The inspection took place on 23 and 24 June 2015, and was an unannounced inspection. An announced visit was arranged on 1 July 2015 to look at recruitment records. The previous inspection on 9 January 2014 found no breaches in the legal requirements.
The service is registered to provide accommodation and personal care to nine people who have a learning disability. There were no vacancies at the time of the inspection. The service was previously two semi-detached houses, which have since been joined on a side street near the centre of Folkestone. It is not suitable for those with physical mobility problems. There is very limited parking and on street parking. Each person has a single room and there are two shower rooms and a bathroom, kitchen, dining room, lounge, activities room and snug. There are two small accessible gardens, which are totally paved with seating and pots at the rear of the house.
The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People told us they received their medicines safely and when they should. However we found shortfalls in some records relating to medicine management.
Most risks associated with people’s care and support were assessed and people were encouraged to participate in household tasks and access the community safely. However some guidance for staff to help keep people safe required more detail.
People benefited from living in an environment and using equipment that was well maintained. People’s needs were such that they did not need a lot of special equipment. There were records to show that equipment and the premises received regular checks and servicing. Over the last 18 months the premises had benefited from major refurbishment and redecorating work. A development plan was in place to address areas that that still required attention. People freely accessed the service and spent time where they chose.
People were involved in the planning of their care and support. Care plans contained information about people’s wishes and preferences and some pictures and photographs to make them more meaningful. They detailed people’s skills in relation to tasks and what help they may require from staff, in order that their independence was maintained. People had regular reviews of their care and support where they were able to discuss any concerns or aspirations.
New staff underwent an induction programme and shadowed experienced staff, until staff were competent to work on their own. Staff training included courses relevant to the needs of people supported by the service. Staff had opportunities for one to one meetings, staff meetings and appraisals, to enable them to carry out their duties effectively.
People felt safe in the service and out with staff. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.
People had their needs met by sufficient numbers of staff. Rotas were based on people’s needs and activities. People received continuity of care and support from a small team of long standing staff and the registered manager worked on rota alongside staff at times. People were protected by safe recruitment procedures.
People were happy with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were kind.
People told us their consent was gained through discussions with staff. People were supported to make their own decisions and choices and these were respected by staff. Staff understood their responsibility under the Mental Capacity Act (MC) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People were supported to maintain good health and attend appointments and check-ups, such as doctors, dentist and opticians. Some people had complex health needs and these were kept under constant review. Appropriate referrals were made when required and recently assessments had been undertaken by a psychiatrist and an occupational therapist.
People had access to adequate food and drink. They told us they liked the food and enjoyed their meals. People were involved in the planning and preparation of meals. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet. Special diets were well catered for.
People felt staff were caring. People were relaxed in staff’s company and staff listened and acted on what they said. People said they were treated with dignity and respect and their privacy was respected. Staff were kind in their approach and knew people and their support needs well.
People had a varied programme of suitable leisure activities in place, which they had chosen to help ensure they were not socially isolated. People attended local centres and enjoyed activities, such as woodwork, pottery, sport and art and craft. Some people had family and friends that were important to them and contact was supported by staff.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs. Staff had worked at the service for some considerable time and had built up relationships with people and were familiar with their life stories and preferences. This continuity had resulted in the building of people’s confidence to improves people’s quality of life and reduce challenging behaviours. People’s individual religious needs were met.
People felt comfortable in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been positive. People had completed feedback about the care and support provided to an independently organised national survey. Their responses had scored the highest amongst all other care services who took part.
People felt the service was well-led. The registered manager adopted an open door policy and sometimes worked alongside staff. They took action to address any concerns or issues straightaway to help ensure the service ran smoothly. Staff felt the registered manager motivated them and the staff team.
The provider had a set of values and behaviours, which included treating everyone as an individual, working together as an inclusive team to exceed standards and respecting each other. Staff were very aware of these and they were followed through into practice.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.