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Inspection carried out on 12 June 2019

During a routine inspection

.About the service

Nelson’s Croft is a small care home that is part of the range of services provided by Autism Together and was registered to provide accommodation and personal care.

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 eight people. Three people were using the service at the time of the inspection. 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 and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when supporting people in the community and in the home.

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

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 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.

During the inspection we observed warm and comfortable relationships between staff and people living in the home. Feedback from the relatives we spoke with was all positive. People were encouraged and supported to maintain and improve their independence.

Medication needs were assessed and medication was only given by staff who were trained to do so. Staff were recruited safely, and incident and accidents were analysed for patterns and trends. Risks to people were assessed safely, care plans were person centred and regularly updated. Care records contained important information regarding people’s histories, families, likes and dislikes. This information was used to personalise support to meet each person’s needs.

The home was clean, however we identified that a shower room was in need of refurbishment. This was organised and the registered manager informed us of the expected date following the inspection.

The registered manager and provider made effective use of audits and other sources of information to review and improve practice. People were able to give their opinions on their care service and a range of communication methods were in place to ensure people continued to have this opportunity.

Staff received supervisions and attended regular meetings. Feedback from staff we spoke with was all positive and we were told how supportive the register manager was.

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 24 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nelsons Croft on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection p

Inspection carried out on 16 August 2016

During a routine inspection

This inspection took place on 16 and 19 August 2016. It was announced 24 hours before the initial visit as people who use the service often went out in the day and the staff went with them; we wanted to be sure someone would be in.

We visited Oak House, which is the provider’s administrative base, to look at recruitment records, on 16 August 2016 and the service itself later that day and also on 19 August 2016.

Nelson’s Croft is a small care home that is part of the range of services provided by Wirral Autistic Society, now also known as ‘Autism Together’. The home is registered to provide accommodation and personal care for up to eight people with conditions on the autistic spectrum and other associated conditions. At the time of our inspection, there were seven people living there.

The home requires a registered manager. 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.

Nelson’s Croft had a registered manager who had been in post for several years.

We looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the registered manager. We checked that we had received these in a timely manner. The provider had submitted a provider information form (PIR) as requested. We also looked at safeguarding referrals, complaints and any other information from members of the public.

We observed the people in the home on the day of our inspection, but most were unable to communicate verbally with us. We saw that people appeared comfortable with the staff who had a good knowledge of their needs.

We saw that people received sufficient quantities of food and drink and had a choice in the meals that they received.

Medication procedures were followed and the medication stored tallied with the records.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the three files we looked at and there was updated information that reflected the changes of people’s health.

The home used safe systems for recruiting new staff. These included using the Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place which included training them to ensure they were competent in the role they were doing at the home. Staff told us they felt supported by the registered manager.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded.

Inspection carried out on 17 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The Wirral Autistic Society (WAS) locations and premises contained limited records, apart from the care files for the people living at any particular location. The bulk of the files relating to such things were kept in the headquarters of WAS at Oak House. In light of this, we visited the headquarters of WAS at Oak House on 16 June 2014. We sampled records and files for each of the locations in order to fairly appraise them. We looked at 17 staff files and various other audits and records. Some of the records were kept as paper records, others were computerised.

Nelson’s Croft was home to eight people who used the service. The service comprised a pair of large, older semi-detached buildings which were accessible to each other by a lockable door on the ground floor. Each of the semi’s had bedrooms and communal facilities for people. The two buildings were operated as one service and shared many activities together.

We talked with one person who used the service although their communication was limited. We observed them and other people who had returned after a day out at various activities. They appeared to be well supported by the staff member on duty. They were excited about their day but settled to become relaxed and content.

We also talked with four members of staff on duty as well as the registered manager for the home. We looked at various records including three care plans. We had seen other records relating to Nelsons Croft at Oak House.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available or on call in case of emergencies.

Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked. Staff had been trained in safeguarding principles and procedures and the people living in the home had been given information in easy read format to help them raise a concern if they were worried about anything. The home had a safeguarding policy which was regularly monitored.

The home had a friendly and sociable feel. Appropriate risk assessments had been carried out and action plans put into place for safe practice.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We spoke with one person using the service who nodded “yes” when asked if they liked living at Nelson’s Croft.

Staff had received training to meet the needs of the people living at the home. One staff member said, "The training is excellent”.

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Is the service caring?

People were supported by kind and attentive staff. We saw that workers were patient and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. People and their families had been involved in the creation of their care plans and continued to be involved throughout their stay in the home. We noted that peoples preferences about, for example, activities, room layouts or clothing choices, were respected by the staff. The people who used the service were supported, where necessary, to make these choices and decisions.

Is the service responsive?

People's needs had been assessed before they moved into the home and frequently re assessed whilst they lived there. They had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other professionals, such as speech and language therapists and the organisation's own 'Autism Practice' department, were involved in peoples care when necessary.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. All of the people we saw appeared happy and content in the home and were supported well by staff.

Is the service well-led?

The home had a registered manager in post which indicated that the person had undergone the relevant checks. This meant that they were of good character, were physically and mentally fit and has the necessary qualifications, skills and experience.

The staff we spoke with and the registered manager had a good understanding of the ethos of the organisation. Quality assurance processes were in place. People, staff and other professionals had been asked for their feedback on the service. This also confirmed that respondents were listened to and as a result, some changes had been made. The home completed various other audits throughout the year, which contributed to an annual audit. An action plan had been produced to address any areas of concern raised through all of the audit and feedback processes.

The provider had a number of homes and they all same systems and IT package for much of its record keeping and policies. The provider had a centralised administration office at the head office. The manager was able to demonstrate effective knowledge of this and showed us that they had acted according to policy regarding such things as recruitment,safeguarding procedures and CQC notifications.

You can see our judgements on the front page of this report.

Inspection carried out on 19 November 2013

During a routine inspection

We spoke with one relative who told us they were very happy with the home and said they “couldn’t fault the home.” They told us that “A whole new world was opened up to my son since he joined Wirral Autistic Society. He is supported so well. The staff are excellent.”

We looked at the people's care records and found they provided clear guidelines for the staff to enable them to support the people in their care. The relative told us they were part of the care planning process and they attended annual care review meetings. We found that all staff we spoke with were knowledgeable about the Mental Capacity Act (2005) and the issues of consent and had received training.

We found the home supported people to access other health care professionals.

We saw the home had a recruitment procedure in place and that appropriate checks were carried out to ensure suitably skilled staff were employed.

We saw the home had a complaints procedure which was accessible to the people at the home. One relative told us that when they had raised concerns in the past they had been dealt with promptly and to their satisfaction.

Inspection carried out on 15 December 2012

During a routine inspection

Nelson’s Croft is a small care home providing support for eight people who have autism. It is part of the range of services provided by Wirral Autistic Society. All of the people who lived at the home attended a variety of daytime services that were provided by Wirral Autistic Society, with an individual programme in place for each person. People were also supported to pursue their hobbies and interests outside the home.

All of the people who lived at Nelson's Croft had close contact with their families and when we visited on 15 December 2012, two people were spending the weekend with their families and four other people went out for a day trip with staff in the home’s small minibus.

People's bedrooms reflected their personality and interests and we could see that people had been able to choose what they had in their room. People who lived at the home were supported to keep their bedrooms clean and tidy and to do their own laundry. Pictorial communication aids were provided throughout the house to help people express their needs and choices. We spoke with one of the people who lived at the home and they told us that when there was anything they didn’t like they "talked it over with the staff".

All staff were required to complete the Wirral Autistic Society mandatory training programme which covered 23 subjects including safeguarding and non-violent crisis intervention. Some subjects were updated annually, some every two years and some every three years.

Inspection carried out on 26 August 2011

During a routine inspection

When we visited Nelson’s Croft on 21 July 2011 there were eight people living there. The people living at the home have restricted verbal communication so the service manager provided telephone numbers for family members of each person and confirmed with them that they would be agreeable to speaking with us. We spoke with four people who were all parents of people living at the home and who all have very regular contact with them.

One person told us: It is fantastic. We have complete and utter peace of mind. Our son has had other placements but he has really settled here. He loves everything he does, loves the activities, loves the people. He has just had his annual review. Personal care is brilliant he is always clean and fresh. There is good communication, for example when he had an accident we were informed immediately. We can visit him any time and he can come home for visits. We feel confident to raise any concerns with a team leader. The only one issue is that there are not always the same regular staff but this is a small point. Before he went there he had severe behavioural problems but these have totally gone, it’s amazing.

Another person told us: It is absolutely wonderful and our daughter has come on in leaps and bounds since moving there. She was in a larger service for ten years and it was too noisy and crowded for her. She needed somewhere quieter. The change has been remarkable and she loves it. She likes to be quiet and make things and she has far more opportunity now to do the things she likes. We visit her regularly and she comes home for a weekend or for a meal. She now calls Nelson’s Croft ‘home’. We feel that she is safe there.

Another person said: We are very happy with Nelson’s Croft. Our son is very happy there and settled. There have been difficulties along the way but these have been managed well. Communication with them is good. He has a review every year. We can ring or visit any time and can discuss any issues or concerns. He always likes to do the same things and we feel that he could do more and the staff are always coming up with things they try to get him to do. He is getting more amenable as he gets older. We always feel that he is safe.

The fourth person we spoke with said: In the main we are really, really happy. Most staff are very good and the team leader is excellent, but there is a big turnover of staff and there are some communication problems between the carers. This has led to problems such as losing his glasses, losing his TV remote control and his electric toothbrush, not putting lifters in his shoes. One hot day last year he was inappropriately dressed. All of these have been raised with team leaders and management. We have no hesitation in making complaints or raising issues and are encouraged to do so. He is safe and loved. They encourage him to be independent with personal care. Our only problem is with the lack of consistency with the high standards usually achieved. Sometimes he misses his day out due to staff shortage. He is happy and healthy and the house is always immaculate. They go out of their way to make sure it suits his needs. They meet his needs and make sure he has a full agenda. In the main he gets a great life and Wirral Autistic Society is a great organisation. We are involved with fundraising for them.