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Inspection carried out on 6 October 2017

During a routine inspection

This was an unannounced inspection that took place on 6 October 2017.

Unicorn House is a residential care home that offers accommodation and personal care and support for up to twelve adults with learning disabilities and associated mental health issues.

At the time of our inspection the home had 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 and associated Regulations about how the service is run.

At the last inspection on 10 August 2015 the home met all the key questions and was rated good in each with an overall good rating.

Unicorn House was warm and welcoming with people freely coming and going as they pleased. Some people had limited speech and therefore relatives spoke on their behalf. We also based our findings on the observation of staff care practices and people's responses to them. People said and their body language demonstrated that they enjoyed how staff provided care and support for them and that they liked living at the home. During our visit people were engaged in a variety of activities at home and in the community. Staff supported them to choose their activities themselves, when they wished to do them and with whom. They were safe in the home and the local community. There was positive interaction between people and also with staff.

People were given information about any planned activities so that they could decide if they wanted to join in. Staff provided care and support in a friendly, professional and supportive way that was focussed on people as individuals. Staff said they knew people and their likes and dislikes well and this enabled them to provide the care and support that people needed. Staff were well trained, had appropriate skills and made themselves accessible to people. They said that they really enjoyed working at the home and received good training and support from the registered manager.

The home’s records were accessible, kept up to date and covered all relevant aspects of the care and support that people received. This included the choices people made, activities they attended and way their safety was protected. People’s care plans were completed and the information contained was regularly reviewed. This meant staff were able to perform their duties competently and efficiently. People were encouraged and supported by staff to address their health needs and had access to GP’s and other community based health professionals. People were supported to be healthy by choosing nutritious, balanced meals that promoted a healthy diet whilst taking into account their likes, dislikes and preferences. The body language of people with communication difficulties and their smiles showed that they liked the choice and quality of their meals.

Relatives said the registered manager and staff were very approachable, responsive to requests made or concerns raised and frequently encouraged feedback and acted upon it. The registered manager consistently monitored and assessed the quality of the service and encouraged staff to put forward ideas that may improve the quality of peoples’ lives.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible with the policies and systems at the home supporting this practice.

The health care professionals that responded to our questions were happy with the support that the home provided for people.

Inspection carried out on 10 August 2015

During an inspection to make sure that the improvements required had been made

We carried out an inspection of Unicorn House on 10 August 2015. The inspection was unannounced. At the previous inspection of 14 and 15 August 2014 the home had not met all the standards and was found to have been in breach of legal requirements relating to maintaining appropriate standards of cleanliness and hygiene. We also found that the registered person did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

We had asked the provider to submit an action plan describing how they would improve matters and this was provided. At this inspection we found that improvements had been made to these areas. The home was found to meet the relevant requirements of cleanliness and hygiene and now had suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Unicorn House is a home for up to 12 people who have learning disabilities, mental health needs and behaviours which may challenge the service. At the time of our inspection there were eight people living in the home.

The home had 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.

People who lived at the home were protected from the risk of abuse happening to them. People who were able to told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Other people were able to demonstrate through their body language and interaction with staff that they felt safe and well cared for.

We saw that people’s health and nutrition were regularly monitored. There were well established links with GP services and other community health services such as occupational therapists, community mental health teams and other social and health services.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, and information which would be helpful to hospitals or other health support services.

Staffing levels were managed flexibly to suit people's needs so that people received their care when they needed it. Staff had access to information, support and training that they needed to do their jobs well. The provider’s training programme was designed to meet the needs of people using the service so that staff had the knowledge and skills they required to care for people effectively.

There was an open and inclusive atmosphere in the service. People who used the service and staff told us they found the manager to be approachable and supportive. Staff were able to challenge when they felt there could be improvements.

The provider carried out regular audits to monitor the quality of the service and to plan improvements. Action plans were used so the provider could monitor whether necessary changes were made.

Inspection carried out on 14 and 15 August 2014

During a routine inspection

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 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Unicorn House is a care home that offers accommodation and support for up to twelve people. The service provides support to people with learning disabilities, mental health needs and behaviours which may challenge the service. There were ten people using the service at the time of our inspection.

At our previous inspection in July 2013, the provider was meeting the regulations inspected.

There was no registered manager in post at the time of our inspection. A new manager had been appointed and was in the process of applying to register. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). We found the provider was not meeting the requirements of DoLS. Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision. For example, the provider had not made an application under the Deprivation of Liberty Safeguards even though people’s liberty may have been restricted. Staff did not always respect people’s independence and standard restrictions were applied to everyone using the service. We found that people were restricted from using the laundry room and the front door was kept locked, preventing them from leaving the service.

Arrangements to obtain people’s consent were not always in place. Where people were assessed as not to have capacity to make certain decisions there was little evidence that decisions were made in people’s best interests in accordance with the Mental Capacity Act 2005 (MCA).  

People were not living in a clean environment and some parts of the premises were in need of redecoration or repair.

People using the service were not involved in day-to-day decisions about their care as much as they could be. Information was not always available to people in a format which was meaningful to them and promoted choice.

All of the people we spoke with said that staff listened to them and were approachable. In general we observed that staff were kind and attentive to people and showed dignity and respect. However, we saw that some staff interactions could be more caring at times.

People told us they felt safe using the service. Staff were trained in safeguarding adults and the service had policies and procedures to explain to staff how they should respond to allegations or suspicions of abuse. Staff knew how to manage and minimise risks to people’s health and well-being.

Staffing levels were managed flexibly to suit people's needs so that people received their care when they needed it. Staff had access to information, support and training that they needed to do their jobs well. The provider’s training programme was designed to meet the needs of people using the service so that staff had the knowledge and skills they required to care for people effectively.

Care plans contained information about the health and social care support people needed and records showed they were supported to access other professionals when required.  We saw that there was effective communication with other professionals and agencies to ensure people’s care needs were met. Where people's needs changed, the provider responded and reviewed the care provided.

People were provided with activities in and outside the service which met their individual needs and choices. Staff knew people well and supported them to maintain their hobbies and interests.

There was an open and inclusive atmosphere in the service. People that used the service and staff told us they found the new manager to be approachable and supportive. Staff were able to challenge when they felt there could be improvements.

The provider carried out regular audits to monitor the quality of the service and to plan improvements. Action plans were used so the provider could monitor whether necessary changes were made. However, we found these were not effective as they had not identified the issues that we found during the inspection. The manager knew what was required to improve the service although they lacked knowledge about legislation relating to the Mental Capacity Act 2005 and infection control.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 16 July 2013

During a routine inspection

On the day of our inspection there were nine people living at Unicorn House. We used a number of different methods to help us understand the experiences of people using the service as some of the people who lived at Unicorn House were not always able to communicate with us in an effective way.

People who we did speak with were generally positive about their experiences of living at the home and the support they received from members of staff. One person told us “I really like living here. I have my own keys and can come and go when I please”. We also gained verification of people's experiences of the service by speaking to representatives of people who use the service and the deputy manager as well as other members of staff who worked in the home.

We observed that people’s experiences of the service were positive. During our inspection we saw the deputy manager and other members of staff treat people in a dignified manner and spoke to people in a respectful way and listened to what they had to say.

We saw the service had adopted various ways to ensure that people who use the service were supported fully and people’s needs were being met. Frequent residents meetings were held and provided opportunities for people who use the service to meet collectively and discuss any issues or concerns.

People’s views and experiences were taken into account in the way the service was provided and delivered and there were effective systems in place to regularly assess and monitor the quality of service that people receive. We saw people using the service had been fully involved in developing their care plans and had been able to state their preferences and choices about how they lived their lives.

Inspection carried out on 28 January 2013

During a routine inspection

During our inspection we spoke to four out of the eight people who currently live at Unicorn House. They told us that staff that worked at their home were always kind and caring. Typical comments made by people we spoke with, included “this is my home, I have lived here a very long time, and I still like it here”, “I am very, very happy here”, and “the staff are very good to me”.

Throughout our visit we saw staff always treated the people who use the service with the utmost respect and courtesy. We also saw staff actively supported people to make informed decisions about how they lived their daily lives.

We found people received effective and safe care from suitably trained and experienced staff who were familiar with individual’s needs and preferences. The provider also had effective systems in place to routinely assess and monitor the quality of the care and support that people received.

Inspection carried out on 14 December 2011

During an inspection in response to concerns

The feedback we received from the people who live at Unicorn House was very positive about the standard of care and support they received there. Typical comments made by people we spoke with, included: “I am very happy living at Unicorn House”, “it’s very, very nice here”, and “”I like it here because I can do what I want”.

The people we met spoke very highly of the staff that worked at Unicorn House. Typical feedback we received, included: “Staff knock on my bedroom door before coming”, “Staff are very, very kind to me”, and “Staff look after me here”.

Throughout the course of our visit we observed staff always interacting with the people who use the service in a very kind, respectful and friendly manner. People who use the service always appeared to be at ease with the staff we met.

We also received very positive feedback from people who use the service about the opportunities they had to engage in meaningful activities both within their home and the local community. Typical comments we received from the people we met, included: “We do lots of things here. My favourite is playing ‘Frustration’”, “I am going to go Christmas shopping with the manager today”, and “We go out a lot to the shops, the pub, the day centre, and sometimes we go on holiday".

Everyone we met told us they felt safe living at Unicorn House and felt able to tell staff if they were feeling unhappy about anything. One person said: “If I am upset I will tell the manager “.

Inspection carried out on 2 September 2011

During an inspection in response to concerns

The feedback we received from the people who use the service was positive about the overall standard of care and support they received at Unicorn House. Typical comments made by people we met, included: “I like it here” and “its all good here.”

The people who use the service we met spoke very highly of the staff working at Unicorn House. Typical feedback we received, included: “I like the staff” and “the staff are all right here”. During our visit we saw staff interacting and engaging with the people who use the service in a very kind, respectful and friendly manner. People who use the service appeared to be at ease with the staff and on several occasions we observed staff taking their time to actively listen and respond to what people had to say to them.

We also received mainly positive feedback from people who use the service about the opportunities they had to pursue their social interests and participate in meaningful activities. People we met told us they went to a local day centre during the week and at weekends they went to the pub, cafes, cinema and shopping with staff.

All the people we met were complimentary about the quality and choice of the meals they were offered at the care home. Typical comments we received, included: “The food is good here”, “Lots of choice of food I like to eat”, “We sometimes have takeaways”, and “We had mince, potatoes and peas yesterday, which was good.” During our visit we saw staff taking their time to find out exactly what the people who use the service wanted for their lunch and actively support them to make the meal of their choosing.

All the people we met who use the service told us they liked living at Unicorn House and felt safe there. Typical comments we received included: “Nothing to complain about. It’s all good” and “I feel safe living here.”

We toured the premises and saw the care homes interior was decorated and furnished to a reasonable standard. People who use the service we spoke with told us Unicorn House was a comfortable and homely place to live. It also looked very clean and smelt fresh. People who use the service told us their home was always kept clean and tidy.