L'Arche Bognor Regis Zacchaeus

About the service

Zacchaeus is a residential care home providing personal care to three people with a learning disability at the time of the inspection. The service can support up to five people.

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

Right Support: The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff enabled people to access specialist health and social care support in the community. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

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.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture: Staff knew and understood people well. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. People and those important to them, were involved in planning their care.

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 7 December 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the provider.

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.

As a result of concerns found during a recent CQC inspection of another of the providers services, we undertook a focused inspection at L’Arche Zacchaeus to review the key questions of safe and well-led only.

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

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for L’Arche Zacchaeus on our website at www.cqc.org.uk.

Follow up

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

L'Arche Bognor Regis Zacchaeus is a care home for five adults with a learning disability and or autistic spectrum disorders. At the time of our inspection there were four people living at the service. We refer to L'Arche Bognor Regis Zacchaeus as Zacchaeus House in the body of this report. The service was provided from a domestic style eight-bedroom house over two floors. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our last inspection, due to not having a registered manager in place at the time of our visit this had limited the rating for well led to requires improvement. This was because it was a condition of the provider's registration that a registered manager be in post at this location. At this inspection, a registered manager was 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 person’s'. 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.

L'Arche originated in France in 1964 and is now an international movement that builds faith based communities with people with learning disabilities. Zacchaeus House is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at Zacchaeus House are known as 'core members' and staff as 'assistants'. Due to the philosophy of L'Arche that people with disabilities live in a community, three assistants live in the service alongside core members, sharing all of the facilities.

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.

Staff described procedures that were in place to safeguard the people they supported. They fully understood the safeguarding policies and procedures and felt confident to raise a concern and thought they would be listened to.

Recruitment systems at the home continued to be safe and robust. There were sufficient trained and competent staff to meet people's individual assessed needs. All staff undertook an induction at the start of their employment and completed shadow shifts to fully understand their role and the people they supported. The staff were supported by the management team through on-going supervision and team meetings.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. All staff had undertaken medicines training and had their competency assessed annually or when needed. The registered provider had medicines policies and procedures in place.

The design and layout of the building was hazard free and met the needs of people who lived there. All areas of the home were clean and in a good state of repair with equipment maintained.

People received care that was personalised and responsive to their needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

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 were involved in the planning of meals and menus. They received appropriate nutrition and hydration support to maintain their health and wellbeing.

We observed kind and caring interactions between people and staff. People living in the home praised the caring nature of the care staff and registered manager. People were involved in planning their care and supported to engage in meaningful activities of their choice. There were regular opportunities for social inclusion with access to the community and annual holidays.

The registered provider had a clear complaints policy and procedure that people and their relatives were familiar with and felt confident any concerns would be listened to.

The registered manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. Morale was good within the workforce.

The service had a quality assurance system and shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

Further information is in the detailed findings below.

L'Arche Bognor Regis Zacchaeus provides accommodation for persons who require personal care for up to five people with a learning disability or autism. At the time of our inspection there were four people living at the service. We refer to L'Arche Bognor Regis Zacchaeus as Zacchaeus House in the body of this report.

It is a condition of the provider’s registration that a registered manager be in post at this location.. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered provider are also ‘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 registered manager had left in December 2015.

The provider had notified the Care Quality Commission of this and had started the process of correctly de-registering that person. The service was being managed day to day by a house leader, who was supported by a director. The director told us the registered manager position was being advertised and recruited for. Due to not having a registered manager in place at the time of our visit this has limited the “well led” domain to requires improvement. .

L'Arche originated in France in 1964 and is now an international movement that builds faith based communities with people with learning disabilities. Zacchaeus House is a large property, with bedrooms on the ground and first floors. There is one communal lounge and an open planned kitchen/diner. There is a garden to the rear of the service with an outdoor hut which is used for people to relax in and do activities. Zacchaeus House is part of an ecumenical, meaning all inclusive, Christian community which welcomes people of all faiths and those who have none. The community has a cycle of events throughout the year that provide a focus for spiritual development. These include an annual pilgrimage, monthly community gatherings, days of reflection and occasional retreats and gatherings. People who live and receive a service at Zacchaeus House are known as ‘core members’ and staff as ‘assistants’. Due to the philosophy of L’Arche that people with disabilities live in a community, most assistants live in the service alongside core members, sharing all of the facilities.

Staff worked positively with community professionals such as learning disability nurses, psychologists and speech and language therapists to ensure that people’s needs were met. Changes and recommendations by professionals were clearly communicated to people who lived at Zacchaeus House in an easy to read format which helped them to understand the advice given.

People were protected against avoidable harm and abuse. Good systems were in place for reporting accidents and incidents and the service was responsive to people's individual needs.

Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the provider's required staff training was up to date. This training was refreshed regularly to enable and ensure staff had retained and updated the skills and knowledge required to support people effectively. Staff told us that they felt supported and had received training to enable them to understand about the needs of the people they care for.

There were sufficient numbers of staff on duty to keep people safe and to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting was employed.

People received their medicines safely, administered by staff that had completed safe management of medicines training and had their competency assessed annually by the house leader. Staff were able to tell us about people's different medicines and why they were prescribed, together with any potential side effects.

People who used the service expressed satisfaction with their care and felt confident that staff understood their needs.

Staff were kind and caring. People who lived at the service were allocated key workers and we observed trusting friendships between people who lived in the service and staff members.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA 2005, and whether any conditions on authorisations to deprive a person of their liberty were being met. DoLS applications had been submitted for three people in the service. All three applications were in the process of review and authorisation.

People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. We observed communal mealtimes where people and staff ate together. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, while protecting them from harm and promoting their dignity

We looked at care records and found good standards of person centred care planning. Records showed that people who lived at the service were assessed against risk on an individual basis. Care plans represented people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes. There were three incidences of risk assessments not being fully completed for falls, epilepsy and a caffeine addiction, however staff told us they knew how to support these individuals and were able to explain this in detail

People who lived at the service and staff were invited to weekly meetings. People were encouraged to engage in the running of the service and involvement was clearly a key principle of care at the service.

The service was responsive to people's individual needs. The good level of person centred care meant that people could lead independent lifestyles, maintain relationships and be fully involved in the local community.

The service had robust systems in place for monitoring the quality of care and support. The auditing systems showed that the house leader was responsive to the needs of people who lived at the service.

Some areas of the environment were tired looking and in need of refurbishment. The house leader showed us maintenance plans which detailed improvements to be made and these were on going. This included the décor of two hallways and two upstairs bathrooms.

We saw that staff treated people with respect and consideration whilst promoting their right to choice. This approach by staff was confirmed by our review of people's records.

We saw that staff interacted well with people when they were supporting them and appeared knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. We saw that activities were provided to suit individual needs and were flexible to accommodate choice.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided and were presented in a form that assisted people to understand what care plan goals had been agreed. People were encourage to take a lead in their care plan reviews however a relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs.

We looked around the building which was clean and free from unpleasant odours. The bedrooms were personalised with photographs, books, computers and pictures.

During our visit we were unable to speak to any of the people who use the service. However we spoke with three members of staff (including the registered manager who was responsible for the day to day management of the home) and the L'Arche home coordinator (who is also registered as the manager for the home). We also looked at the care plans of the people who lived at the home and other documentation.