We carried out this unannounced inspection on 17 November 2015. May Morning is a service for up to eight people with learning disabilities or autistic spectrum disorder who may also have some behaviours that other people could find challenging. The service was full at the time of inspection. People had their own bedrooms. The service was not accessible for people who needed to use a wheelchair or found stairs difficult. This service was last inspected on 13 September 2013 when we found the provider was meeting all the requirements of the legislation.
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.
Staff had been trained in how to protect people, but in every day practice there was a culture within the service of not reporting some incidents which they viewed as minor. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the registered manager or outside agencies if this was needed, but their view of incidents could be compromised by their assessment of the significance of some incidents.
Improvements were needed to the recruitment procedures for new staff to ensure these protected people from the appointment of staff who were unsuitable.
Medicines were managed safely by trained staff, but minor improvement was needed to ensure unused out of date medicines kept in the fridge were also disposed of appropriately.
A range of quality audits were in place to help the registered manager and provider monitor the service, but these were not sufficiently in depth or effective and failed to highlight the issues found at inspection, or provide the provider with the assurance that a safe standard of care was being maintained. People’s relatives were routinely asked to comment about the service but were not informed about actions taken in response to their feedback.
Fire detection and alarm systems were maintained. Day staff knew how to protect people in the event of a fire as they had undertaken fire training and participated in fire drills. However, night staff were not routinely participating in fire drills to ensure they understood the actions to take to keep people safe.
Staff showed that they understood people’s individual styles of communication, and how they made their needs known. Staff used communication aids such as pictorial prompt cards with some people to help them with making independent decisions and choices. However, there was an absence of visible accessible information for people to read about everyday routines and events.
People were happy and comfortable in the presence of staff. Relatives told us they were kept informed and had been consulted about their family members care and treatment plans.
Staff monitored people’s health and wellbeing and supported them to access routine and
specialist health when this was needed. People ate a varied diet and were individually consulted about their personal food preferences to inform menu development.
People were given support to pursue their interests and hobbies. Each person had their own daily planner and this took account of their activity and interest preferences.
Risks were assessed, and risk reduction measures were developed and implemented to ensure people were kept safe; these were kept updated. Staff were provided with guidance to inform them about the actions to take in the event of emergency events so they knew who to contact and how to protect people.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and had taken the appropriate steps to refer all the people living at the service who met the requirements for a DoLS authorisation. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
There were enough staff to meet people’s needs. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs. They received support through regular staff meetings and had opportunities to discuss their performance through one to one meetings and annual appraisals of their work performance.
People lived in a clean, well maintained environment. Decoration and furnishings were maintained to a high standard. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe.
We have made three recommendations:
The provider should liaise with the Fire service to determine the expected number of fire drills night staff should attend in any one year in accordance with the Regulatory Reform (Fire Safety) Order 2005.
The registered manager should review staffing to enable staff to meet together with her without the presence of people who need support.
The provider reviews current practice around the availability of visible and accessible information to people.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.