South Highnam

South Highnam is a residential care home providing personal care to 7 people at the time of the inspection. The service can support up to 8 people with a learning disability.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Staff did not always have complete, up to date information about the best way to support people or how to safely manage risk. People within the service received their medicines as prescribed however support plans, and records to ensure this was done safely were not always in place or accurate.

People were supported by staff to pursue their interests as much as possible. Staffing levels sometimes meant people were not able to go out whenever they wanted to. The registered manager was going to review this.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff enabled people to access specialist health and social care support in the community.

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.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s care needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

People and those important to them, including advocates, were involved in planning their care. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 2 April 2020).

Why we inspected

We received concerns in relation to potential restrictive practices and a failure to raise safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South Highnam on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care, accurate record keeping and effective auditing at this inspection.

We have made recommendations about reviewing staffing levels

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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.

Staff used creative ways to help people understand COVID-19 and to promote handwashing.

The service followed robust procedures for those visiting the service including ensuring that visiting professionals were vaccinated against COVID-19.

Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme had been implemented.

The home was clean and well-ventilated. Staff frequently cleaned high touch surfaces to reduce the risk of spreading any infections.

South Highnam is a detached, eight-bedroom, residential care home providing care for up to eight people living with complex learning disabilities including autism. At the time of this inspection there were seven people living at the service.

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 who used the service and their relatives were happy with the service they received. Their needs were met in a personalised way. Staff were kind, caring and respectful and people had developed good relationships with them.

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 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’s care was based on detailed assessments and person-centred care plans. Risks to people’s safety and wellbeing were appropriately mitigated. People and those important to them had been involved in planning and reviewing their care.

Staff worked closely with other professionals to make sure people had access to health care services. People received their medicines safely and as prescribed. People’s nutritional needs were assessed and met.

Staff enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had effective recruitment and induction procedures to ensure only suitable staff were employed.

People’s independence was promoted. Staff ensured each person felt included and valued as an individual. People were engaged in meaningful activities of their choice. Staff ensured people maintained links with their friends and family.

The provider had a complaints procedure. People and their relatives or representatives felt confident raising concerns. There were systems for monitoring the quality of the service, gathering feedback and making continuous improvements.

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 4 August 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.

At the last inspection in May 2015 the service was rated Good. At this inspection we found the service remained Good.

Staff knew how to keep people safe and prevent harm from occurring. Staff were confident they could raise any concerns about poor practice in the service and these would be addressed to ensure people were protected from harm. Recruitment checks were carried out to ensure suitable people were employed to work at the service. Medicines were managed safely and administered by staff trained for this role.

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. People were supported to have enough to eat and drink and attend appointments with healthcare professionals. Staff had undertaken a structured induction and essential training at the beginning of their employment. This was followed by periodic refresher training and on-going support sessions.

Staff provided care and support with kindness and compassion. There were positive interactions between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say.

Detailed support plans were in place which guided staff how people wished and needed to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. People's independence was promoted and encouraged.

People and relatives spoke positively about the registered manager. The registered manager used a variety of different methods to monitor the quality of the service. A recent audit had been effective in identifying where improvements were needed and generating improvements for the benefit of people who used the service.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We inspected the premises and saw that there were systems and safety precautions in place to protect staff and people using the service. Staff had received safeguarding training and relatives we spoke with told us they thought South Highnam was a safe place for their family member to live. A relative told us, 'He is in a safe and loving environment.'

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been submitted, relevant staff had been trained to understand when an application should be made.

Is the service effective?

People's health and care needs were assessed with them and they were involved in writing their plans of care. Relatives we spoke with told us they were also involved in the planning of care and were invited to assessment meetings. We saw that support plans and risk assessments were up to date and reflected people's individual needs.

Is the service caring?

People were supported by kind and attentive staff. Care records were accurate and up to date. People and their relatives told us they were happy with the care provided at South Highnam. A relative told us, 'We've had no issues with the staff' and 'they are all so dedicated to their jobs.'

Is the service responsive?

People were given the chance to make decisions for themselves. Records showed that people's preferences, interests and needs had been taken into account and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them. People and their relatives knew how to make a complaint if they were unhappy. A relative told us, 'We have no issues with the place.'

Is the service well-led?

The provider gathered information about the safety and quality of their service from a variety of sources. The manager held regular team meetings with staff and asked people and their relatives their opinions on how the service was run. Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.

The service ensured that people's health and well being were promoted because they involved health professionals in people's care planning. Staff also contacted health professionals when people were unwell and made sure people attended medical appointments.

Staff were aware of their responsibilities relating to safeguarding vulnerable adults and had access to a comprehensive policy and contact details for the local authority safeguarding team.

Staff received regular supervisions and annual appraisals. Staff told us that they were supported by the whole team to help them carry out their role. New staff had a full induction and were assessed before being able to support people unaccompanied.

Regular checks on the quality of the service took place and changes were made where improvements were needed.

Records used by the service were stored securely, up to date and fit for purpose.

Records used by the service were detailed and person centred so they ensured that staff were aware of the needs of people and how they should be supported. However some records had not been reviewed within the last six months and therefore there was a risk that they did not accurately reflect the support people needed.

We saw evidence that family members were happy with the care and support their relatives received. There were a number of different ways that relatives and people who used the service could make their concerns, complaints and compliments known. There had been no complaints made about the service within the last 12 months however the service had a complaints policy and people could be assured that any complaints would be investigated appropriately.

Staff employed by the service had the relevant skills and experience to support people who used the service and pre employment checks had been carried out. Where specialist equipment was used, staff had received training in how to use it and all equipment had been serviced, maintained and checked for wear and tear correctly.