Ulcomb House

Ulcomb House is registered to provide accommodation and personal care for a maximum of five people who have learning difficulties. There were four people living at the service at the time of the inspection. Some people at the service had one to one and two to one support. The service was spread over three floors of one adapted building and had an enclosed garden at the rear. This property housed several small buildings including office space for the provider and administrative staff and a maintenance workshop.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that included control, choice and independence. People using the service received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

People were treated with kindness, respect and compassion. We saw staff listening to people, answering questions and taking an interest in what people were saying. People were supported to express their views and be actively involved in making decisions about their care and support. People's privacy, dignity and independence were respected and promoted. One relative commented in a review, "My Son is well supported by the staff.”

People were protected from abuse. Staff received regular safeguarding training, knew how to identify potential signs of abuse and knew how to report concerns. Risks to people and the environment were assessed and minimised. Risks associated with people’s care had been identified and appropriate risk assessments were in place.

Staff were knowledgeable about the Mental Capacity Act 2005, knew how to seek consent for care and knew the process to help those who lacked capacity to make decisions. People’s needs were met by the adaptation, design and decoration of the service.

People had good relationships with staff, who were knowledgeable of their support needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

There were enough staff to keep people safe and meet their needs.

The registered manager recruited staff with relevant experience and the right attitude to work with people. New staff were given an induction and all staff received on-going training.

People’s needs were assessed, and their care was delivered in line with current legislation.

People felt included in planning their care. People were supported to live the lifestyle of their choice. People told us they were listened to by the management of the service. One person told us about a future move to more independent living.

People could involve relatives and others who were important to them when they chose the care they wanted.

People received a person-centred service that met their needs and helped them to achieve their goals and ambitions. People were encouraged to be as independent as possible.

People were fully involved in their care planning and received information in a way that they understood. The care plans used were consistently reviewed and updated.

Care planning informed staff what people could do independently and what staff needed to do to support people.

Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GP’s and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Medicines were stored and managed safely. There were policies and procedures in place for the safe administration of medicines. People received their medicines when they needed them from staff who had been trained and competency checked.

People were protected by the prevention and control of infection.

People felt comfortable raising any complaints with staff and the registered manager.

People were asked for feedback about the service they received.

People said the registered manager was approachable and supportive.

Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong.

The provider and registered manager made sure they monitored the service in various ways to ensure they continued to provide a good quality service that maintained people’s safety.

The provider, registered manager and staff were working with a clear vision for the service.

Rating at last inspection:

This service was rated, ‘Requires Improvement’ at the last inspection (published on 26 July 2018).

At this inspection, we found the service met the characteristics of ‘Good’ in all key questions.

Why we inspected:

This was a comprehensive inspection scheduled based on the previous rating.

Follow up:

We will continue to monitor the service.

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

Ulcomb House provides support for up to five people with learning disabilities. There were four people living at the service at the time of the inspection. Some people at the service had one to one and two to one support. The service was spread over three floors of one adapted building and had an enclosed garden at the rear. The communal areas included a lounge, a large kitchen, a chill out space and a large conservatory that was used for activities and as a dining space. A gate to the rear of the back garden led to property owned by the provider. This property housed several small buildings including office space for the provider and administrative staff and a maintenance workshop.

There was a registered manager at the service who was supported by a deputy manager. 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.

Ulcomb House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection on 16 February 2016 the service was rated Good. At this inspection we found that the provider had been unable to sustain the rating of Good as we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to the failure to provide Good Governance.

Staff told us that they had the skills and knowledge to undertake their role. However, some training for staff was overdue. The registered manager had identified this through regular auditing. However, the provider had failed to arrange the training required in a timely manner.

We have made a recommendation about staff training.

The environment had been adapted to meet people’s individual needs. However, some areas of the décor were tired and worn and the service would benefit from re-decoration. The service was clean and staff were aware of infection control and the appropriate actions had been taken to protect people.

We have made a recommendation about the environment.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There were sufficient numbers of staff to meet people’s needs. Staff had regular supervision meetings and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

Medicines were managed safely. Medicine records were accurate and up to date and people received their medicines on time and when they needed them. Risks to people continued to be assess and there was guidance in place to support staff to minimise risks. There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns.

People’s needs were appropriately assessed and support plans were up to date and accurately reflected people’s needs. People were involved in decisions about their support. Where people did not have capacity to make decisions staff had followed guidance in line with the Mental Capacity Act 2005.

Some people at the service could display behaviours that had a detrimental effect on them and the people around them. There was sufficient guidance for staff to support people to maintain behaviour and manage anxiety.

People continued to be supported to maintain their health and wellbeing. People were supported to eat and drink healthily and maintain or achieve a balanced diet. People had appropriate access to healthcare services when they needed it. When people accessed other services such as going in to hospital they were systems in place to ensure continuity of care.

People were treated with respect, kindness and compassion. Staff knew people well and provided people with the support they needed to communicate and express their views. People supported to maintain relationships with those who were important to them.

People were supported to express their views. People were supported to increase their independence and learn new daily living skills. People’s privacy was respected and they were supported to maintain their dignity.

There was a complaints system in place if people or their relatives wished to complain. There were systems in place to seek feedback from people, relatives to improve the service.

The provider had a clear vision and values for the service which the registered manager and staff understood and acted in accordance with.

Staff and the registered manager understood their roles and responsibilities. The registered manager and the provider regularly audited the service to identify where improvements were needed. The service worked in partnership with other agencies to develop and share best practice.

When things went wrong lessons were learnt and improvements were made. Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon. Lessons learnt were shared with staff.

You can see what action we told the provider to take at the back of the full version of this report.

Ulcomb House is registered to provide care and support for up to five people who have learning disabilities and or Autism. People were supported to learn life skills to increase their independence and confidence. At the time of our inspection, there were four people living at Ulcomb House. The people had different levels of independence, and required specific individual support.

There was a registered manager at the home. 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 were protected against the risk of abuse; they felt safe and staff recognised the signs of abuse to look for. Staff understood their role and responsibilities in reporting any concerns and were confident that any concerns would be taken seriously by the registered manager.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s physical and social needs with details of how the risks could be minimised. This enabled the staff to take immediate action to reduce or prevent harm to people.

There were sufficient numbers of suitably trained staff to meet people’s needs and promote people’s safety. Staff were aware of their roles and responsibilities and the lines of accountability within the home. Staff received regular supervision and had an annual appraisal with staff meetings three times a year.

The registered manager followed safe recruitment practices to ensure staff were suitable to work with vulnerable people. Staff told us the management was approachable, very open, and supportive. Staff morale was good and staff talked positively about their roles within the home.

Staff were kind and respectful, and were aware of how to respect people’s privacy and dignity. We observed that staff had formed very positive relationships with the people. We heard that people were encouraged to make their own choices and decisions, which were respected by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who had been assessed as lacking capacity to make decisions for themselves, staff made sure their best interests were taken into account. Staff received training in the Mental Capacity Act 2015 and DoLS to enable them to understand the need for referrals and their responsibilities around best interest decisions.

There was a policy and procedure for the ordering, storage, administration and the return of medicines to the pharmacy. These were followed by staff to ensure people received their medicines safely. People had good access to health and social care professionals when required.

People were very much involved in the care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans.

People were encouraged and supported to pursue activities inside and outside of the home. Staff made people aware of what events were happening within the local community. People were also encouraged to keep active and continue learning.

Health action plans were in place and people had their physical and mental health needs regularly monitored. Regular reviews were held and people were supported to attend appointments with various health and social care professionals. This ensured they received treatment and support as required.

Residents meetings took place on a regular basis. Minutes were recorded and any actions required were documented and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.

People who lived at Ulcomb House told us that they were happy there. One person said, 'The staff reminds me when I forget, look after me and I like them'. They also said that they liked living at the home.

Staff asked for the person's consent before we looked at their personal file. Each person had a comprehensive plan of support which they had agreed with. The plans included people's preferences, needs assessment, goals for future independence and risk assessments.

People in the home had received their medication as prescribed.

The home had been maintained and looked in good order generally. People's bedrooms had been personalised.

Staff had received the training that they needed to care for people and to develop within their job role.

There were systems in place to monitor the on-going quality of the care and environment in the home.

People living at the home spoke positively about their experiences of living in the home. They said they liked living there, and were able to make their own choices about their lifestyles. They said that the staff supported them with making decisions about what they wanted to do. One person said "The staff take us out and are like my friends, there's a lot to do."