Archived: Principle House

We found the following examples of good practice and provided feedback on environmental improvements needed.

Staff had undertaken infection, prevention and control (IPC) training and regularly had their competencies checked. This included hand washing technique, putting on and taking off personal protective equipment (PPE) and correctly wearing PPE.

Visiting arrangements were in line with the latest government guidance and included up to five people being named visitors, with only two visiting at one time. An appointment system was in place and on arrival visitors needed to take a rapid COVID-19 test and have their temperature taken. Alternative arrangements included video and telephone chats.

PPE was worn correctly, available to staff and in good supply. Staff and people at the service were participating in the testing and vaccination programmes. Some people had declined a vaccination and additional support was being provided by a registered learning disability nurse specialist. They were exploring individual concerns about healthcare and offering support and guidance.

We spoke with the registered manager about changes to the environment needed to ensure people were protected from avoidable harm. This included replacing a stained, poorly fitting carpet, damaged sofa and uneven patio.

Principle House is a care home. It provides accommodation, personal care and nursing care for up to six people who have learning disabilities and mental health needs. At the time of the inspection six people were living at the home.

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.

People’s experience of using this service:

People told us they were happy, felt safe and that staff had a good understanding of their needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes. Staff looked to offer people solutions to aid their independence and develop their skills.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards inclusion and enabling people to learn essential life skills. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. 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 pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, team manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

A full description of our findings can be found in the sections below.

Rating at last inspection:

Requires improvement (published 23 May 2018)

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

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.

Principle House 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.

Principle House is detached property in Walkford. The home provides accommodation for up to six people with learning disabilities or autistic spectrum disorder and mental health needs. At the time of our inspection six people were living at the home.

The service had not had a registered manager in place since 30 September 2016. 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. A new manager was in post for and in the process of registering with us.

Systems were not in place to ensure the safety of the environment. Fire requirement works had not been completed. We shared our concerns with the local Fire Service. The property was in a poor state or repair and there was an offensive odour in the hallway.

Robust governance and quality monitoring systems were not being completed regularly, established or embedded within the service. This meant that some areas for improvement to keep people safe had not been identified, lessons were not always learnt and actions had not been put in place to address them.

Incident reporting systems were not always effective or investigated appropriately.

We had not received any notifications since the previous registered manager left in 2016. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive. This was a breach of the services registration requirements.

Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Professionals, staff, people and relatives told us they had no concerns relating to abuse or safeguarding. Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines. There were sufficient numbers of safely recruited staff at the home.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred. Staff were able to access care plans and guidance.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were diabetic and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Assessments of capacity and best interest decisions were recorded and conditions set out in people’s Depravation of Liberty Safeguards (DoLS) were met.

People and staff told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. The staff told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People and relatives told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before moving into the service and support provided reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People were encouraged to feedback. House meetings took place weekly which people said they enjoyed.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. The home manager told us that they had received no complaints since the last inspection.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them. Staff felt recognised and that team moral was good.

People, relatives, professionals and staff were positive about the home manager. The home manager encouraged an open working environment.

The service worked in partnership with other agencies.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach under Health and Social Care Act 2008 (Registration) Regulations 2009 .

Principle House provides care and accommodation for up to six people. On the day of the inspection five people lived within the home. Principle House provides care for people who have learning disabilities.

The service had 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.

During the inspection we observed people and staff were relaxed. There was a calm and pleasant atmosphere. People had the freedom to move around freely as they chose and had an abundance of opportunities to maintain social contact within the community. People’s relatives all spoke well of the care and support Principle House provided. Comments included, “In my opinion the home offer a wonderful service and just a brilliant level of care”, “I am very happy with everything that goes on, there is a very homely atmosphere and it is […]’s home so that’s good” and, “Having the right staff in place, makes all the difference. The staff they have do just that, they make a difference”.

People told us they felt safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse; they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. People’s capacity to consent to their own care was assessed as required. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Care records were focused on giving people control. Staff responded quickly to people’s change in needs. People, and those who mattered to them, were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People’s life histories, disabilities and abilities were taken into account, communicated and recorded. Staff provided consistent personalised care, treatment and support.

People’s risks were managed well and monitored. There was a culture of learning from mistakes. Accidents and safeguarding concerns were managed promptly. Investigations were thorough and action was taken to address areas where improvements were needed. There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed.

People were promoted to live full and active lives and were supported to go out and use local services and facilities. Activities were meaningful and reflected people’s interests and individual hobbies. Relative’s told us their loved ones enjoyed a variety of activities which the staff enabled them to take part in.

People were supported to have a say in what they ate and drank and a healthy balanced diet was encouraged.

People medicines were managed safely. People were supported to maintain good health through regular access to health and social care professionals; such as GPs, social workers and speech and language therapists.

Staff were encouraged to be involved and help drive continuous improvement of the service. This helped ensure positive progress was made in the delivery of care and support provided by the service.

People knew how to raise concerns and make complaints. An easy read version of the complaints policy was available. Relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

There were sufficient staff to meet people’s needs. The service followed safe recruitment practices to help ensure staff were suitable to carry out their role. Staff received a comprehensive induction programme. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs. Comments included, “It is a pleasure to come to work, the managers are very good at praising you and making you feel like you are doing a good job”, “It’s lovely working here, the management are good at showing their appreciation for the good work we do” and, “I do feel I have the best job, I would do anything for the people here”.

We also examined records, spoke with the manager and four other care staff, and observed staff supporting people in communal areas. We saw that staff treated people respectfully. We noted that people appeared comfortable with staff, readily approaching them and starting conversations.

The provider had addressed the compliance action from our inspection in September 2013. This related to planning and delivering care and welfare in a way that was intended to ensure people's safety and welfare. Risk assessments and care plans were reviewed and, where necessary, updated after each incident, such as a display of agitation. Staff recorded their contact with people's families and professionals.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected. One person told us "the staff are great, I have lots of fun - it is fantastic here."

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas singing with staff, watching television and interacting with each other. During our inspection we observed people spending time in their bedrooms doing jigsaws, listening to music and talking to family members. We also saw people being involved with activities in the living room with staff members.

The care plans showed that risk assessments for seizures were not updated at the same time as the care plans. The lack of updates meant that people using the service were not protected from harm and the risks were not reduced. Incident forms were detailed although there was not any evidence of care plans or risk assessments being updated following an incident.

We saw care workers had good relationships with the people who lived in the home. They understood how people communicated and responded to people's different methods of communication.

One care worker told us, 'We work very well as a team; the people's needs are always put first'.

We found that care plans accurately reflected people's needs and had been drawn up with their involvement or the involvement of their next of kin. The care plans contained a range of risk assessments and appropriate measures to ensure people remained safe and healthy.

We spoke with care workers who understood what safeguarding was and what they would do if they suspected someone was being abused.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw there were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.