The Bungalow

People’s experience of using this service:

In June 2017, CQC published guidance called ‘Registering the Right Support’. This along with other associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism.

The principles of ‘Registering the Right Support is on ensuring that people who use services can live as full a life as possible and achieve the best possible outcomes. They reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The Bungalow was built and developed prior to this guidance being published. This meant that there were some aspects of the service that did not comply with this guidance.

The home was located in a campus style setting with other autism together services which did not meet the principles of Registering the Right Support. There were signs on the campus site which identified to anyone visiting The Bungalow that the home was part of a range of services for people living with learning difficulties. These aspects of service design did not comply with the principles of Registering the Right Support.

People living in the home however were supported to be independent as much as possible, were encouraged to make informed and positive choices and led meaningful lives in the community. They had access to community services for social and recreational pursuits and health care services in support of their well-being. This was good practice and reflected the fundamental principles of Registering the Right Support.

There were systems in place to check the environment, medicines, care planning and service delivery. Some of these systems were not always effective. For instance, they failed to identify that staff training was not always completed or that best interest decision making at the service required improvement.

The number of medicines administered at the home was minimal. Records showed medicines were managed correctly. Records indicated however that some staff had not completed training in medication administration. This increased the risk of errors and poor practice. Training information provided by the manager also indicated that some staff members had not completed training in safeguarding, mental capacity act, first aid and MAPA (management of challenging behaviours). This aspect of service delivery required improvement.

Where people found it difficult to make specific decisions about their care, their capacity to consent was assessed in line with the Mental Capacity Act 2005. But where decisions were made on people’s behalf, there was little evidence of their involvement or the involvement of relevant others (i.e., family members, social worker) in this process. This required improvement.

People’s needs and risks were assessed and staff had clear guidance on how to provide safe and appropriate person centred care. It was clear staff knew people well. People who lived at the home looked happy, relaxed and comfortable with staff and feedback on the service and the staff team was positive.

People received enough to eat and drink and they were involved in menu planning and meal preparation with staff support. People’s needs were met by a range of health and social care professionals and staff supported people to attend external appointments in support of their mental and physical well-being.

Regular meetings took place with people living in the home and staff to ensure that their views and opinions with regards to the service were sought.

Staffing levels were sufficient to meet people’s needs and staff employed at the service had been recruited safely. Staff told us they felt supported by the manager and records showed they received regular supervision in their job role.

The culture of the service was open and transparent. It was clear that there were aspects of the service that were well-led. People liked living in the home, the staff team were positive and committed to their job role and people’s care was well managed.

Rating at last inspection and why we inspected: This was a planned inspection based on the previous rating. The overall rating at the last inspection was good (published 15 December 2016). At this inspection, the overall rating has changed to ‘Requires Improvement’.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Bungalow is registered to provide accommodation for persons who require personal care for up to three people. At the time of our inspection, there were three people living in the home. The people who lived in The Bungalow were on the autism spectrum.

The service is located on the Raby Hall site and is a distinct and separate building from the others.

The Bungalow is a relatively modern building once used as a manager’s accommodation. It is owned and staffed by the provider, Wirral Autistic Society (WAS), which now has the ‘working name’ of Autism Together. The service is still registered as being provided by WAS. Also nearby this building were other WAS homes and a home farm centre.

The home required 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.The Bungalow 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. We also looked at safeguarding referrals, complaints and any other information from members of the public.

The home is a domestic style and had previously some years ago, been used for the manager’s accommodation. It was furnished in a homely way which was according to people’s taste, especially in their own rooms. We observed the people in the home on the day of our inspection and spoke with two of them. They appeared happy and comfortable with their surroundings and with staff.

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 files 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 Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place that included training them to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

The staffing levels were seen to be appropriate to support people and meet their needs and the staff we spoke with considered there were adequate staff on duty.

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.

We talked with one people who used the service and observed two others. We were not able to speak to these two people because one had communication difficulties and the other refused to speak with us. However we spoke with all the people's relatives. All the people using the service appeared realxed and content. We also talked with three members of staff. We looked at various records including three care plans and four staff files.

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 were 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 Bungalow had a friendly, clean and well maintained feel about it.

Appropriate risk assessments had been carried out and action plans put into place for safe practice. A person living in the home told us, 'I feel safe'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, 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?

People's family members told us that they were happy with the care received by their relatives and felt their needs had been met. 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 told us, 'I can tell staff what I want".

Staff had received training to meet the needs of the people living at the home.

.

Is the service caring?

People were supported by kind and attentive staff. We saw that workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us about the staff, "They treat me well'.

People 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 people were supported, where necessary, to make these choices and decisions.People were invited to be part of the selection process for the staff. One person was very active and involved in this.

Is the service responsive?

People's needs had been assessed before they moved into the home and frequently re-assessed whilst they lived there.

People 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. One person was happy to speak with us and another had communication difficulties. The third was not willing to speak with us. However, all appeared happy and content in the home and communicated well with staff.

Is the service well-led?

The home had a registered manager in post which indicated that the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience.

Staff had a good understanding of the ethos of the organisation and 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 for all, used the same system and IT package for much of its record keeping and policies. The provider had a centralised administration at the head office. The manager was able to demonstrate effective knowledge of this and show us that he had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications.

Care plans identified people's needs and how their needs should be met. Risk assessments were individualised and covered all aspects of a person's needs.

People were provided with a clean, comfortable, safe and homely environment to live in.

People were supported by staff who had appropriate experience and knowledge.

People who used the service were involved in how they were cared for. Care plans demonstrated people had been involved in discussions and review meetings regarding their care and treatment plans.

We looked at the care plans of the three people who lived at the home. We found that the plans identified people's needs and how their needs were to be met. Risk assessments were seen to be individualised and covered all aspects of a person's needs including physical, behavioural, mental health and social. Formal risk assessments were used and management plans were in place detailing what staff needed to do to prevent or minimise the risk. Risk assessments and care plans had been completed in full and reviewed regularly. Records were seen to be accurate and appropriate and stored safely.

We found there were sufficient staff with appropriate experience and knowledge who cared for the people who used the service. Staff demonstrated knowledge in safeguarding people from abuse and had received appropriate service specific training. People who used the service sometimes participated in the recruitment of new staff to ensure they would be suitable to work with them.