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Inspection carried out on 9 February 2018

During a routine inspection

Care service description

Anderida is a residential care home for up to three people with learning difficulties. The service is a detached bungalow in a small village with local amenities. There were two people living at the service when we inspected.

Anderida 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. Anderida accommodates two people in one adapted building.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

At the last inspection, the service was rated ‘Good.’

Rating at this inspection

At this inspection we found the service remained ‘Good’

Why the service is rated Good

The service had robust systems in place to keep people safe. The registered manager assessed and mitigated risks, and ensured care plans were up to date to reflect people’s needs. People received the medicines they needed in a timely manner, and their medicines were managed safely. There were enough staff to meet people’s needs, and the necessary pre-employment checks completed to ensure people had the suitable skills to work in a care setting. People were supported by an experienced staffing team who knew them well, and understood how to safeguard them from any potential abuse. The service was clean and well maintained. Staff had received training in infection control and used personal protective clothing where required. Incidents had been reviewed and improvements made to improve the safety of the service.

People’s needs had been assessed and treatment delivered in line with current legislation. Staff worked with external organisations to share best practice. Staff received effective training, and regular supervision and observations from the registered manager. The environment had been adapted to meet people’s individual needs. People were supported to maintain a balanced diet and were referred to health care professionals when required. Staff had good understanding of the Mental Capacity Act and people made their own decisions.

People were treated with kindness and respect. Staff took the time to have meaningful interactions with people. Staff supported people to be as independent as possible, and encouraged them to make choices. Staff respected people’s privacy and dignity, and supported people to maintain relationships with those who were important to them.

People received personalised care in line with their needs. Activities were planned around people’s known likes and dislikes. The provider had systems in place to seek feedback from key stakeholders in order to improve the service. At the time of inspection the service was no supporting anyone at the end of their life.

Staff and healthcare professionals told us the service was well-led. Staff told us they were supported by the registered manager. There was a positive culture between staff. The registered manager understood and was meeting their regulatory responsibilities. There were robust processes in place to learn from accidents and incidents. The provider and registered manager regularly audited the service to strive for improvements. The registered manager attended a number of internal and external forums to learn and share best practice.

Further information is in the detailed findings below

Inspection carried out on 02 December 2015

During a routine inspection

This inspection took place on 2 December 2015 and was unannounced. The previous inspection was carried out in June 2014 and there were no concerns identified.

Anderida is registered to provide accommodation and personal care for up to three people who have a learning disability. Anderida is in the semi rural village of Mersham which has a general store. Three people were living at the service, each had their own bedroom, one with an ensuite wet room. People had access to a communal lounge, kitchen/diner, laundry room and a shared bathroom. There is a well maintained garden and outside area. There is off street parking within the grounds and easy access to public transport.

The service has a registered manager, who was present throughout the inspection. 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 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted. They were waiting for the outcome from the local authorities who paid for the people’s care and support. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people moved into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People were satisfied with the care and support they received. The care and support needs of each person were different, and each person’s care plan was personal to them. People had in depth care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way which demonstrated that they cared about people’s welfare. Staff knew people and their support needs well. Established members of staff had built up relationships with people and were familiar with their life stories and preferences.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People could not communicate verbally. During the inspection staff anticipated or interpreted what they wanted and responded quickly.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other basic training provided by the

company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. The complaints procedure was on display in a format that was accessible to people.

Staff told us that the service was well led and that they had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with the registered manager. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

Inspection carried out on 10 June 2014

During a routine inspection

We spoke with the manager and care staff. We also observed staff supporting people with their daily activities. We used a number of different methods to help us understand the experiences of people using the service. This was because the people had complex needs which meant they were not all able to tell us their experiences.

Anderida can provide accommodation for up to three people. There were three people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with staff supporting people and the manager:

Is the service safe?

The service was safe. We found that practices in the service protected people using the service, visitors and staff from the risk of harm.

Each person had a care plan which detailed their care and support needs. We saw that risk assessments were in place and that staff had guidance to follow to reduce the risks and implement strategies to ensure people were as safe as possible.

There were systems in place to ensure that accidents and incidents were acted on appropriately and in a timely manner to safeguard people.

We found the environment to be clean, well maintained and free from unpleasant odours.

Is the service effective?

The service was effective. People who used the service were not able to tell us how they felt. We observed staff during our visit and found them to be attentive to the people using the service and responded promptly when needed.

Care plans were regularly reviewed to reflect any changes in people’s care and support needs.

Staff support was consistent and structured. A core staff team was used across two of the services run by the provider. Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people and promoted their independence.

We saw that the staff were inclusive of people and they were involved in the day to day running of Anderida.

Is the service responsive?

The service was responsive. People received personalised care that met their needs.

We saw records that showed the service worked closely with health and social care professionals to maintain and improve people’s health and well-being.

Staff with whom we spoke told us they felt they would be listened to if they raised any concerns.

It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led. Quality assurance processes were in place.

There was a clear management structure I place. Staff we spoke with said that they understood their roles and responsibilities and that they felt supported by the management team.

We saw evidence which showed that the service worked well with other agencies and services to make sure people received their care in a joined up way.

Inspection carried out on 11 November 2013

During a routine inspection

People who used the service were unable to tell us about their experiences due to their complex needs. Therefore, we used other methods to obtain information about their care and experience. We observed staff interactions with people, spoke with a staff member and looked at care records.

At our inspections on 5 February 2013 and 8 July 2013 we identified concerns that a system used to record marks observed on people and to review this information was not always used effectively to monitor the care and welfare of one person at the service. At this inspection we found that the system had been reviewed, staff knew about the system in place and the system included sharing information with the person’s care manager. However, we found that not all the records used in monitoring this aspect of care were completed clearly and consistently. They were not always signed by the manager or senior staff member to show that the information had been reviewed.

Inspection carried out on 8 July 2013

During a routine inspection

At the time of inspection two people were living at the service. We observed staff interactions with people, spoke with staff and looked at care records to help us understand the experiences of people, because they had complex needs which meant they were not able to tell us their experiences. We saw that people’s privacy and dignity were promoted and people were involved in day to day decisions about their care.

At our inspection on 5 February 2013 we identified concerns that a system used to record marks observed on people and review this information was not always used effectively to monitor one person's welfare. At this inspection we found that there had been a review of the person’s health and medication. However, there was no information to show that the information about the marks had been reviewed and assessed in order to promote the welfare of the person at the service.

We saw that people were protected from the risk of abuse because staff knew how to recognise potential abuse and what action to take.

There were enough staff on duty to be able to meet people’s needs and staff were suitably trained to be able to undertake their role safely and effectively. A health care professional who regularly visited people at the service, told us that “The staff there are 100% committed” and “they could not be more helpful”.

There were systems in place to regularly monitor the quality of the service and the health and safety of the service.

Inspection carried out on 5 February 2013

During a routine inspection

At the time of inspection two people were living at the service. We used different methods to help us understand the experiences of people because they had complex needs which meant they were not able to tell us their experiences. We spoke with two professionals linked to people who live at the service and they told us “the staff know what people need” and “there is a consistent staff team” at the service and the service was “very good”. A staff member told us “It is all focussed on the service user”.

We saw that there were systems in place to involve people in day to day decisions around their care. People’s capacity to consent to treatment was assessed and the relevant legislation was followed by staff. We saw that staff met people’s day to day care needs. There was a system to record marks observed on people to collate and review the information, however this was not always used to monitor the care and welfare of one person at the service.

We saw that there was a system in place to manage people’s medicines effectively. Staff were trained and assessed as being competent before administering medication to people.

Staff were supported in their role and received ongoing training and development.

There were systems in place to regularly monitor service delivery and the health and safety of the service.

Inspection carried out on 22 March 2012

During an inspection to make sure that the improvements required had been made

Both of the people who use services had impaired vision. The person we saw was happy spending time in their bedroom listening to music. Their bedroom was personalised and contained things that was of interest to them like a music system and C.D’s. They were seen to be comfortable in and familiar with their home.

Inspection carried out on 7 June 2011

During an inspection in response to concerns

There were two people living in the service at the time of our visit. Both of them communicated using sounds, body language and by pointing to objects. They were relaxed in their manner and they were confident in the company of staff.

Reports under our old system of regulation (including those from before CQC was created)