Support for Living Limited - 43 Shirley Gardens

Support for Living Limited - 43 Shirley Gardens is a residential care home providing personal care and support to up to 7 people with mental health needs. At the time of our inspection there were 7 people using the service who were accommodated in 1 building over two floors.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People indicated they received safe care. The provider had risk assessments and risk mitigation plans in place to help reduce risks and keep people safe.

Safe recruitment practices were followed to help ensure suitable people were employed. Staff received relevant training so they had the right skills to meet people’s care needs.

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.

Care plans included information about individual care needs and people’s preferences. People using the service told us they knew how to raise concerns with the provider.

The provider had procedures for managing incidents, accidents, safeguarding alerts and complaints. Quality monitoring processes were in place to help monitor and improve service delivery.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 26 September 2017).

Why we inspected

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

Follow up

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

We found the following examples of good practice.

The provider had COVID-19 risk assessments for service users and staff. However, the staff risk assessment was general and we discussed with the provider adding in risk indicators such as age and ethnicity and completing one for each of the five staff.

The provider had clear procedures for visitors to help ensure infection was controlled and prevented. The provider undertook a number of checks before anyone entered the building. This included questions around COVID-19, lateral flow testing and evidence of receiving vaccinations if required.

The environment and layout helped to promote social distancing and open windows helped to ventilate rooms. All people using the service could go out independently and were supported to go out and return safely to the home. The provider had procedures in place to safely admit new people to the service.

Staff and visitors wore and disposed of personal protective equipment (PPE) appropriately. Staff completed training around infection control, and the registered manager did a daily walk around to help ensure staff were wearing PPE correctly and following infection control guidelines.

Everyone in the home participated in regular testing. The provider followed the government guidance and supported people to test and isolate as required. The provider responded appropriately to people with positive test results. Information was shared with relevant agencies such as the local authority and healthcare teams to help ensure people received the treatment they needed. People and staff had received vaccinations to help keep them safe.

We observed the home was clean. Cleaning schedules recorded when cleaning had taken place and were audited monthly to help maintain a good standard of cleanliness and help reduce the risk of infection.

Support for Living Limited - 43 Shirley Gardens is a care home for seven people with mental health needs. Support for living Limited is an organisation with a number of services for people with mental health needs. At the time of our inspection there were seven people living at the service.

At the last inspection on the 27 August and 1 September 2015, the service was rated Good. At this inspection, we found the rating remained Good.

People spoke positively about the registered manager and staff. The registered manager spoke passionately about improving people’s wellbeing and staff were caring and kind in their approach.

People’s care plans contained their views and stated how they wished to be supported. Staff reviewed care plans on a regular basis.

Staffing needs were assessed to ensure people had adequate staff support when it was required. The staff recruitment procedure was robust to ensure the safety of people who use the service.

People told us they felt safe and staff had received safeguarding adults training so they knew what to do if they suspect people were at risk of abuse. People had risk assessments in place to minimise the risk of harm to them and others.

Staff had received training to administer medicines and people’s medicine administration records were completed without errors or omissions.

The service was clean and well –maintained and staff had received infection control training to prevent cross infection.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005. 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.

Staff received appropriate training and confirmed they received supervision sessions and appraisals to support them to undertake their role.

Staff told us about people’s mental and physical health and the support they required to keep well. Staff supported people to access the appropriate health services in a timely manner. There was close liaison between the service and mental health professionals.

Staff supported people to eat a nutritious and healthy diet and remain hydrated.

The service was well-led, the registered manager was well thought of by staff and people. People and staff said they felt comfortable in raising concerns and knew how to complain. Auditing and checks took place to ensure the quality of the service.

The service worked in partnership with the health and social care professionals and the commissioning body.

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

' Is the service safe?

All the people we spoke with said they felt safe and they were able to raise any concerns with the staff. Risks to individual people had been assessed; plans were in place and reviewed to maintain people's safety. These were personalised and individual people had been involved in their own risk management. The premises were clean and well maintained. People were involved in making decisions about all aspects of their care. Staff demonstrated a good understanding of the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards. They were able to describe the process to make sure that the right professionals were involved in taking decisions in the person's best interests.

' Is the service effective?

People told us that staff supported them and, where they had raised concerns about their safety, the staff had listened and acted upon these. People's needs were regularly reviewed and care, treatment and support plans reflected people's needs choices and preferences. One person told us 'we are involved in all decisions regarding our care'. Staff worked closely with other healthcare professionals so that people received safe and coordinated care, treatment and support. People had been involved in decisions regarding some areas of redecoration. Information on advocacy services available to people was clearly displayed.

' Is the service caring?

People told us the staff were kind and caring. We saw that the staff offered people choices and treated them with respect. Personalised care plans were in place and identified individual needs and preferences. This meant that care was provided in accordance with people's wishes. People were involved in the development and review of their care plan. Staff supported people to attend appointments with other healthcare professionals. The healthcare professional we spoke with said the staff had a caring manner and always sought advice if they were unsure about a person's condition.

' Is the service responsive?

Staff responded to people's changing needs. We spoke with one health professional who was involved in the care of people living at the home. They told us that staff contacted them for advice and support when needed and this had helped make sure people's healthcare needs were met. They said staff assessed people's needs, were proactive and responsive to any changes. Regular care reviews were held and any changes to the care planned was discussed and agreed with the individual person concerned. People told us they liked to participate in individual activities and that staff were supportive if they wanted to carry out a new activity.

' Is the service well led?

Governance and quality assurance systems were in place. The provider had an overview of the performance of the service and areas that required improvement. There was good partnership working with other stakeholders. People using the service said that it was well managed. Staff had a good understanding of their roles and responsibilities. They spoke positively about person centred care and valuing people's diverse needs. CQC had not been notified of three notifiable incidents. Staff had taken action to maintain the safety of the people involved.

The previous inspection visit on 19 December 2012 had found that outcomes 4 and 16 of the essential standards of quality and safety were non-compliant. During this inspection we found that the provider was complying with the outcome areas we assessed. We found that improvements had been made to ensure that people's needs had been assessed and care was planned and delivered to meet people's individual needs. Improvements had also been made to ensure that effective systems to assess and monitor the quality of the service were in place.

People told us they had been involved in the review of their care plan and risk assessments.

The provider had in place appropriate arrangements for the management of medicines. There were sufficient staff on duty to meet the needs of the people using the service.

People using the service told us that improvements had been made since our last inspection such as the decoration and new flooring in the communal areas.

There was an effective complaints management system in place. People told us they had 'no complaints'.

People told us they liked living at the home and that they had choices about where they spent their time and what activities they participated in. One person told us 'I'm well settled here'. We observed staff interacting with people in a positive and respectful manner. Two people that we spoke with said the staff were 'good' and 'alright'. One person said 'the staff encourage us to express ourselves. We can tell them anything'.

People told us they attended care reviews and were involved in the development of their care plan. We found that people's needs were not always assessed and care and treatment was not planned and delivered in line with their individual care plan. This meant that they were at risk of receiving unsafe and inappropriate care.

People told us they felt safe in the home. The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained.

Effective systems to regularly assess and monitor the quality of services provided to people and to identify, assess and manage risks relating to the health, welfare and safety of people were not in place.