Archived: Care Management Group - Smitham Downs Road

People’s experience of using this service: At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Smitham Downs Road had undergone complete refurbishment and redecoration since we last inspected. The provider had managed this in such a way to accommodate the needs of new people moving to the service. This included making sure people’s bedrooms were furnished according to their needs and choices before they moved in.

People needs were fully assessed before moving to the home so the provider knew whether they could meet the person's needs. Risks to people’s health and wellbeing were understood and staff had the information they needed to support people and keep them safe. Care plans were personalised to reflect individual needs and preferences. People’s needs were regularly monitored and reviewed and staff responded appropriately to changes in people's needs or circumstances.

People were protected from abuse and discrimination. Staff were trained to recognise signs of potential abuse and how to manage and report any situations in which people may be at risk. The provider followed safe recruitment practice to make sure staff were suitable to work in a care setting.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff training included supporting people who presented behaviours that could result in harming themselves or others. Staff also learnt how to communicate effectively with people in their preferred ways, for example, where people did not use verbal communication.

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 treated people with dignity and respect. People decided how they spent their time and staff respected their choices and independence. Information was made available in accessible formats to help people who needed support with communication. People took part in activities they liked or had an interest in and staff supported people to try new ones.

People received the care and treatment they needed to maintain their health and wellbeing. They had access to appropriate health, social and medical support when it was needed. Medicines were managed safely and people received their medicines as prescribed.

People maintained relationships with those that mattered to them. People and their relatives had opportunities to share their views and the provider listened to their feedback. Relatives knew how to raise concerns and told us they would be confident to do so. Arrangements were in place to monitor, investigate and respond to complaints.

There was an inclusive culture at the service where staff felt listened to and supported. The new manager showed effective leadership and knew what was working well and what needed improving in the home. Staff and relatives told us the manager had made positive changes since joining.

The provider had good oversight of the service and used effective systems to monitor quality and safety, keep checks on standards and develop the service. Where improvements were needed or lessons learnt, action was taken to make the necessary changes.

At the time of the provider’s registration, the care service had not been developed and designed in line with the values that underpin the 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. However, we found care was provided in line with these principles and values. People received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Rating at last inspection: At the last inspection the service was rated Good. (Report published September 2016)

Why we inspected: This was a planned inspection to check the service remained Good.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection schedule or sooner if required.

At the last inspection in October 2015 the service met all regulations but it required improvement in the Well Led domain. At this inspection the service met all regulations.

There has been a change of management. The provider had recently appointed an experienced manager for the service. The person appointed had submitted an application to register with the Care Quality Commission; the application had not been processed at the time this report was drafted. ‘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 felt safe. The service had procedures and risk assessments in place which staff operated to reduce the risk of harm to people. Staff were trained in safeguarding adult’s procedures, they knew how to recognise the signs of abuse and how to report any concerns. Appropriate recruitment checks were carried out on staff to ensure they were suitable to work with people.

There was a strong emphasis on learning, with a comprehensive staff training and development programme in place. Staff had training and were assisted to develop the skills, knowledge and experience to care for people safely. Support networks ensured staff were effectively supported.

The home considered people’s needs and assigned sufficient numbers of skilled staff to support people and meet their needs. Staffing levels were flexibly arranged over twenty four hours to respond to the needs of people.

People’s medicines were managed safely. People who were able to self-administer their medicines were supported to do this safely. Those requiring assistance from staff were administered medicines as prescribed.

Support that staff provided to people was outcome-focused. There was evidence of staff working hard with individuals to develop strategies that helped people gain greater independence. As a result people were encouraged and enabled to learn new skills and become more independent.

Staff actively sought from people their consent to care and support. The manager and staff were aware of their role and responsibilities in providing support to people within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff provided meals to people, which met their personal preferences. People had a choice in meals they wanted to eat and assisted staff in their preparation. Staff knew how to support people with their nutritional needs for the maintenance of their health.

Staff identified and documented people’s personal histories, which helped them to understand their likes and dislikes. Care and support plans were person centred and people were cared for in a way that reflected their personal preferences, and choices. Staff were kind and compassionate; they continually encouraged people to achieve their goals and acknowledged their progress.

People were supported to maintain relationships with friends and relatives that mattered to them. People and their relatives contributed to reviews of their care and support needs. Activities were provided in and outside of the service and people had an opportunity to take part in them if they chose

People knew how to make a complaint and make comments about the service, care, or support they received.

The provider had systems in place that monitored, and reviewed the service to improve the quality of care to people. When any shortfalls were identified improvement plans were developed. Staff implemented any necessary changes in the service to ensure people received effective quality of care. People and staff were positive about the impact of the new manager’s appointment.

People using the service were asked how they wanted their care and support to be provided and had personalised care plans that they helped create. Records provided staff with accurate information about people's care needs and how to support them. Comments from people using the service included, 'it's alright here' and 'I can chat to someone if I'm concerned about something.'

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were safe and effective recruitment and selection processes in place. This helped ensure that people were protected from the risk of being cared for by unsuitable staff.

Staff had the skills and expertise to support people's needs because they received on-going training and regular management supervision. Staff we spoke with described the training as 'very good' and 'useful.'

The provider regularly monitored the care, facilities and support for people using the service. Where issues were identified, action was taken as necessary.

Staff described the process for assessments. care planning and review and the keyworker system. We found that care plans were comprehensive, accessible and up to date and there was evidence of the involvement of the people using the service in decision making.

Staff and people who used the service were aware of the risk of abuse and one resident told us that he "can tell staff if I have been assaulted". There were posters to advise people what to do if they suspected abuse displayed in the service and an up to date safeguarding policy.