The Four Seasons Trust Limited - 33 Abbotswood

33 Abbotswood is a 'care home' registered to provide accommodation and personal care support for up to four people living with a learning disability and/or autistic spectrum disorder. At the time of this inspection three people were living there.

People’s experience of using this service:

Care plans were not fully up to date and did not always reflect people’s risks needs and preferences. Work was in progress to review and update care plans, so they more accurately described how each person should be supported. However, aspects of the older care plans, which were still in use, were not up to date. This meant staff did not have accurate information about how to support people with specific needs. Renewal of one person’s Deprivation of Liberty Safeguards authorisation had not been actioned before the expiry date, which meant the service was not adhering to the requirements of the Mental Capacity Act 2010.

The registered manager had worked with local authority and Skills for Care quality improvement staff to improve the systems and processes to run the service effectively. This included developing audits and checks to ensure the safety and quality of the service. However, these checks had not identified all the issues found at this inspection.

Medicine storage was in the kitchen where it was possible the temperature would be above recommended levels. Medicines were administered and recorded by staff who were trained and competent. Where an error occurred, actions were taken to report the problem and find ways to reduce risks of reoccurrence. People living at the service were protected from abuse because staff had received training and were confident in raising concerns about people’s wellbeing.

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.

The service was a domestic sized house, which was in keeping with other homes in this quiet residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear a uniform or anything that suggested they were care staff when coming and going with people.

People and relatives were very positive about the service, with comments about how much staff and the registered manager cared and often went above and beyond duty. There was a happy relaxed atmosphere in the service with people planning what they were going to do. Activities included opportunities to make and meet friends, follow hobbies and interests and keep active.

People were supported to develop life skills such as cooking, shopping and housework. People were supported to have choice and control of their lives by staff who supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were involved in choices about food and said they enjoyed the meals they had at the service. People’s health was monitored, and staff involved health and social care professionals appropriately.

Rating at last inspection

The last rating for this service was Good (Report published on 17 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Safe, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We found no evidence during this inspection that people were at risk of harm from the concerns regarding care plans and the storage of medicines. The provider was acting to mitigate the risks working with the local authority and this had been effective. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Four Seasons Trust Limited – 33 Abbotswood on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The Four Seasons Trust Limited - 33 Abbotswood is a residential care home for three people who have a learning disability and autism. People have varied communication needs and abilities. At the time of inspection there were three people living at the service, although one was on holiday with their family.

A week before the inspection the registered manager left their 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 provider had been proactive and appointed a new manager who had started work. Unfortunately on the day of inspection the new manager was unwell.

We last inspected the service over two days. The inspection happened on 29th March and 12th April 2016. We identified concerns with the water temperature monitoring and the quality assurance systems in place. The provider had made improvements with regards to these areas.

People felt safe at were safe at The Four Seasons Trust Limited - 33 Abbotswood. Risks of harm to people were identified at the initial assessment of care and staff understood what actions they needed to take to minimise risks. Staff understood people's needs and abilities.

People were supported by staff who understood the signs of abuse and their responsibilities to keep people safe. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

People were supported by regular members of staff who supported people in a timely manner. Staff were confident and had the knowledge to administer medicines safely. They knew how to support people to take their medicines safely and to keep accurate records.

Staff felt they received the training and support they needed to meet people's needs effectively. Staff felt supported by the management team.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS. When people lacked capacity the best interest process was followed.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People praised staff for their caring nature. Staff were kind and respected people’s privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People received person centred care and people were supported with activities which were meaningful to them and were in line with their interests and preferences.

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them.

The provider audited the care and support delivered and sort feedback from people and relatives regarding the support received. All feedback from audits and questionnaires was positive so it was hard to judge if this had been used to improve the service provided to people.

The provider understood their responsibilities in terms of notifying CQC of significant events at the service. Staff support people in line with the organisational values as support was centred around increasing people’s independence.

The home had 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.

Three people told us they liked living at 33 Abbotswood and said staff were kind and caring towards them. There was an informal relaxed and friendly atmosphere when we visited.

There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers were sufficient to help make sure people were kept safe.

People received care and support from staff who knew them well and understood their needs and preferences. Each person had individualised support plans to make sure they received the support they required.

People were supported to have their health needs met. We saw that people’s medicines were being stored securely and administered as prescribed. The systems to safely manage and audit medicines could however be improved.

The registered manager supported staff to deliver appropriate care and support. Staff attended regular training which gave them the knowledge and skills to support people effectively. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

The systems in place to monitor the quality of the service required improvement. Quality assurance and management supervision processes were not fully embedded, consistent and robust. The provider organisation did not have the necessary governance in place to ensure full oversight of the service and drive improvement where required.

We found that people who used the service were always being asked by staff if they consented to their care, and their right to refuse care was being respected. The people we spoke with said that staff always asked their permission before offering support. We also found the provider would know how to deal with situations where decisions had to be taken in a person's best interest.

We found that people were happy with their care and that staff engaged with people in an appropriate and sensitive manner. One person told us that they felt properly looked after in the home and that 'everything's fine.' We also found that people's needs were being properly assessed, managed and reviewed.

We found that people were being properly protected against abuse and staff were able to identify, respond to, and report abuse. All the people we spoke with said they felt safe from harm in the home.

We found that there were enough suitably qualified staff to provide proper staffing cover at all times. One of the people we spoke with said there were 'loads of staff to look after me.'

We found that the provider was regularly obtaining feedback from people and staff. We also found that the provider monitored and assessed the whole service on a regular basis.

People said they were fully involved in all aspects of their care. People told us, "We are involved in setting our goals and in the review of our care with the help of the registered manager or our support worker". People said their treatment included their total involvement in their care. People said, "We like the support we receive from our support worker, neurologist and the registered manager".

We found that the service sought people's consent prior to providing them with care and support. We saw systems in place that ensured medicines were administered safely.

People told us they were able to eat and drink adequate amounts of food and fluid to meet their needs. They said, "We have what we like for breakfast, sometimes a cooked breakfast and sometimes a continental breakfast".

We saw that staff had the relevant checks carried out prior to commencement of employment.