Evergreen

People’s experience of using this service:

The registered manager told us, “We are about the individual, every day is different.”

People continued to receive safe care. Staff understood their responsibility around safeguarding people and they knew how to recognise abuse.

Risks to people were assessed and managed and known well by staff.

There were enough staff who were appropriately trained and recruited to support people.

People received their medicines as prescribed and systems were in place for the safe administration of medicines.

We saw staff used protective equipment such as gloves and aprons to help protect people from the prevention and control of infection.

Relatives told us their loved ones were supported by staff who had the relevant skills to meet their needs.

Staff told us how they supported people to eat and drink enough to maintain a balanced diet.

People were supported to access other health professionals when 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.

We saw staff were kind and caring when interacting with people.

Staff treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible.

People’s support plans included information about their wishes and goals.

Staff identified people's information and communication needs by assessing them and were responsive to people’s individual needs.

Complaints received had been investigated and resolved. People and their relatives knew who to contact if they had any complaints.

The provider had quality assurance systems in place and these were used to drive improvement. People's feedback was sought through different methods to meet people’s communication needs and this information was used to implement actions and changes.

People, relatives and staff spoke positively about the registered manager.

Rating at last inspection: The service was rated Good overall. Our last report was published on 29 April 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The service is registered to provide care for up to eight people with a learning disability or an acquired brain injury. Seven people were living there when we visited. There is 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 registered manager was not available on the first day of our visit and so we returned on a second day to speak with them.

There were systems for making sure that staff reported any allegation or suspicion of poor practice and staff were aware of the possible signs and symptoms of abuse.

There were sufficient numbers of staff to meet people’s needs. We saw that pre-employment checks had been carried out for staff. These checks are important and ensure as far as possible that only people with the appropriate skills, experience and character are employed.

There were some improvements were needed to the systems of administering medication but we saw that this was usually done safely and that some recent improvements had been implemented.

Staff were appropriately trained and skilled to provide care and support to people. The staff had completed most of the relevant training to make sure that the care provided to people was safe and effective to meet their needs. The registered manager and staff we spoke with understood the principles of protecting the legal and civil rights of people using the service. We did not find anyone being unlawfully deprived of their liberty.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. Most staff were aware of people's needs arising from their medical conditions.

Staff showed kindness and compassion to people who used the service. People told us that staff treated them with dignity and respect. Care had been planned around each person’s individual needs. Staff were able to describe how people preferred to be supported and told us how they worked with people to find out what they liked and didn’t like.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

The registered manager encouraged feedback from people who used the service and their family members, which she used to make improvements to the service, where needed. Systems to monitor and improve the quality of the service were in place and actions were in progress to improve the service people received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

This is a summary of what we found;

Is the service safe?

We saw that people had been cared for in an environment that was safe and appeared clean. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People told us they felt safe. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made in accordance with these safeguards, proper policies and procedures were in place, and the manager understood their responsibilities in relation to the law.

There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected. The staff and manager had a good understanding of whistle blowing policy.

Is the service effective?

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People told us that they were happy with the care that had been delivered and their needs had been met. Some people had certain dietary needs that staff supported them with, enabling people to make informed choices. This included taking people to the shops and supporting them to buy food of their choice.

We found that the home placed the needs of people at the centre of all the support provided. All staff were aware of peoples choices, preferences and support needs. Care plans had been written to reflect this. One staff member told us 'I've done loads of training; I get good support from the seniors.'

Is the service caring?

We saw that people were supported by kind and attentive staff. We saw that the staff and manager showed patience and gave encouragement when supporting people. One staff member told us, 'We're very client centred here, the clients go out a lot, we've got a lovely home here.' We observed that when one person became upset and anxious that they were supported by two staff in an appropriate and caring way.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they had a lot of one to one time with the staff. People had access to activities that were important to them. We observed one person enjoying gardening in the grounds of the home and another person told us that a new shed was being bought to enable them to continue with their wood work. The person showed us the woodwork they had completed. One person told us, 'If I've got any problems I just tell the staff and it's fine.'

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. The service worked well with other agencies and services to make sure people received their care safely and effectively. A visiting professional said, 'Staff seem to be pretty on the ball, they are involved and know what's going on. There's always enough staff here.'

We spoke to three people, four staff and one social worker. We found that the service was well-led and staff were knowledgeable about the people who used the service and were responsive to their needs. This meant that people were cared for in an appropriate manner and their changing needs were taken into account. There were sufficient staff to meet the needs of people in a timely way. One staff member told us that: "Management is good, approachable and effective."

We observed good interactions between staff and people living at the home. This showed that people were at ease with the staff caring for them. One of the people we talked to told us that: "Staff are caring" and "I feel comfortable talking to staff about anything."

People living at the property had regular reviews with multidisciplinary teams and their relatives to ensure their health and wellbeing was monitored. This allowed the home to pick up any changes in people's views about their care. One person told us: 'The staff really let me get involved in the decisions about my care."