Ordinary Life Project Association - 17 Berryfield Road

17 Berryfield Road is a care home for up to four people with a learning disability. Four people were living in the home at the time of the inspection. 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.

What life is like for people using this service

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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.

Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively. People received good support to take any medicines they were prescribed and to manage their health conditions.

People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date.

The management team provided good support for staff. The provider’s quality assurance processes were effective and resulted in improvements to the service.

More information is in Detailed Findings below.

Rating at last inspection and update

Requires Improvement. Report published 12 July 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 14/05/2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ordinary Life Project Association - 17 Berryfield Road 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 programme. If we receive any concerning information we may inspect sooner.

17 Berryfield Road offers accommodation and personal care for up to four people with learning disabilities. At the time of the inspection four people were living at the service.

People’s experience of using this service:

The manager audited the quality of service delivery monthly. However, their assessment of some outcomes were not consistent with our findings.

Records were not always up to date. Information in care plans were difficult to follow because of the number of amendments and duplications. Some care plans including person centred plans (PCP) were duplicated but the information was not consistent with each other.

Care plans were not always person centred and were based on the assistance needed from staff. Where people's preferences were documented, this information was not part of the care plans. One person we spoke with was aware of having care plans and told us the staff helped them understand them.

Risks were assessed, and action plans were developed on how to reduce the potential of harm to people. However, some risk assessments were difficult to follow because of the number of amendments.

Although staff recorded when people expressed their emotions using behaviours deemed to be difficult, care plans were not devised based on an analysis of behaviours observed. We noted that people were given time and space when they expressed anxiety.

Mental capacity assessments had not been reviewed to ensure people had capacity to make decisions. The date changes were used to indicate people’s capacity was reviewed. However, there was no other documented evidence of an assessment. People told us the day to day decisions they made.

The staff were supported to meet the responsibilities of their role. New staff had an induction when they started work, they attended training set as mandatory by the provider and there were one-to-one meetings with the line manager.

There were existing staff vacancies and staffing levels were maintained with regular agency staff.

People said they felt safe living at the service. The staff were knowledgeable about safeguarding procedures including the types of abuse and about reporting concerns.

Medicines were safely managed, and protocols were in place for medicines to be administered “when required” (PRN).

People's dietary needs were met. There was guidance for people with specialist dietary needs such as textured and enriched diets. People were supported to prepare menus.

The home was clean and free from odours However, the garden was overgrown and difficult for the person with pets to access.

People's ongoing healthcare was met. People had annual health checks. Hospital passports detailed important and essential information about the person in the event of an admission.

People’s rights were respected. One person told us the staff were kind. We saw staff giving people their full attention when they were interacting with each other. Comments from staff showed they knew how to show kindness and compassion as necessary to people.

People views were sought and they gave positive responses about their experiences of service delivery.

Staff told us the team worked well together. They said the registered manager was fair and approachable.

Rating at last inspection:

The service was rated as Good at the comprehensive inspection dated 27 July 2016. This report was made public on 29 September 2016

Why we inspected:

This inspection was a scheduled inspection based on previous rating.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Three people were currently living at the service which is registered to provide accommodation for up to four people with learning disabilities.

A registered manager was 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 person we spoke with said they felt safe living at the home and staff made them feel safe. Staff said they attended bi-annual safeguarding of vulnerable adults training. They said the procedures were updated to reflect recent changes. The staff we spoke with had a clear understanding of the safeguarding of vulnerable adults procedures. They were able to describe the types of abuse and the actions they must take.

Risks were assessed and staff were knowledgeable on the actions they must take to minimise risks. Staff told us risk assessments were discussed at team meetings and were developed by the registered manager. They said there was an expectation they read the risk assessments and sign to indicate their agreement with the plan of action.

Staffing levels were being maintained with agency and permanent staff. Staff said the same agency staff were used to ensure people had continuity of care. The rota in place showed two staff were on duty throughout the day and one member of staff at night.

Medicine systems were safe. Medication administration records (MAR) chart were signed by staff to indicate the medicines administered. Protocols were in place for medicines administered “when required” (PRN).

Staff were supported to develop their skills and their performance was monitored. Staff attended essential training as identified l by the provider and specific training to meet the changing needs of people. One to one meetings were regularly held with the line manager and at these meetings concerns, training and personal development was discussed.

People made decisions and Deprivation of Liberty Safeguards (DoLS) application to the supervisory body for people subject to continuous supervision.

People were supported with their ongoing health care needs. Reports of healthcare visits were maintained and demonstrated people had access to specialists and had regular check-ups, for example optician and dental check-ups.

The two people we asked told us the staff were kind and caring. We saw staff interact with people and where people became agitated we observed staff used a calm approach to prevent any escalations. People were supported with their activities programme which including outings with keyworkers and to attend clubs.

Support plans were person centred and included the person’s ability to meet their needs and how staff were to assist them. For example, Daily routine plans described the person preferred times to rise, menu planning, activities and how staff were to assist them. Support plans were signed by the person to show their agreement. The person we asked told us records were kept about them.

Systems were in place to gather people's views during tenant meetings. Questionnaires were used to seek feedback for visitors. Systems and processes were used to assess, monitor and improve the quality, safety and welfare of people. There were systems of auditing which ensured people received appropriate care and treatment.

People using the service were complimentary about the staff and the care provided. One person said "I wanted to move here, I like the staff". Another person nodded and smiled when asked if staff were kind. People said that they were given choices and described being able to influence how they spent their time. Staff were observed talking to people in a kind and respectful manner.

Peoples' needs were assessed and they were involved in the development their records. Care plans clearly identified their preferences and aspirations for the future. Appropriate formats were used to support decision-making and peoples' involvement. Staff also described how the service was person-centred.

Extensive building work was taking place to provide another bedroom and a new conservatory. Staff described the impact on people as 'minimal', and people using the service seemed unaffected at the time of our visit. Bedrooms were observed to be personalised and homely, and communal areas were attractively maintained.

Staff said that they were an "established team" and that they "all got on well." They described systems in place to support them, and said that the manager was supportive.

Records were safely stored, with lockable storage for confidential information. Care plans were evaluated and information was shared appropriately with other agencies.

We saw that people in the service were respected. We observed staff spending time with people.

Information was clearly recorded in order to provide good continuity of support at all times. The care records were an accurate reflection of people's care needs and how those needs were to be met.