New Boundaries Group - 329 Fakenham Road

We found the following examples of good practice.

People were supported to continue relationships with their family members. Arrangements were in place to safely support relatives to visit people living in the service without restrictions. People were also supported to spend time with their family outside of the home including staying overnight when they wished.

The environment was clean and hygienic. Enhanced cleaning had been put in to place as a response COVID-19.

People and staff were being supported to engage in regular COVID-19 testing in line with Government guidance.

329 Fakenham Road is a care home providing support for up to three people with a learning disability. At the time of our inspection, two people lived at the service.

At our last inspection on 12 November 2015, we gave the service an overall rating of good. We rated the key question of ‘Is the service well led?’ as requires improvement. This was because at the time of that inspection, there was no registered manager in post, and the service had a high turnover of managers which had resulted in a period of instability within the home. At this inspection, we found the evidence continued to support an overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Improvements were also found within the well-led section and therefore, we have changed our rating of ‘Well Led’ to good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There was enough staff to keep people safe and meet their needs.

Peoples care and support needs had been assessed which was reflected in their support plans. Staff provided support in line with this. Staff were competent to carry out their roles effectively and had received training that supported them to do so.

People were supported to prepare fresh meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed. 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.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect and were able to lead their lives with high levels of independence. Staff enabled people to maintain relationships with relatives who did not live nearby.

People were confident that they could raise concerns if they needed to and that these would be addressed. People could access a range of activities of their choosing which they enjoyed to enhance their wellbeing.

The registered manager ensured that the home was well run. Staff were committed to the welfare of people living in the home. Staff were motivated and worked together with strong teamwork and high morale.

Further information is in the detailed findings below.

New Boundaries Group - 329 Fakenham Road provides accommodation and support for up to three people with a learning disability. When we inspected there were three people living there.

There should be 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 service had been without a registered manager since January 2015. However, a permanent manager had been appointed just before our inspection and was intending to register with us.

People received care and support that was focused on their individual needs. Their medicines were managed in a safe way. There were enough skilled staff who were able to ensure that support was delivered to meet people’s needs and minimise risks. Recruitment practices were robust and contributed to promoting people's safety.

People were encouraged to make decisions. Staff had been trained in the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and were aware of how people's rights should be promoted. Any restrictions necessary to promote the safety of individuals were considered carefully and the management team liaised with other professionals to establish what was in their best interests.

People were supported by staff who treated them warmly and with respect and their privacy and dignity was promoted. People were consulted about their care and involved in planning how their needs were to be met. They were supported to pursue activities that reflected their hobbies and interests within and outside the home. Staff were able to communicate well with people using the service.

Staff were knowledgeable about the support people required and care plans were kept up to date when their needs changed. People had opportunities to raise concerns or complaints.

There were systems in place for monitoring and reviewing the quality and safety of the service. The views of people using the service and their families were taken into account. The new manager had a clear view of where further improvements could be made and had already succeeded in improving the support available to staff.

Is the service safe?

People who used the service told us that they felt safe and they felt confident to report any concerns.

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

Staff had an understanding of their roles and responsibilities in making sure people were protected from the risk of abuse and knew how to follow correct procedures.

The provider had a system in place to demonstrate that they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes have affected the decision and how they were involved in the decision making process. The provider was taking appropriate action to ensure that people's rights were protected by appropriate consideration and use of the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Is the service effective?

People we spoke with told us that they were happy with the service which they received. The relative we spoke with told us that the service met the needs of their family member.

Staff were knowledgeable about people's individual health and wellbeing needs. They worked closely with health professionals to ensure that people's needs were met.

The care plans were personal to each individual and were reviewed on a regular basis. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

Staff told us they received a very good level of training and felt equipped to undertake their role at the service. Staff expressed some concerns about the level of staffing at the service, as on some occasions, the service was supported with staff who did not usually work at the service.

Is the service caring?

People who used the service told us that they liked the staff and they thought they were friendly and caring. We saw that people had positive relationships with the staff who supported them. We spoke with one relative who said that they found the staff to be caring and felt they understood the needs of their family member.

We observed how staff spoke with people using the service and how they supported people. We saw that this was done in a respectful way. We saw that staff were friendly and approachable and encouraged people to be independent and supported them to engage in meaningful activities. We saw that people were involved in making choices about various aspects of their daily life.

Is the service responsive?

People's individual physical, emotional, psychological and social care and support needs were assessed and met. This included people's individual choices and preferences as to what they would like to eat and how they liked to spend their day.

People's needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people's likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities which suited their individual choice. They were supported to participate in activities within the local community. Staff promoted the independence of people who used the service.

Is the service well led?

The service had a registered manager in place. The manager had been in post for about six months prior to the inspection.

Staff told us that on some occasions they did not feel supported by the management team and the provider. They said they did not always feel listened to and felt that support could be improved. Over the previous months there had been many changes at the service and staff felt unsettled.

Staff told us they received regular supervisions and appraisal meetings. We saw evidence that this was the case.

The relative we spoke with told us they felt the service was well-managed. They said they were confident to raise any concerns or complaints they had with the manager. The manager and staff maintained positive and frequent contact with relatives of people who used the service.

The provider had effective quality assurance and audit systems in place to monitor the service and ensure improvements were made where necessary.

After the inspection we received updates showing improvements that had been made in monitoring and checking service quality. The information included details of actions the manager needed to take to improve. We were also provided with a schedule for ensuring that people living in the home, relatives, staff and other professionals were asked for their views so that they could be taken into account in improvements.

We concluded that actions had been taken to ensure people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We also concluded that the provider had taken action to ensure systems for monitoring the quality of the service people received were effective.

Staff had training to help them understand how to support people with making informed decisions and what to do if people could not make informed decisions about their own care and treatment. Staff spoken with understood people's needs. There felt there were enough of them to support people consistently and to assist people with their chosen activities.

There were some systems for monitoring the quality and safety of the service. However, people living in the home were last formally consulted a year and a half ago. There was no evidence of consultation with staff or representatives other than relatives, as part of assessing and monitoring service quality. Audit reports completed on behalf of the provider to assess quality and compliance with standards had not identified this or the shortage of 'in house' checks to ensure continued safety.