complaints were managed. Quality assurance checks had not been recorded and events were not being reported to us consistently as required within the law.

Although some improvements had been made, this inspection identified that there were still some aspects of the service that required improvement. The systems in place to audit the quality of the service were not always effective because they did not identify where some improvements were needed. The protocol for managing prescribed creams was not followed, the CQC ratings was not displayed as is required by law and we, the Care Quality Commission (CQC) had not been notified about the outcome of DoLS applications. Although action was taken to address these issues at our inspection, these had not been identified through the day to day auditing of the service.

There was a registered manager in place. 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.

People received a safe service because the provider had clear procedures in place to support staff in recognising and reporting abuse. Risks associated with people's everyday living had been identified and plans were in place to help to reduce risks. Staff were recruited safely and staffing levels ensured that people were safe. People received their prescribed medicines by staff who had been trained to do this safely. The systems in place to ensure prescribed creams and other applications were in date were improved following the inspection.

Staff were trained to meet people’s specific needs and they had regular supervision to reflect on and develop their practice. Staff understood the importance of seeking people's consent and were aware of any limitations on people’s liberty. People had choices regarding what they ate and drank and were supported to access a range of health care professionals to meet their healthcare needs.

The interactions between people and staff were caring, supportive and friendly. Staff protected people's privacy and dignity and promoted their independence.

People’s preferences were explored with them so that they received care that was personal to them. People were supported to pursue their hobbies and interests. Systems were in place to respond to concerns or complaints.

Staff described the management arrangements as supportive and they felt motivated. People's feedback on the service was sought.

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 caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that care was provided in an environment that was safe, accessible, clean and adequately maintained.

Care records showed that risks to people had been identified and appropriate plans put in place to protect them from harm. We checked people's care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

Staff recruitment practices were safe and comprehensive. We checked staff training records and saw that staff had received recent training in relation to safeguarding vulnerable adults. We found that people's welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made under this legislation for any person living at this home, we found that the provider and the staff employed there had received appropriate training and understood their responsibilities in relation to the law.

Is the service effective?

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans contained information and guidance about people's specific conditions; this enabled care staff to meet the individual needs of the people who used the service. We saw that people had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

We found that most of the care staff had worked at this care home for many years and knew the people they supported very well. Care staff told us that they were well trained, competent and able to safely meet the needs of the people who used the service.

People were given opportunities and support to live full lives. We found that people were offered daily activities in and outside of the home including going swimming and visiting the cinema and museum. This meant that people were able to participate in new experiences and enjoy the activities of their choice.

Is the service caring?

People were supported by kind, caring and attentive staff. It was apparent during our observations that care staff were attentive, polite and sought consent before providing care and support. We saw that care staff were patient with the people they were supporting and treated them with respect and dignity. People were supported to do things at their own pace with no pressure to hurry from staff.

Care plans showed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

We spoke to relatives of people who lived at the home. Comments included, '(Name of relative) has got some fantastic carers, but they don't seem to stay at the home very long' and 'No complaints, the carers are really good, they really do care'

Is the service responsive?

We found that the manager had regular contact with relatives of the people who lived at the home. This afforded them the opportunity to exchange views and provide feedback about the quality of service being delivered.

We found that care staff had regular meetings with the manager including group meetings, one to one supervision and annual appraisals. This meant that care staff had the opportunity to discuss their training and development needs, personal welfare and any concerns they might have about the people they were caring for.

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. An 'easy to read' version of this policy was also available.

Is the service well-led?

A check of records showed that the provider had an effective system to regularly assess and monitor the quality of service that people received. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures, and regular maintenance checks and audits.

We found that the home was visited regularly by the provider's quality assurance team. We saw that their reports were shared with the manager who acted upon the comments and recommendations made.

Staff told us they were clear about their roles and responsibilities. We saw that staff were well trained, had a good knowledge of safeguarding procedures and received appropriate supervision and support from their manager. We saw that there were meetings with staff to discuss quality issues and the care and welfare of the people who lived at the home.

People with learning disability are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them. Throughout the day we saw staff communicating with each person in the way that they could understand. One staff said, 'We have worked with them for a long time and know how to communicate with them.'

We saw that choices were offered and that people's views were sought and acted upon. Staff spoken with were able to tell us about people's needs and how they ensured that people received care in a way that they preferred. A relative told us, 'Staff know what X likes to do and helps him to do them.'

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. A relative told us, ' X is very safe there.'

We saw that a range of training was provided to staff so that they had up to date knowledge and skills in order to support the people who lived in the home.

There were systems in place to monitor how the home was run, to ensure people received a quality service.