Archived: Priory Radstock Satellite

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

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe and had a good relationship with staff. Staff felt confident to raise safeguarding concerns with the registered manager and were aware of external agencies where they could report concerns.

Staff supported people to manage their medicines safely. There were enough staff available to support people safely and ensure people that needed support to access the community could do so. Staff were recruited safely. Risks to people were identified and guidance was in place for staff to reduce the level of risk to people.

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. Where required, capacity assessments were completed and there was an effective system to monitor Deprivation of Liberty Safeguards applications and authorisations.

Staff received training and were knowledgeable about their roles and responsibilities. Staff had the skills, knowledge and experience required to support people with their care needs. Staff received one to one supervision and told us they felt supported.

Support plans were detailed and reviewed regularly. People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.

People were supported by caring staff who worked towards promoting their dignity, privacy and independence.

There were systems to ensure care was responsive. People said their concerns and complaints would be listened to and responded to.

People gave us positive feedback about the quality of care they received. The feedback on the leadership of the service and the registered manager from people and staff was positive.

There were effective governance systems in place to monitor the quality of service and the health, safety and welfare of people.

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 requires improvement (published 20 March 2019). At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 17, (Good governance).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 undertook an unannounced focused inspection on 15 February 2019. This inspection was undertaken due to whistleblowing concerns we had received. This report only covers our findings in relation to those concerns.

People’s experience of using this service:

A culture had developed at the service where staff did not always have professional boundaries and some staff did not understand the impact their conversations could have on people. People were, however, supported to receive care and live their lives in the way they wanted.

We found shortfalls in leadership and oversight of the service. Staff could not be sure they were consistently told about events in people’s lives which were important. Information in care plans and risk assessments was not always updated; staff may not always have had accurate information.

Staff received supervision but not always with the same person which meant the culture that had developed amongst some staff had not been identified and addressed quickly.

Systems and processes to monitor the effective running of the service had not been operated consistently. Records were disorganised and some audits and information could not be found.

Rating at last inspection: Good (report published 17 October 2017).

Why we inspected: We inspected following concerns raised to us by staff who worked at the service.

Enforcement: We found one breach of The Health and Social Care Act Regulations (2014). Further information is at the end of the report.

Follow up: We will ask the provider to send us a report setting out how they will improve.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to cook their own meals. 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.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. People were supported to follow their own activity programmes. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home continued to be well led. People and staff spoke highly about the management. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The service met all relevant fundamental standards.

We spoke with the one service user who was using the service. He told us that 'I decide what I do each day. I have a timetable which I have agreed with my keyworker and it helps me work towards independence'. He also told us 'I agree to see a psychologist and a doctor when I need to do this; in fact nothing is arranged without my agreement'. We also saw that there was good documentation of the consent to care, treatment and support received by the people who used the services.

We saw that care and support was centred on people as individuals and considered all aspects of their circumstances. We observed one case file for the person using the service where we saw individual care plans for a number of aspects of their care such as personal care, self-medication, cooking, cleaning, independent travel, physical health and contact with family.

We saw that risks have been identified, managed and reviewed.

We found that the provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. We spoke to one person using the service who told us that he was very pleased with his accommodation.

We saw that the service had effective recruitment and selection procedures in place.

We saw that there was system for monitoring quality of service delivery which included surveys and audits.