Bells Piece - Care Home Learning Disabilities

There was no 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. A new manager had started at the service in March 2018 and had submitted their application to register with the Commission. The new manager (hereon in known as the manager) assisted us with our inspection.

At the last inspection on 4 December 2015, the service was rated Good. At this inspection we found the service remained Good in Safe, Effective, Caring and Well-Led. The service had progressed to ‘Outstanding’ in Responsive.

People ‘s care and support was planned proactively in partnership with them. Staff used individual ways of involving people and people took a key role in the local community and had opportunity to access education and work. People were supported in a way that promoted an enhanced sense of well-being. They had facilities and support available to them to help them live as fulfilling a life as possible

People had opportunities to take part in activities that reflected their interests and preferences. This included activities on site, such as gardening and growing their own foods, going to the on-site art studio and contributing towards the running of the shop. People told us how much they enjoyed living at Bells Piece, spending time with their friends and being given opportunities to learn and to work.

People were supported by sufficient numbers of appropriately skilled staff to meet their needs and keep them safe. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. People’s care would not be interrupted in the event of an emergency and people were made aware of fire procedures.

People lived in a home which was clean and hygienic and both people who self-medicated and those who did not received their medicines safely and as prescribed.

People’s needs had been assessed before they moved into the home to ensure staff could provide the support they required. Staff had the training and support they needed to carry out their roles effectively. All staff attended an induction when they started work and had access to ongoing training.

People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. Applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People could make choices about the food they ate and were supported to maintain a healthy diet. People were supported to maintain good health and to obtain treatment when they needed it. Each person had a health action plan which detailed their health needs and the support they needed. Staff worked with external organisations and professionals to help provide the most effective care to people.

The home provided bright and spacious accommodation with access to large grounds and outside space. People had been encouraged to choose the décor and were able to personalise their bedrooms.

Staff were kind, caring and compassionate. People had positive relationships with the staff who supported them and there was a homely, caring atmosphere in the home. Staff treated people with respect and maintained their dignity. People were supported to make choices about their care and to maintain relationships with their friends and families.

There were appropriate procedures for managing complaints. Were complaints had been received by the service these had been responded to appropriately.

People, relatives and staff benefited from good leadership provided by the manager. Relatives said management was open and transparent and it was clear from our discussions that they had a drive to continuously improve the service people received. Staff said there was a strong team ethos and staff said they received good support from their colleagues. Staff had established effective links with health and social care professionals to ensure people received the care they needed.

People who lived at the home, their relatives and other stakeholders had opportunities to give their views. The provider’s quality monitoring systems were effective in ensuring people received good quality care and support. Important areas of the service were audited regularly and action plans were developed when areas for improvement were identified.

Further information is in the detailed findings below.

The service also provides day support although this activity is not regulated by the Care Quality Commission (CQC). There is an activities centre onsite ; ‘Simply Unique’ offering a range of activities such as gardening, arts and crafts, literacy, IT classes, healthy eating programmes, music and games to people who live at Bell’s Piece and those people who visit.

The home also runs a farm shop which is open to members of the public. It has a range of goods on offer from arts and craft to homemade jams and chutneys. All these products are made by the people who live and visit Bell’s Piece.

There was a registered manager in post. 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 inspection took place on 4 December 2015 and was unannounced.

Staff understood what was important to people and worked closely with them, and with families to ensure each person had a meaningful and enjoyable life. People played an active daily part in the running and development of the home.

An outstanding feature of the service Bell’s Piece provided was the time spent in developing the service, using innovative strategies with communication and guidance to help people gain independence skills and supporting people to achieve their full potential. People had access to all sorts of social and skills development activities that were tailored to and met their individual needs. Some of these were based on site in Simple Unique, Classes Café and the farm shop. The home also promoted people’s participation in the wider community; supporting people access to friends, attending further education and developing citizenship. The staff knew the people they supported as individuals.

Innovative approaches such as ‘My Choice Pad’ and ‘Seed to Plate’ enhanced people’s quality of life and provided therapeutic benefit to people. My Choice Pad brings together proven speech and language therapy techniques with market leading technology to deliver language development via tablet computers that is both effective and measurable. Seed to plate is a horticultural programme that supports people to grow, harvest and cook their produce.

There was positive feedback about the home and caring nature of staff from people and relatives. A relative said, “They’re all very caring. I’ve never come across anyone who isn’t and I’m in and out a lot. It’s always open house. You can visit any time you want. They keep us involved.”

People were safe at Bell’s Piece. There were sufficient staff deployed to meet the needs and preferences of the people that lived there; A relative said, “There are enough staff to help.” One person said; “There’s always staff here.”

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. One staff member told us; “We risk assess to make sure people are safe, for example with bathing, we look to see if that person can get in and out of the bath, if they need help or if they can be left alone.”

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. One staff member said “If there was an incident or accident I would treat the injury and record it in the accident and or incident book” and “I would always tell the manager if I saw anything that wasn’t right.” There was clear information displayed in the home for people and visitors to know who to contact should they have any concerns.

People knew what to do in the event of an emergency and there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency. One person showed us what they would do if there was a fire.

People were supported by staff that were suitable for the role and understood the values of the home. The registered manager had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed people’s medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff asked people for their permission before they provided care and their choice in how they wanted it undertaken was respected.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had plenty to eat and drink, and received support from staff where a need had been identified. One person told us “The food is good, I get a choice, I have enough to eat and drink.” Specialist diets to meet medical, religious or cultural needs were provided where necessary.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and staff made sure they received appropriate treatment. People’s health and welfare had improved due to the care and support staff gave. People met with their psychiatrist and behaviour specialists to ensure that their behaviours were managed appropriately by staff.

People said the staff were kind and caring and treated people with dignity and respect. One person said; “Everyone is really nice.” People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Bell’s Piece provided highly personalised support plans which were based around the individual preferences of people as well as their medical needs and life goals. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details such as favourite foods, or choice of toiletries recorded in the care plans matched what we saw on the day of our inspection.

People knew how to make a complaint. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. People had the opportunity to comment on the service at regular meetings. The service had received a number of compliments in regards to the newsletter they provided which was designed by people who used the service with the support of staff. Staff knew how to respond to a complaint should one be received.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people. The senior management team from the provider organisation regularly visited the home to give people and staff an opportunity to talk to them, and to ensure a good standard of care was being provided to people.

People were strongly encouraged to be involved in how the home was managed on a daily basis. Surveys were completed and the feedback was reviewed, and used to improve the service. The registered manager and volunteer coordinator had utilised support from an outside organisation and had a wide range of volunteers supporting the home, which included a Corporate Volunteer Programme; this involved organisations such as Surrey County Council, the police and Zurich Insurance staff undertaking tasks with people such as painting and decorating, building a pond and setting up the summer fete.

People told us they loved living at Bells Piece. They said it was a happy house and the staff were very good and some were wonderful. People told us they were supported to do the things they enjoyed and they had a lot of choice about how they spent their time.

We spoke to five people using the service. Two people told us they were very happy and loved living at Bells Piece and had lived there for many years. Other people demonstrated that they were happy and content by their general demeanour and their response and interaction with staff.

Two people we spoke with told us that they felt the registered manager and staff listened to what they had to say. They said that they thought all the staff 'were nice, friendly and helped them when they needed it.' They told us they liked to play jokes on the staff and liked having fun.

We also gathered evidence of the service provider's performance through observing staff practice and sampling records and documents during and following the inspection.

We saw that the staff appeared happy in their work and were positive about working at the service.