United Response - 2a St Alban's Close

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

We received positive feedback about the service from relatives and health professionals who said care and support met individual needs. They said they were fully involved in care and support planning and said communication with the home was good.

Overall, improvements had been made to care planning with care records being clear, person-centred and reflective of people’s individual needs. Further work was ongoing to ensure all care related documents were brought up to a consistent high standard, with a plan to complete this over the coming weeks. Staff had a good understanding of the people they were caring for, giving us assurance that care plans were followed.

We also assessed infection control procedures within the home. Overall, we felt assured that appropriate systems were in place to help keep people safe. We have signposted the provider to resources to develop their approach to make these systems more robust, please see the safe section of this report.

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

Rating at last inspection and update

The last rating for this service was requires improvement (29 May 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the requirement action we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on breaches of regulation or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response - 2a St Albans Close on our website at www.cqc.org.uk.

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.

People’s experience of using this service: During our inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. Care records were not always regularly reviewed or up to date. This had been identified via the provider’s audits but had not yet been actioned.

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 outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion.

Family members told us their relatives received a good service and were happy they were safe. Accidents and incidents were recorded and reviewed. Risk assessments were in place but not all records were up to date. The registered manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions.

People’s needs were assessed before they started using the service. Staff treated people with dignity and respect and helped to maintain people’s independence where possible.

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

The provider had a complaints procedure and family members were aware of how to make a complaint. People, family members and staff were regularly consulted about the quality of the service.

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

Rating at last inspection: At the last inspection the service was rated Good (published November 2016).

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Enforcement: Details of the action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At the inspection on 2 September 2016 we found improvements had been made with regard to these areas.

United Response - 2a St Alban's Close provides care and support for up to four people with learning disabilities. Nursing care is not provided.

At the time of this inspection the home did not have a registered manager as they had left two weeks before our inspection. A new manager was in post on the day 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.

Staffing levels had been reviewed since our last inspection and both relatives and staff we spoke with were confident there were sufficient numbers of staff in place. Each shift had an allocated leader who was nominated at each handover.

Recruitment procedures followed were found to be safe as relevant background checks had been carried out. We recommended the registered provider ensured candidate applications forms were kept on file for us to review. Risks to people had been identified, assessed and reviewed. Relevant mental capacity assessments had been completed and DoLS authorisations were in place.

Relatives were able to visit their family members at all times and they spoke positively about the care provided by staff. Staff received support through their induction, training and regular supervision and appraisal support. Team meetings were held on a monthly basis and were a good record of discussions which had taken place.

A number of quality management systems had been introduced by the registered manager which ensured continuous improvement of the service. Relatives and staff spoke positively about the support they received from the registered manager.

Care plans were very person-centred and contained detailed information which meant staff were able to provide effective care. Relatives were invited to attend reviews and told us staff also attended reviews for their family member which related to other services they received.

Relatives were aware how they could complain if they were dissatisfied and systems were in place to record and respond to any concerns.

Staff knew about people’s likes and dislikes and how they wanted to receive their care. People were supported by staff to access a range of activities and events in the community and were also stimulated within the home.

Effective systems had been introduced which ensured the safe management of medicines. Staff received medication training and had their competency checked. Medicines were stored correctly and MAR charts showed people received their medicines as prescribed.

Relatives and staff felt people living in the home were safe and protected from harm. The privacy and dignity of people was well managed by staff who discussed this at regular team meetings. Relatives and staff were confident people’s privacy and dignity was maintained and through our observations, we saw this happened.

The living environment was clean and all maintenance certificates were up-to-date. Fire safety was well managed with evidence of staff training and regular checks of equipment.

People’s needs were assessed and care and support was planned and delivered in line with their care plan.

People who used the service benefitted from equipment that was comfortable and met their needs.

There were effective recruitment and selection processes in place. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People’s individual needs, and their likes and dislikes were taken into consideration when care was planned and delivered. Where people were unable to consent their preferences were discussed and reviewed with others who had sufficient knowledge.

Care and support was planned and delivered in a way that ensured people’s safety and welfare. Care files contained good evidence to show risks had been identified and how these should be managed.

The provider had appropriate arrangements in place to manage medicines.

There were enough staff to meet people’s individual needs, which included frequently accessing the local and wider community.

Effective systems were in place to identify when people were unhappy, concerned or not their usual self. Concerns or comments would be dealt with promptly and appropriate action taken where necessary.