Archived: Flint Cottage

About the service

Flint Cottage is a residential care home providing personal to 4 people at the time of the inspection. The service can support up to 4 people.

People’s experience of using this service and what we found

Right Support:

Assessments of people’s needs did not always consider known risks and guidance for staff was limited. Support plans and risk assessments were not always detailed although for some people who had lived at Flint Cottage for many years more extensive information was available. Safeguarding concerns were not consistently reported to the local authority or to CQC. At times these concerns had significantly impacted on people’s lives and well-being. The provider had begun an investigation into the reasons these concerns had not been shared as required.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Capacity assessments and best interest decisions had not always been completed in relation to restrictions in place. This meant there was a risk people’s legal rights were not being met.

People were supported to access healthcare when required and staff were vigilant at identifying health concerns. People’s medicines were reviewed regularly and reduced where possible. Records of medicines administration were being reviewed as the way medicines were signed for was not in line with best practice.

People had choices regarding their food and staff were aware of people’s preferences and dietary needs. People were able to choose where they spent their time when at home and staff were respectful of their decisions. Adaptations had been made such as placing a gazebo in the garden and fitting a swing to support people’s sensory needs.

Right Care:

Different opportunities for people were not fully explored to take account of people’s interests. Care plans did not contain goals and plans to develop people’s day to day lives. However, people did have the opportunity to take part in activities they had enjoyed for many years such as horse and cart riding and bowling.

There were sufficient staff available to support people. Staff received training in relation to people’s needs. Staff had requested training in supporting people with specific mental health support needs and the provider was in the process of arranging this.

People were supported with kindness and staff showed genuine affection in their approach. Day to day choices were offered to people and staff demonstrated a good understanding of people’s communication styles. People were encouraged to take an active role in their home with tasks such as making drinks and doing laundry.

Right Culture:

Effective quality assurance systems were not in place to monitor the service people received and to ensure continuous learning and development. This meant shortfalls in the service people received were not always identified and acted upon. Records were not always consistently maintained which had led to concerns not being reviewed promptly. The provider had employed a quality assurance manager to monitor systems and audit processes going forward.

Staff told us they worked well together as a team and felt supported in their roles. The provider held a number of different staff forums to enable staff to raise concerns and share good practice. Staff received an induction when starting their employment and on-going supervision.

Staff knew people well and had formed positive relationships with people and their loved ones. Relative’s told us they were kept informed of any significant events. Staff accompanied people to see their relatives where this was their wish.

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 outstanding (published 17 September 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about risks to people’s safety and how people’s mental health support needs were being met. A decision was made for us to inspect and examine those risks. During our inspection we found improvements were needed in the way risks to people’s safety and well-being were managed, how assessments were completed and how people’s goals and opportunities were explored. In addition, we found improvement were required in the management oversight of the service to ensure concerns were identified and acted upon promptly.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, person-centred care, need for consent and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Flint Cottage is a residential care home providing personal care and accommodation for up to four adults living with a learning disability and/or autism.

Services for people with learning disabilities and or autism are supported

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 small home, like other domestic style properties in the area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Although in a rural location, there were vehicles which ensured people were able to access the local community easily. Staff did not wear anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The service was led by a very committed registered manager who constantly looked at ways to improve the care and support of people. The registered manager had introduced innovative systems to support people to lead happy, fulfilled lives. These systems were based on gradually developing people’s independence supported by records which demonstrated how effective the approach was. Feedback from families and health professionals about the registered manager and staff was very positive. The provider had a staff recognition scheme which encouraged staff loyalty. The registered manager recognised the importance of supporting staff and motivating them. Staff had received awards demonstrating their work and commitment to people. Feedback from health professionals was extremely positive.

Best practice standards were used to implement high quality, effective care. People were 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 supported this practice.

The provider, managers and staff were very committed to an open learning, culture. This approach focussed on what people could achieve, recognising their potential despite their disabilities. Staff supported people to do activities they enjoyed individually and with friends in Flint Cottage and the local community. People were encouraged to be as independent as possible with clearly described aspirations and achievements. People did activities which reflected their interests and hobbies as well as everyday chores. These included domestic activities such as loading the dishwasher, spending time in the garden and trampolining. People also spent time in the local community. These included shopping, eating out as well as going to special events including concerts, music festivals and holidays. Staff understood how to work with each person to achieve positive outcomes for the person. This included supporting people to use indoor and outdoor spaces which had been designed to meet their specific needs.

Care records showed that information was collected to support an evidence-based approach to delivering care. People’s care records described their risks, needs and preferences. Risk assessments and care plans provided clear, detailed information for staff on how to support people to lead a happy, safe, fulfilled life. Care records were reviewed regularly and updated when necessary to ensure they reflected the person’s current care and support needs.

The service had been adapted to ensure people with high levels of autism lived in an environment which was comfortable and safe. There were robust systems to check the safety and quality of care in the service. This included audits of the buildings and equipment as well as care records. The provider’s governance systems ensured key performance measures were monitored; where action was identified as necessary, this was completed in a timely fashion. The registered manager reviewed staffing levels and ensured there were enough staff to meet people’s needs.

People received safe care from staff who had been recruited and trained safely. There was a consistent staff team, some of whom were long-serving and knew people very well. Staff communicated with each person using both verbal and non-verbal methods. Staff were able to interpret fluently what people wanted. This meant that the people living at Flint Cottage, some of who had little or no verbal communication, were very well understood and supported

Medicines were stored, administered and recorded in line with best practice.

People, and their families, were involved as much as possible in their care and support which helped to give them choice and control in their lives. There were systems to manage complaints and people were supported to communicate concerns when necessary. Staff supported people to stay in touch with relatives and friends.

Staff understood and had taken appropriate actions to ensure people were supported in line with the Mental Capacity Act (2005). People appeared happy and contented in the service. They were offered activities both inside the home and in the local community.

Rating at last inspection

The last rating for this service was Good (published 20 December 2016). At this inspection we found the service had improved to be Outstanding

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we 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

Flint Cottage is registered to accommodate a maximum of four people with learning disabilities. The home is situated in a rural location close to South Nutfield in Surrey. At the time of inspection the home was fully occupied.

At the time of our inspection the home had a registered 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 and associated Regulations about how the service is run.

In October 2013, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

Flint Cottage had a warm, welcoming atmosphere with people freely coming and going as they pleased. People’s body language showed that they enjoyed the way that staff provided care and support for them and living at the home. People engaged in a variety of activities. They chose their activities themselves, when they wanted to do them and with whom. They were safe in the home and the local community. There was positive interaction between people using the service and also with staff.

People were provided with information about any activities taking place so they could decide if they wanted to join in. Staff provided care and support in a friendly, professional and supportive way that was focussed on people as individuals. Staff told us they knew people who use the service and their likes and dislikes well. Staff were well trained, had appropriate skills and were accessible to people. They said they enjoyed working at the home and had received good training and support from the manager.

The home records were accessible, kept up to date and covered all relevant aspects of the care and support that people received. This included the choices people made, activities they attended and the way their safety was protected. People’s care plans were completed and the information contained was regularly reviewed. This enabled staff to perform their duties competently and efficiently. People were encouraged and supported by staff to address their health needs and had access to GP’s and other community based health professionals. People were supported to be healthy by choosing nutritious, balanced meals that promoted a healthy diet whilst taking into account their likes, dislikes and preferences. This meant people were protected from nutrition and hydration associated risks. We saw that people enjoyed the meals provided and that they were of good quality with plenty of choice.

Relatives told us the manager and staff were approachable, responsive and listened to them. The quality of the service provided was consistently monitored and assessed.

We saw that people's consent was sought, wherever possible, before care and support was provided. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and their preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the provider's policy. We noted that there were sufficient numbers of experienced staff to provide good care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.

The people who live in Flint Cottage had little or no verbal communication skills. We relied on the staff, gestures, and some sings to communicate to people.

They told us that they liked living in the home.

We saw that people chose where to sit to eat their lunch. We saw there was good interaction between staff and people who used the service and staff had a very good understanding of people's needs.

The people who lived in the home had complex and challenging needs. They felt unsure of our presence and worried that our being there would prevent them from attending a pre arranged Church Carol Service that afternoon.

We saw that the service maintained good care plans and people profiles.

We also saw that the staff had the skills, training and confidence that met individual assessed needs.