Background to this inspection
Updated
25 November 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We visited the service on 17 and 18 August 2015 and the inspection was unannounced. One inspector and an Expert by Experience conducted the inspection visit. The expert-by-experience had personal experience of caring for family members with disabilities.
Before our inspection we reviewed all the information we held about the service including notifications received by the Care Quality Commission. A notification is information about important events which the home is required to send us by law. We also contacted the local safeguarding team, commissioners and health professionals who worked with people at the service.
We looked at how people with complex needs were supported by using our Short Observational Framework for Inspection (SOFI). We used this to help us see what people's experiences were.
During our inspection we spoke with four relatives, four members of staff and a district nurse who was visiting people. We also spoke with the registered manager and a member of the provider’s management team who was conducting a quality audit of the service. We spent time looking at records, which included three people’s care records and daily notes, menus, staff rotas and three recruitment records and records relating to the management of the service.
We last inspected the service on 10 December 2013, when no concerns were identified.
Updated
25 November 2015
The inspection was carried out on 17 and 18 August 2015 and was unannounced. At the time of our inspection the service was providing support to five people.
The service provides care for adults who have complex needs and learning disabilities. The provider had considered people’s needs and abilities when designing the premises. The building had been adapted to provide a spacious living area for people who use wheelchairs and to meet people’s health, physical and wellbeing needs. People had easy access to a well maintained garden and a spacious conservatory. Raised beds provided opportunities for people to be involved in growing flowers and vegetables. Staff and the registered manager had added finishing touches through imaginative décor, colourful soft furnishings and pictures which created a welcoming and homely environment for people to enjoy.
The service provided amazing care and support to people to enable them to live fulfilled and meaningful lives. Staff were skilled at ensuring people were safe whilst encouraging them to stretch their potential and achieve as much independence as possible. People and relatives were very positive about the service they received. Comments included “We are so pleased and satisfied of the care that my relative receives here”, “This place is led well from the top and it spills down to the lower levels extremely well” and “It is an excellent place”.
The leadership provided by the registered manager, with superb support from the provider, was excellent. The registered manager and staff team demonstrated passion and commitment to providing the best possible care and opportunities for people.
There was enough staff to meet people’s needs and to ensure they were able to access activities and be part of their local community. The provider operated safe and robust recruitment and selection procedures which people were involved in where possible.
Staff protected people’s privacy and dignity. All interactions between staff and people were caring and respectful, with staff being consistently patient, kind and compassionate. Staff demonstrated affection and warmth in their contact with people, which was clearly reciprocated.
Thorough investigations had been carried out in response to safeguarding incidents and these had also been appropriately reported to CQC by the provider. Learning from incidents was evident in adjustments to procedures such as how medication was handled, to ensure people were protected from harm. Comprehensive audits were carried out by the management team to ensure the appropriate improvements took place within the home.
Records and conversation with the registered manager and relatives showed that people were listened to and complaints or concerns were taken seriously and responded to appropriately. There was a clear complaints procedure which was available in pictorial form.
The registered manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Each member of staff had a personal development plan to enable them to think creatively about the support they provided to people. Staff were able to access additional training to ensure they understood and could support people effectively. Staff were clear about their roles and responsibilities and received excellent support from the provider and registered manager to provide care for people.
A variety of choices of food and drinks were offered at the home. Staff used a number of different methods to tempt the appetites of people who were reluctant to eat. Staff supported people to eat and drink with patience and dignity. A holistic approach was taken to supporting and promoting people’s health and wellbeing. The registered manager was proactive in seeking advice and input from a range of therapists, health and social care professionals on behalf of people.
The provider demonstrated how they had sustained outstanding practice, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved good results through close working with other agencies. Staff recognised the importance of new concepts of care as a way to improve people’s standard of living. They were highly motivated and were actively involved in and contributed to continuous improvements in care.
Staff had received training in Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people’s rights. There were guidance in relation MCA and people were asked for their consent before staff carried out any care or treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, provider and staff ensured that people were supported in ways that did not restrict their freedom and were looked after appropriately.
People who used the service, family members and external agencies were highly complementary about the standard of care provided. The registered manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests.
Staff supported people with patience and an unhurried approach to ensure they promoted active involvement their care and do as much as possible for themselves.
People had full, varied and personalised activity programmes. These were designed to provide a variety of familiar and new experiences for people to lead fulfilled lives in accordance with their individual interests and abilities. People were encouraged and supported to engage with their local community through involvement with their local church, the local library and visits to local amenities such as pubs, leisure centres and the library.
There was a strong emphasis on person centred care. All the care records showed people’s needs were continually reviewed. The plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People and their family members were consulted and involved in assessments and reviews.
The registered manager demonstrated passion and commitment to people, strong values and a desire to learn about and implement best practice throughout the service. Staff were motivated and proud of their work they did. The service had developed and sustained effective links with organisations that helped them develop best practice and contribute to the development of other organisations that supported people with disabilities.
The registered manager used effective systems to continually monitor the quality of the service and had on-going plans for improving the service people received. The provider gathered information about the quality of their service from a variety of sources including people who used the service, their family and friends and external agencies. This was used to enable the provider to identify where improvement was needed and to implement and sustain continuous improvement in the service.