Archived: Real Life Options - 58 Ormesby Road

58 Ormesby Road is a residential care home providing personal care for up to six people aged 18 and over who are living with a learning disability and/or autism. At the time of inspection, the service was providing support to five people

58 Ormesby Road is a large adapted house situated in a residential area with close links to transport, shops, parks and countryside. It has its own private enclosed gardens which all people can use if they require quiet time or a safe space.

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 and what we found

People were observed to be happy living at the home. Relatives told us they felt their loved ones were safe and cared for by staff who knew them very well.

People experienced safe care. Risks to people were identified and managed safely by staff who understood their responsibilities to protect people from abuse and avoidable harm. Enough staff with the required skills and knowledge were deployed and provided people with safe care. People received their medicines safely, and as prescribed, from staff who had completed the required training and had their competency to do so assessed. The registered manager reviewed accidents and incidents to prevent reoccurrences. Any lessons to be learnt from incidents were shared with all staff.

Staff were observed to be kind and caring. People were treated with dignity and respect. Staff helped to promote people’s independence. Staff knew people’s interests and preferences and supported them to access a wide range of community activities of their choice, which enriched the quality of their lives. People were supported to maintain relationships with people close to them.

Staff, in line with the provider’s infection control policy, maintained high standards of cleanliness and hygiene in the home.

People received effective care and support, which consistently achieved successful outcomes and promoted a good quality of life. Staff felt valued and well supported by the management team because there was a system of effective training, competency assessment, supervision and appraisal. Staff consistently delivered care in accordance with people’s support plans and recognised best practice.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 08 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected the service on 26 October, 10 November and 11 December 2015 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for safe care and treatment and good governance. We found that risk assessments were incomplete and care records had not been updated when people’s needs had changed or when they had been recommendations from health professionals involved in people’s care. People had missed healthcare appointments. There were significant gaps in all records looked at during inspection and audits had not highlighted these gaps. We also found that the registered provider had not been regularly visiting the service to monitor the quality of the service. We asked the registered provider to take action to improve the quality of the service and issued a warning notice for the quality of record keeping at the service.

Real Life Options: 58 Ormesby Road is a service for people living with a learning disability. The service is registered to provide accommodation for up to six people who require personal care. At the time of inspection there were six people using the service. The service was located in a residential area within its own grounds and had on-site parking. The service was located close to local amenities.

The previous registered manager had been registered with the Commission since 13 January 2013; however they had left the service in December 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 place at the time of inspection; they had been employed by the registered provider for many years. They had started the application process to become the registered manager.

At this inspection, we found that the registered provider had listened to our concerns and had taken action to improve the quality of the service. Significant improvements had been made to all records which meant that staff had the most accurate and up to date information to provide care and support to people which reflected their needs, wishes and preferences. Good systems were now in place to make sure people’s health and well-being needs were regularly reviewed. They now visited the service each month and carried out a comprehensive review of the service and provided action plans and feedback to the manager.

Staff showed they understood the procedures which they needed to follow if they suspected someone was a risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow (tell someone) if they suspected abuse had occurred.

Detailed risk assessments were in place which were individual to people and demonstrated the action taken to reduce the risks to people. These had been regularly reviewed. Staff recognised that people were vulnerable to harm because they did not always recognise risks to themselves.

Health and safety certificates were up to date and showed that the service was safe for people and staff.

All staff had a Disclosure and Barring Service check in place. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups.

There were enough staff on duty to provide care and support to people. Staffing levels changed throughout the day to meet people’s needs and to provide one-to-one activities to people out in the community.

Good procedures were in place to manage people’s medicines. ‘As and when’ (PRN) protocols were in place for people who needed them; records were individual to each person. This meant staff had the information needed to respond when people experienced a deterioration in their health conditions.

Good procedures were in place to support new staff during their induction period. Records had been fully completed and we could see staff received regular reviews.

Staff received regular supervision and appraisals. The quality of these records had significantly improved and action plans were in place where support had been identified. These were then checked at the next supervision sessions to ensure staff had addressed any outstanding areas.

Staff training was up to date for most staff. Any gaps in training had already been highlighted by the registered provider and staff had either been booked onto training or the training courses had recently been developed and were due to be rolled out to staff.

Staff had a good understanding of the principles of the Mental Capacity Act (MCA). Deprivation of Liberties Safeguards had been sought for people and best interest decisions made where appropriate.

Staff involved people in their care and tried to obtain consent from people. Staff told us about the different ways in which people gave their consent and we observed this during inspection. This information was also contained in people's care records.

Staff supported people with their nutrition and hydration and ensured people had the appropriate equipment in place for this. Care records reflected people’s individual needs and included recommendations from health professionals.

People’s care records provided detailed information about their contact with health and social care professionals. Each month, staff reviewed people’s health and well-being needs and arranged any appointments which were due, which included annual healthcare reviews, dental and optician appointments.

Care records provided detailed information and examples about how to involve people in their care, this included menu choices, getting up and going to bed and how to spend their day. The care records showed the different ways people made these choices which included hand gestures, different sounds and guiding staff to a particular area.

We observed interactions between people and staff. We found people responded well to staff and could see staff knew people well. Staff knew detailed information about people and understood the importance of people’s individual routines.

We observed staff giving people choices and they tried to encourage people to make decisions about their care. A relative told us they were kept up to date and were invited to be involved in care plan reviews.

People’s privacy and dignity was maintained whenever care and support was carried out. Staff told us that they always ensured they were prepared, such as making sure they had all of their clothes and toiletries before assisting people to bath.

Some people’s behaviours meant that their privacy and dignity was not always maintained. However staff had a good understanding of this and remained vigilant to people. Staff took the action needed to make sure they responded quickly to these behaviours.

Staff told us that people saw their families regularly, and staff had good relationships with them. Relatives were able to visit at any time and we saw that staff kept in regular contact with them.

Detailed person centred records were in place. Each person’s records included information about their routines and how and when to provide care and support to people. Care records were regularly reviewed.

Each person had an activities timetable in place. Staff were allocated to provide one-to-one support to people participating in activities in the community. This included attending social groups, community venues and eating out. We also observed people participating in activities at the service.

People and staff had good links with the local community. People accessed local shops, pubs and restaurants and had good relationships with people they came into contact with. People also attended community events, most recently this included the switching on of Christmas lights in the town centre. One person attended the local church with the support of staff.

People had been given the complaints procedure in an easy to read format, however none had made a complaint. All staff understood how to deal with a complaint.

Staff told us they enjoyed working at the service and had confidence in the new manager. Staff told us they would not hesitate to approach the manager if needed. The new manager had worked at the service for many years in a previous role and people had good relationships with them.

The service regularly reviewed all safeguarding alerts and accidents and incidents. This meant the service could identify any patterns and trends and take the action needed to minimise the risk of reoccurrence and harm to people.

Staff told us they were kept up to date with any changes or events occurring at the service and minutes were available if they had not been able to attend any meetings.

We could see that staff understood the requirements of their role and worked under the guidance of the manager to ensure people received safe care and support. We could see the staff team worked well together and communicated well.

Notifications had been submitted to the Commission when required to do so.

Fifty eight Ormesby Road is a large detached house situated in a residential area of Normanby which can provide accommodation for up to six people who live with a learning disability Care and support is provided to people on both floors of the service which can be accessed via stairs. At the time of our inspection there were five people living at the service.

The registered manager had been in place at the home for many years. 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.

We previously inspected 58 Ormesby Road on 9 February 2015. We found that checks of the emergency lighting for the service had been overdue and some policies such as quality assurance, Deprivation of Liberties Safeguards (DoL’s) and health and safety had not been reviewed for some time. There were no records to show that applications to deprive a person of their liberty had been made or reasons for this decision making. Records such as training and recruitment, weight charts, key worker reports and cleanliness were not up to date.

At this inspection we could see that all staff were aware of safeguarding procedures and training was up to date. The service had dealt with safeguarding alerts appropriately. All staff told us they felt confident discussing any concerns they may have had.

Risk assessments were in place for people and had been reviewed. Risk assessments for the day to day running of the service had also been regularly reviewed. Certificates relating to the day to day running of the service were up to date.

Each person who used the service had detailed personal emergency evacuation plans in place. This meant people involved in the emergency situation could provide people with the most appropriate support.

There were enough staff on duty to provide care and support to people and staffing levels changed according to people’s activities each day. People who used the service were involved in the interviews of potential staff members.

Medicines were managed appropriately. There were sufficient stocks of medicines in place for people. We highlighted some gaps in medicine records which were rectified during inspection.

People lived in an adapted house with bedrooms available on the ground and first floor. People had access to a variety of communal spaces on the ground floor and also had a large garden which they could access.

We could see that staff knew people well. Staff told us about people’s likes and dislikes as well as their daily routines. People, their relatives and staff had good relationships with each other.

Each person who used the service had deprivation of liberties safeguards in place to keep them safe. Although people could not always make their own decisions, staff did try to involve them where possible. Staff always sought people’s consent before any care and support was provided.

Staff told us that people’s relatives were involved in making decisions about people because they had safeguards in place to protect them however the records did not always show this.

People’s dignity and respect was maintained. People were not rushed when supported by staff and staff gave explanations when needed. Staff also supported people to access the local community and maintain relationships with the people important to them.

A complaints policy was available at the service. No complaints had been received at the service during 2015.

Meetings for people, their relatives and staff had been carried out and well attended. We found this allowed people and staff to be kept up to date of any changes occurring at the service.

Staff spoke positively about the registered manager. They had been in post at the service for many years. The registered manager was responsible for managing three services. We questioned the appropriateness of this because the demands of this outweighed the resources of the registered manager.

We found gaps in all the records we looked at during inspection. We also found that reviews were not always carried out in a timely manner.

Training, supervision and appraisal were up to date and where gaps had been identified we could see that dates had been planned in. Gaps relating to these records had been rectified during inspection.

People were involved in menu planning and were offered a varied selection of food and hydration. We saw that recommendations from one person’s dietician on discharge had not been updated in the person’s records.

People had regular access to health and social care professionals. Records of these appointments had not always been updated within people’s records. This meant that we did not know if any changes had been recommended as a result of these appointments.

Accidents and incidents had been recorded, but there were gaps in these records.

Records relating to recruitment were not available for inspection.

We questioned the appropriateness of audits carried out at the service because they had not highlighted many of the gaps we found during our inspection. There were no records of any provider visits having been carried out at the service.

Following our inspection, we shared our concerns about the workload of the registered manager and the standard of record keeping of the service with the local authority. We knew they had similar concerns and these are being addressed outside of this inspection process.

We found two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.

We looked at three care plans which showed that a person centered planning approach was taken to assess needs and deliver appropriate care. We found that there were clear policies and procedures in place for the administration of medication and measures in place to reduce risks of drug errors.

We found that staff were supported to undertake training to enable them to deliver quality care, staff meetings were held and staff had regular supervision but we saw that staff had not had annual appraisals in the last eighteen months.

The home had a complaints procedures in place which was accessible to people and their relatives. Mechanisms were in place to undertake health and safety audits.

We found that there were care plans in place and these were regularly reviewed. We saw that records were not always signed and dated by staff and some decisions had not been formally recorded.

We observed people living in the home and returning from activities. Staff were attentive and interacted well with people. We saw that people were made comfortable and offered drinks. We observed staff explain everything to people in a way that could be easily understood.

We were able to observe the experiences of people who used the service. The people we observed seemed happy and relaxed with staff. A relative told us, 'I am happy with things here, I am very involved with the care plan and they keep us involved in everything with regular meetings. '

We observed people returning from activities with support workers from other agencies. The staff were attentive and encouraging when interacting with people. We found evidence of good communication with other agencies.

We found the premises that people, staff and visitors used were safe and suitable.

There were appropriate arrangements in place for the recruitment of staff.

The home had a complaints procedure in place and this was accessible to people who used the service and their relatives.