St Anne's Community Services - Smithies Moor Lane

St Anne's Community Services - Smithies Moor Lane. Is a residential care home providing accommodation, and personal and nursing care to up to 6 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 5 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care:

The service did not have effective systems to show care was person-centred care. People did not have plans to set out their day or week and there was no record to show how people's days should unfold, which meant staff decided what people should do. People did not have assessments and plans to ensure they were offered opportunities to achieve goals, learning, and new experiences.

People were not supported to follow their interests or take part in activities that were relevant to them. People did not have regular contact with the community and activities within the home were limited.

There were sufficient numbers of staff to keep people safe but the provider did not have effective systems for ensuring they had the enough staff to deliver high quality care. Care staff were observed cleaning the home and cooking meals so had less time directly supporting people.

We observed many positive interactions between staff and people who used the service. Staff knew people well and were kind and caring. For example, we saw staff supporting people to eat with care and dignity. People’s support plans guided staff around how to deliver individual care tasks such as eating, continence and mobility in a person-centred way.

The service worked effectively with external stakeholders and other professionals.

Right Support:

The service did not manage several areas of risk and quality well. For example, the service had a minibus which was funded by 4 people. However, the minibus was used infrequently. The provider was aware of the issue but had not addressed this. CQC shared these concerns with the local safeguarding authority.

People were not supported to receive their medicines in a safe way and risks to people were not always well managed.

People were usually supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service usually supported this practice.

Right Culture:

The service had an action plan but this did not identify shortfalls that we highlighted at the inspection, which meant actions to drive improvement were absent. Many issues were not included such as the lack of community access, unsafe management of medicines, failure to assess some risks to individuals, inconsistencies in incident recording and reporting, and failure to monitor decision making processes.

Feedback about the registered manager was positive. Relatives and staff shared examples where they felt improvements had been made, such as communication and views. Staff felt well supported in their role.

The management team were responsive to the inspection findings and shared information to show they were making improvements. However, we did not receive complete assurance from the provider that the issues relating to the minibus would be fully addressed.

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

Rating at last inspection

The last rating for this service was Good (published 20 September 2018).

Why we inspected

We inspected due to the length of time since the last inspection.

We undertook a focused inspection to review the key questions of safe and well-led only.

During the inspection we found there was a concern with supporting people to follow interests and to take part in activities that are socially and culturally relevant to them so we widened the scope of the inspection to include the key question of responsive.

For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Anne's Community Services - Smithies Moor Lane on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to management of medicines and risks to individuals, person-centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St Anne’s Smithies Moor Lane 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. The care home accommodates six people in one adapted bungalow. People at the home have complex physical and learning disabilities and require care provided by trained nurses.

There was a registered manager in place who had been registered since 2016. 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 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 and were embedded within this service which worked to ensure people could live as ordinary a life as any citizen.

Staffing levels were based on the needs of people at the home and were reviewed daily. Staff had been trained and were confident to recognise safeguarding issues which meant people were protected from harm.

Risks were well managed to ensure people’s freedoms were not overly restricted and risk assessments were based on positive outcomes for people.

The provider continued to perform safe recruitment practices which were evidenced when we reviewed the records of the one person who had been recruited since our last inspection.

We found decision specific capacity assessments had been carried out for people who lacked mental capacity to consent to aspects of their care delivery. These were compliant with the Mental Capacity Act 2005 (MCA). Staff understood the principles of the MCA and how to ensure people’s human rights were respected when making decisions on their behalf.

Staff received ongoing support from the management team through a programme of regular supervision and appraisal and they had been trained to ensure they had the knowledge and skills to care for people.

People’s nutritional needs had been assessed and detailed plans were in place to support those people with enteral feeding systems. We observed staff supporting people appropriately to maintain their nutritional and hydration needs.

People had been referred to other health professionals when the need arose and we saw this had positively affected people’s wellbeing. How to contact professionals was clearly referenced in care plans to ensure all staff had access to this information.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well.

Consideration and thought has gone into the decoration and layout to create a homely environment and relatives commented the homeliness of the service was a decisive factor which helped them choose the home for their relative.

There was clear evidence of person-centred care and records contained information detailing people’s life histories, preferences and choices

The registered manager was visible in the service and communication was open, honest and transparent. Staff had clear direction and were sure about their roles and responsibilities. Systems and processes for ensuring the quality of the service were securely and effectively in place.

There was evidence the organisation reflected on and learnt lessons following incidents ensuring learning was shared to improve safety for people using their services.

The registered manager provided leadership and was visible at the home. Communication was open, honest and transparent. Staff spoke about how much they enjoyed their work. They had clear direction and were confident of their roles and responsibilities.

Systems and processes for ensuring the quality of the service included nationally recognised evidence-based standards to ensure they provided a quality service to people living with a learning disability and/or complex physical disabilities.

There was oversight from the registered provider and they ensured the service continued to develop with support and encouragement for the registered manager.

There was an issue with how the service had been registered by the registered provider. The registered manager acted immediately to ensure this issue was rectified.

St Anne’s, Smithies Moor Lane provides accommodation with nursing to six people living with physical and learning disabilities. There were four people living at the home at the time of our inspection.

The service did not have a registered manager at the time of our inspection. 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. An acting manager was in post to provider management at the service until a registered manager could be appointed.

The service had previously been inspected on 20, 21 and 22 July 2015 and was found to be in breach of regulations in relation to person centred care, the need for consent, safe care and treatment, governance and staffing. We received an action plan from the registered provider, who told us all actions would be completed by January 2016, and we confirmed at this inspection that all actions had been completed.

At our previous inspection we found risk assessments lacked details. At this inspection we found significant improvements had been made and all risk assessments were detailed, and covered all possible risks to the people living at the home and were effective in reducing risks to the people who lived there.

We had found at our previous inspection, at certain times, there were not enough staff to support the people who lived there. At this inspection we found significant improvements had been made and there were sufficient numbers of staff to ensure the service was safe. In addition, the service had employed a driver for 20 hours a week to support people living there to attend day care but also to take part in activities in the local community.

The home continued to perform safe recruitment practices which were evidenced when we reviewed the records of the one person who had been recruited since our last inspection.

We found medicines continued to be stored and administered safely and in addition medicine competency checks had been undertaken by the acting manager to ensure staff were competent in their administration practices and followed national guidelines.

At our last inspection we found a lack of recorded decision specific capacity assessments in the care files we looked at. At this inspection, significant improvements had been made and detailed capacity assessments and best interest meetings had taken place in relation to specific decisions around the administering of medicines, restrictions in place such as lap belts and splints, bed rails, 24 hour observation, and day care.

There had been a lack of supervision and appraisal for existing staff at our last inspection. We found significant improvements and staff were supervised, appraised, mentored and trained to ensure they had the skills to provide a high quality service.

We saw evidence that the people who lived there were supported well to maintain their health and social care needs and referrals had been made appropriately to services such as physiotherapy, occupational therapy, dental services and speech and language therapy services. The home also had a good range of preventative equipment such as pressure mattresses, cushions, profiling beds and moving and handling equipment which was well maintained and serviced regularly. They had also provided one tilting bed to relieve and promote tissue viability for one person living there and were in the process of purchasing a second one. This ensured the people living there were supported using the most up to date equipment available to maximise their comfort and health.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well and were keen for people to feel they were at home at Smithies Moor Lane. We observed staff to be kind and compassionate throughout our inspection.

We previously found the systems of recording complicated and difficult to navigate. Significant improvements had been made and staff had been allocated time away from the home at the registered provider’s local office, to ensure care files were updated regularly and contained only relevant and accurate information on how to support the people living there. We found the recording to be of a high standard and would enable unfamiliar staff to care for the people living there if the situation arose.

At our last inspection we found there had been a lack of leadership and management in the home and staff had not been supported to develop in their roles as supervision and appraisals had not happened. There had also been a lack of oversight by the registered provider and although audits had been done monthly, actions identified had not been undertaken and no checking was done from month to month to check these actions had been completed. At this inspection, significant improvements had been made and we found the service to be well led by a acting manager who was supported by a new area manager. Audits had been completed by the area manager and we saw evidence that actions from one month to the next had been completed.

Regular team meetings were happening at management level, for the staff in the home and for the qualified nurses to ensure staff kept up to date with best practice and communications from the registered provider. We reviewed the minutes of these meetings and concluded these demonstrated the meetings were effective and productive and enabled the service to monitor the quality of the provision and the standard of care and support for people using the service.

Care staff supported people in a sensitive way using differing methods of communication to ensure that people who used the service understood what was going to happen.

Staff we spoke with said people were treated with respect and their privacy and dignity was upheld. This assured us that their rights were upheld. We saw in the care plans that people had dignity guidance in place.

There were systems and processes, policies and procedures in place to support the delivery of care. Report writing in the care records was good and reflected the changes in care and treatment that people received. We also found that staff and students were supported and monitored in their working practice.

We observed two people who used the service. They appeared comfortable in their surroundings. They appeared to be relaxed with the staff in their interactions. We noted that people who used the service had access to a wide range of activities which were personalised to their individual needs and documented clearly in the care plans.

We were shown information that indicated various sectors of the service were audited on a regular basis to make sure people's needs were met and they remained safe.

We saw that risk assessments and action plans were reviewed regularly and updated to reflect any changes. We saw that staff talked to people before any care was carried out to ensure their rights were upheld. We saw in the care plans that people had dignity guidelines in place. The staff we spoke with told us that they felt people 'were treated with dignity and respect' and people are 'treated well and the care given is good' We saw that interaction between people using the service and staff was warm and respectful.

The staff we spoke with told us that they felt people were kept safe from harm. We saw that staff had received training in safeguarding and there was a corporate policy in place to support staff. We saw that staff received supervision every four to six weeks and their training needs identified through an annual appraisal.

The quality of the service was monitored at local level through monthly audits and annual feedback questionnaires and the people who used the service were encouraged to give their feedback in a variety of ways.