The Bungalow

The Bungalow is a residential care service providing the regulated activity of accommodation for persons who require nursing or personal care to a maximum of 6 people. The service provides support to people with a learning disability and/or autism. At the time of our inspection there were 5 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

People's risks were known and met by enough staff who had the skills and knowledge to meet people’s varying needs. Medicines were managed safely.

Right Care

People’s care and support plans reflected their individual needs. People’s wellbeing was promoted as people were supported with a variety of different activities to enjoy. Staff understood how to protect people from the risk of harm or abuse. People were protected from the risk of infection by safe infection, prevention, and control measures.

Right Culture

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 registered manager and deputy manager sought, listened, and responded to feedback about the service to continually improve the quality of care. This had resulted in an inclusive and open culture.

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 1 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

Visitors to the service had been restricted to essential visitors only. A clear system was in place to prevent visitors from spreading infection in the service. This included a clear checking in process, availability of Personal Protective Equipment (PPE), temperature and health checks and a one-way system to allow for social distancing and hand-washing.

Staff were supporting people to maintain contact with relatives through the use of mobile phones and telephone calls. Consideration was being given to how visits could be safely reintroduced once the national lockdown and restrictions were lifted.

People were being supported to access the community safely, and consideration had been given to additional activities to support people’s mental health and well-being.

The environment was very clean. Additional cleaning was taking place including frequently touched surfaces, such as hand rails and light switches. Infection control audits were carried out. Staff understood the importance of regular hand-washing to reduce the risks of transmission. Changes had been made to the environment to support social distancing measures and to ensure thorough cleaning could take place.

Staff had received training in infection prevention and control and the use of PPE including masks, gloves, aprons, and hand sanitiser. There were sufficient stock of PPE and staff were seen wearing these appropriately. Risk assessments had been completed in relation to PPE, and staff wore eye protection where greater risk of transmission had been identified.

The provider participated in regular COVID-19 testing of people, staff and visitors. Risk assessments were completed for all people and staff and additional measures put in place when people had been assessed at higher risk of infection.

The registered manager kept up to date with Government guidance and appropriate training in infection control. The registered manager ensured all staff had completed training to ensure they knew how to keep people safe during the COVID-19 pandemic.

The registered manager and provider ensured people living in the service, and staff, had access to additional support, including one-to-one meetings and contact by phone, to provide updates and offer any emotional support needed.

The provider had developed specific COVID-19 policies and procedures which had been reviewed and updated where necessary in line with the latest guidance. The provider’s business continuity plan included action needed in the event of an outbreak at the service.

The Bungalow provides care and accommodation for up to three people with learning disabilities. On the days of our inspection there were three people living at the care home.

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. At the last inspection on the 8 October 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

We met and spoke to all the people during our visit and observed the interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example visual choices.

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there was sufficient numbers of staff to meet people’s needs and support them with activities and trips out. Staff said people were safe because; “There is a great staff team here. We all work well together.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training and the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s end of life wishes were not currently documented, however one person had a funeral plan in place which had been provided by relatives. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care plans were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, who had all worked at the service for some time, had built strong relationships with people. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

The service continued to be well led. People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager was very approachable and made themselves available. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the registered manager and provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

An adult social care inspector carried out this inspection. The focus of the inspection was to look at how the provider had addressed the previous concerns and to answer five key questions; is the service safe, caring, effective, responsive, and well 'led?

People who used the service required a high level of support and due to their degree of learning disability were unable to provide verbal feedback about their experiences of the service.

At the time of the inspection there were three people living in the service. We were able to meet all three people and spend time observing the care being provided to them.

As part of the inspection we spoke to the Registered Manager and four members of the care team. We also met and spoke with one relative and a representative from the Learning Disability service in Plymouth.

We reviewed a range of records relating to the service and people's support arrangements. These records included policies and procedures, support plans and risk assessments.

Below is a summary of what we found.

Is the service safe?

We observed that people laughed and smiled when staff spoke and interacted with them and it was evident that people had developed positive and trusting relationships with the staff who supported them.

We saw that detailed risk assessments had been completed. Some of these were general to the service and the environment and others were specific to the individual and their particular care needs. We saw that one person had a risk assessment in place to ensure that they were safe when walking inside and outside the home. Another person had risks identified in relation to their dignity and how this should be protected.

Recruitment practices were safe and thorough. Records confirmed that new staff did not start working in the home until all recruitment checks had been completed.

Staff and management were clear about the need to ensure that any form of restraint or restriction was safe, lawful and protected people's rights. The service followed the correct legal procedures when they believed a person's rights or freedom was being restricted.

There were regular medicine audits to ensure people received the medicines they were prescribed in a safe way.

Financial audits took place regularly to ensure that people's money was safe and all incoming and outgoing expenditure had been accounted for.

Is the service caring?

A relative we spoke to said they visited the home regularly and told us 'The care is very good, there is nothing to complain about'.

We observed that people looked very happy and relaxed in their home. It was a very hot day when we visited and we saw that staff regularly checked that people had sufficient fluids, that clothing and temperature of the room was appropriate and that people were comfortable. We observed that one staff member supported a person to wash their hands and change their top after they had something to eat. The staff member spent time ensuring the person concerned was clean and comfortable, and told us 'It is important that we ensure people's basic care needs are met'.

Is the service effective?

It was clear from what we saw and from speaking to staff that they understood people's care and support needs and knew them well. Support plans were regularly reviewed and updated to reflect any changes.

When people were not able to make choices about their care and support, the views of relatives and other agencies were taken into account and documented. Induction and training plans ensured staff had the appropriate skills and experience to meet the needs of people who used the service.

Is the service responsive?

Records confirmed that people's preferences, interests, and diverse needs had been recorded and care and support had been provided that met their wishes.

We saw that staff were observant to people's changing needs, moods and behaviours and responded promptly to any concerns.

The provider had liaised closely with health and social care professionals and followed advice when needed.

A representative from the specialist learning disability service said 'They make appropriate referrals without any delay'.

People had access to activities they enjoyed and had been supported to maintain relationships with their friends and family. A relative we spoke to said 'I visit every week and the staff pick me up and take me home'. Staff we spoke to said they supported another person to speak regularly to their family using the homes computer and this worked well for all concerned.

Is the service well-led?

Quality assurance processes were in place to ensure that standards of care and excellence were maintained. The provider had responded positively to concerns raised at the previous inspection and had improved recruitment procedures across the service.

The staff we spoke to said they were clear about their roles and responsibilities. The Registered Manager was regularly in the home and staff had access to regular training and supervision.

The service worked well with other agencies to ensure people received care that was joined up and appropriate.

The views of people who used the service, their representatives and relatives were taken into account when planning and delivering care. A formal complaints procedure was in place and a clear record was maintained about any issues raised in relation to the home and people who used the service.

Relatives we spoke to said they had no concerns about the service but felt if any issues arose they would be addressed appropriately.

'The Bungalow' had a friendly and homely atmosphere. A relative told us "they (the staff) do everything well - they (the people) are well looked after" and that they were always made welcome at the home.

People's care needs were being met by staffing ratio of one staff to one person. Each person had a complete and up to date plan of care which contained all the information required to care for each person fully.

Staff knew each person's care needs well and treated people with respect and dignity. Staff told us they worked as a team and felt supported. Comments included "the staff group is stable", "we help each other out" and "we can go and talk to the manager about anything".

We saw that people received balanced and nutritious food and specialist diets were catered for.

People lived in a home that was safe and suitable to their needs, choices and abilities.

The home had an up to date complaints policy. Records showed that people's concerns were listened to and acted upon. One relative told us "there isn't anything to complain about".

Not all of the staff who worked at the home had undergone the necessary recruitment checks before they started work.