On this routine unannounced inspection we spoke with the five people living at Stafford Avenue, two relatives, two members of staff and the manager.
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, effective, caring, responsive and well led?
Below is a summary of what we found:
' Is the service safe?
Robust safeguarding procedures were in place. Staff understood their role and were able to tell us how they would report any concerns regardless of how minor they may seem. Staff understood how to safeguard people from potential harm.
Restraint is sometimes necessary to protect people from harm. It is used only as a final option when other methods have failed. Incidents had been clearly recorded, reviewed by the manager and the provider. Checks ensured that restraint was lawful and not excessive.
Policies and procedures were in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This applies where a person's liberty may be restricted, usually to protect themselves or others. No applications had needed to be submitted in relation to DoLS. Staff had been trained to understand when an application should be made to protect people.
The provider made all the appropriate checks on staff before their full employment commenced. This protected people from unsuitable staff and potential harm.
' Is the service effective?
People had been involved in establishing their personal plans of care. Plans had been reviewed regularly involving the person, their representative, staff and other professionals involved in their care. This meant people's current needs were recorded and known to staff.
Each person had a health action plan to promote their health and wellbeing. We saw that a range of external health professionals had been involved in assessments and provided treatment plans to ensure people's health care needs were met.
People had been asked to sign to confirm their consent to some aspects of care, however they had not signed their care plans giving consent to care, treatment and support. The provider is asked to note that people should give consent to all aspects of care, treatment and support before it is undertaken.
' Is the service caring?
Staff engaged in meaningful conversation with people and treated them with dignity and respect. We saw that people were responsive to this. We observed examples of staff successfully using diversionary methods to avoid potential difficult situations when people's behaviours changed.
A relative we spoke with told us, 'This is the best care that X has had. Staff are friendly and provide excellent care. X is strong-willed but staff know how to deal with this. X is settled and very happy'.
People's preferences, choices, interests and aspirations had been recorded and were known to staff. Care and support had been provided in accordance with people's wishes,
' Is the service responsive?
People had access to activities that were important to them and that they enjoyed. They had been supported to maintain relationships with their friends and relatives. A search for a former friend of a person without relatives had been pursued and contact established. This had been a positive factor in the life of the person.
We saw that minutes of staff meetings and residents meetings had been actioned to improve the quality of the service.
People using the service and relatives were aware how to make a complaint. There was a pictorial complaints procedure so that people understood the message. The procedures stated how complaints would be handled. No complaints had been received since our last inspection
' Is the service well-led?
Regular staff meetings had been held. Staff felt able to raise any concerns in meetings, supervision or on demand day-to-day. Staff told us that the manager or senior person was always available to them.
The provider has a quality assurance system in place. Records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.
Staff told us they had a comprehensive training programme that equipped them well to meet people's needs. They said that they were clear about their responsibilities and they had a good understanding of the ethos and values of the service.