Flexible Support Options Limited (Pengarth)

Flexible Support Options (Pengarth) provides accommodation and personal care to a maximum of 5 people. At the time of the inspection 5 people with a learning disability and autistic people were receiving support.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: 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.

Staff supported people to make decisions following best practice in decision-making. People’s relatives helped people express their needs and wishes. Multidisciplinary healthcare teams were involved in decisions about people’s health.

Staff enabled people to access specialist health and social care support in the community. Staff knew people well and provided person-centred care. Care documentation included clear guidance on how to care for people.

Medicines were managed safely. ‘When required’ medicines had clear guidance on when to administer these medicines when people might not be able to ask for this themselves.

Right Care: Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse.

Risks to people were assessed and regularly reviewed when people's needs changed. The building was well maintained, and health and safety risks were assessed.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. People were supported by staff who had been trained in how to care for their specific needs.

Right Culture: There was a positive culture in the service. Staff said the management team were supportive. Relatives thought the service was managed well and that people enjoyed living there.

People, their relatives, advocates and healthcare professionals were involved in planning their care.

Quality assurance and monitoring systems were in place and effective. The registered manager was continuously improving 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

The last rating for this service was good (published 24 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service, and the length of time since the last inspection.

Follow up

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

We last inspected the service on 25 November 2015 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Flexible Support Options Limited [Pengarth] as ‘Good’ overall and ‘good’ in four domains. We rated the service as ‘Requires Improvement’ in one domain, namely 'well-led’.

Flexible Support Options Limited [Pengarth] 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. Flexible Support Options Limited [Pengarth] can accommodate up to 5 people in one building and provides care for people living with learning and physical disabilities. At the time of the inspection five people were in receipt of care from the service.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The registered manager had been in post for the last year and became registered with CQC in 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the registered manager, the providers and of each other. Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

Medicines were stored and administered in a safe manner and staff were appropriately trained.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. Relatives told us they felt their family members were safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and forward planned. Staff told us they felt supported by the registered manager at the service.

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.

People received the support they needed with eating and drinking and people with specialist dietary needs were closely monitored and supported by the staff team.

People’s needs were assessed before they came to live at the service by the management team and a transition plan put in place. Personalised care plans were then developed and regularly reviewed to support staff in caring for people the way they preferred.

Staff were caring and understood how to support and enable individuals to maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. This was reflected in the care and support that people received. Staff understood people's different ways of communicating.

We observed that people were encouraged to participate in activities that were meaningful to them.

People were supported to access advocacy services if needed. Procedures were in place to investigate and respond to complaints.

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 sustain continuous improvement in the service.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

Flexible Support Options (Pengarth) provides care for up to five people who have learning disabilities. There were five people living at the service at the time of the inspection.

We last inspected the service in August 2014 and found that they were meeting all the regulations we inspected.

There was 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.

Relatives considered their family members were safe. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they would take if abuse was suspected.

We saw that the building was clean and well maintained. Each person had a medicines storage cabinet in their bedroom. Staff explained that this meant that medicines were administered to people in their rooms which promoted a more “personalised” and “dignified” approach to medicines management.

Staff told us and our own observations confirmed that there were enough staff to meet people’s needs. Safe recruitment procedures were followed.

There was a training programme in place. Staff were trained in safe working practices and to meet the specific needs of people who lived at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” Three people had a DoLS authorisation in place. The manager had sent DoLS applications for everybody at the service to the local authority to authorise. The manager was liaising with local NHS Trust care managers with regards to mental capacity assessments and best interests decisions.

People were supported to receive a suitable nutritious diet.

People and the relatives told us that staff were caring. We saw positive interactions between staff and people. People were supported to maintain their hobbies and interests. One relative told us that they were disappointed that the home’s minibus had been exchanged for a vehicle which had only one wheelchair place. They said that this affected people being able to access the local community. The manager told us that they also used a local charitable bus company and people were able to get out regularly.

There was a complaints procedure in place and other feedback mechanisms were in place such as surveys and family forums.

The manager and staff at the service carried out a number of audits and checks to monitor all aspects of the service. We found however, that it was not clear how the provider assured themselves that the home was safe and provided a quality service.

The provider had not notified us of three DoLS authorisations which they were legally obliged to inform us of. The submission of notifications is important to meet the requirements of the law and enable us to monitor any trends or concerns. The manager told us that she was now aware of her legal responsibilities and would notify the Commission of all required incidents and events. This issue is being followed up and we will report on any action once it is complete.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

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

We saw risk assessments had been completed for people who were assessed as being at risk, for example, when they were out in the community, eating and drinking and or at risk of developing pressure areas.

We found the arrangements for handling medicines were safe. All medicines were administered by staff who had received appropriate training.

We found the provider had systems in place to protect people and others who could be at risk from the use of unsafe equipment. We saw records that confirmed regular servicing and maintenance was carried out.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS. The manager was aware of the recent high court judgement and was making a referral to the local authority of people who required an assessment.

Is the service effective?

People's health and care needs were assessed and plans of care were in place. We saw that particular needs were identified in the plans for example, communication, dietary needs and medication. We spoke with staff and they were able to describe people's care requirements and what support they needed.

Staff training was provided that took account of people's needs. For example, we saw training in epilepsy awareness and mental capacity had been provided.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them.

People's preferences, interests and diverse needs were recorded and we saw staff were aware of these during the inspection.

We spoke to a relative whose comments included, "I can't fault the quality of care provided. The staff are pleasant and the manager does a fabulous job."

A survey returned by a relative stated, "Staff are excellent and always looking for new ways to improve the lives of their residents."

We spoke with three care professionals who visited the home and they told us the home worked well with them and made prompt referrals when necessary. They felt the staff were committed to moving forward and enhancing the lives of the people who lived at the home.

Is the service responsive?

We saw that staff encouraged people to be involved in activities which they enjoyed..

A complaints procedure was in place and a relative confirmed they were aware of how to make a complaint. We saw there was information available on the notice board in the home about making a complaint .

We spoke with a relative who felt the premises needed to be improved. We discussed this with the manager who said the home was to be redecorated, a new floor provided for the kitchen and new tables and chairs were to be purchased. This work is planned to commence when the building work for the new bathroom has been completed.

Is the service well led?

The service had a quality assurance system in place that included the use of surveys issued to relatives of people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Staff had regular supervision, appraisals and staff meetings which meant they were able to feedback their views and concerns to the management of the home. Staff told us they felt supported in their role and felt their views were listened to and taken into account.

We found there was a training plan in place and staff told us training opportunities were provided and training needs were discussed when they attended supervision sessions with their manager.