Archived: St David's APL

St David’s APL is a residential care home that provides care for up to nine people who have a learning disability or autism spectrum disorders.

There were six people using the service at the time of our visit.

The care service was meeting 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 and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People lived in a happy and caring environment and had warm and friendly relationships with the staff who supported them and with each other.

People felt safe at the service and told us staff were always kind. One person said, “They’re [staff] very good to me, I like all of them.”

There was a strong person-centred culture. Staff knew the needs and preferences of people well. Staff had developed very positive relationships with people and were seen to display kindness as well as compassionate support to people.

People received personalised care and support which was in line with their care plan. People's privacy and dignity was respected, and independence promoted. Staff were committed to improving the quality of life and opportunities available for people.

People were protected by staff who understood how to protect them from avoidable harm. The risks to people’s health and wellbeing were assessed and action taken to reduce them. There were enough staff deployed to keep people safe. People’s medicines were well managed, and staff understood how to reduce the risk of the spread of infection. There were systems to learn from mistakes including the detailed analysis of accidents and incidents.

Staff understood and respected people's right to make their own decisions where possible and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements.

People knew how to make a complaint and they were confident about complaining should they need to.

People were supported by staff who had received appropriate training to carry out their roles. Staff had access to a wide range of training, including training to meet people’s specialist needs. This meant people could be confident that staff had the skills needed to effectively and safely support them.

The registered manager was described as supportive and approachable. They demonstrated a good understanding of their roles and responsibilities as a registered person. The registered manager promoted an open and inclusive culture and worked in partnership with external agencies to ensure people received the care and support they needed.

Staff told us they enjoyed working at the service and felt respected and valued. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

Rating at last inspection: At the last comprehensive inspection the service was rated ‘Good’ overall with ‘Requires Improvement’ in ‘effective’. (report published 24 October 2016). A focused inspection took place on 23 March 2017 where the rating in ‘effective’ was rated as ‘Good’.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

St David’s APL (Active Programmes for Life) provides accommodation and support for up to nine adults with a learning disability or autism. At the time of the inspection the home was fully occupied. People had complex care and communication needs due to their learning disabilities and this meant we could not talk fully with everyone who lived at the home. We therefore used our observations of care and our conversations with staff and people’s relatives to help us understand their experiences.

The service had a registered manager. 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.

During our inspection we saw staff providing care of a good standard and people were relaxed and happy. However, there were some areas of care that required improvement.

The Mental Capacity Act (2005) and deprivation of Liberty Safeguard were not fully understood or being implemented by the registered manager or staff. This meant people’s legal rights may not be fully protected. The registered manager took immediate steps to remedy this. By the second day of our inspection, all staff were booked on to appropriate training, provided by the local authority, to ensure their knowledge and practice was brought up to date.

People’s freedom of movement around the home was restricted as the dining room and kitchen, which were joined, were locked unless there was a member of staff present. The registered manager told us this was to manage possible risks for one person in relation to the kitchen area. However, the impact of this was to restrict access to communal areas of the home for everyone. The registered manager and provider told us they would cease this practice and focus on managing individual risks in the kitchen area. They said they would review how the two rooms were joined to ensure the risks for the individual concerned were managed in a way which did not put restrictions upon others living in the home.

Records showed each person had assessments of potential risks to their health and welfare. Where risks were identified, care plans or ‘personal profiles’, were in place that gave guidance for staff about how to reduce the risk. Staff had a high level of knowledge about people’s individual care needs and were skilled at meeting people’s complex needs. However, this level of knowledge was not always reflected in people’s care records. For example there was little guidance for staff regarding how to meet one person’s complex communication needs. We saw no detrimental impact on people from this, but the care records would not necessarily provide sufficient detailed guidance for a new member of staff or agency staff to be able to fully meet a person’s care needs. We discussed this with the registered manager who told us they would seek up to date guidance regarding best practice in relation to care planning and review all records to ensure they reflected this.

People appeared relaxed and comfortable living at St David’s; smiling and responding warmly to care staff. This indicated they felt safe and secure within their home. One person said “Staff are 100% kind”. Relatives told us they were very happy with the care provided. One person’s relative said “[Name of relative] wouldn’t be there for a second if I had any qualms about his safety. I am confident he’s as safe as he can be living at St David’s”. Staff received training in safeguarding adults and knew how to raise concerns if they were worried about anybody being harmed or neglected.

The culture of the home was person-centred open and friendly. Staff treated people with kindness and respect and offered people choice in all aspects of their care. For example in relation to meals, bedtimes, activities and how people liked to spend their day. Staff worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their own care as fully as they were able. Staff ensured people's privacy and dignity was respected at all times. They always checked with people before providing care or support and respected people’s decisions.

People’s relatives said they were made very welcome and were free to visit the home as often as they wished. They said the service was very good at keeping them informed and involving them in decisions about their relatives care.

People were engaged in a variety of activities within the home and in the community and there were sufficient numbers of staff to support this. People were encouraged to be active and maintain their independence as far as they were able and to be part of the local community. This helped ensure people experienced a good quality of life.

We observed medicines being administered and this was done safely and unhurriedly. Staff received regular training in medicines management and medicines audits were completed to ensure consistent safe practice. People were supported to maintain good health by external health and social care professionals where necessary.

There were enough care staff to meet people’s complex needs and to care for them safely.

Recruitment processes ensured that suitable staff were employed. Staff were well supported by the registered manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relevant to people’s care needs, including diabetes, epilepsy, person-centred care and first aid. The registered manager recognised that staff would benefit from specific training in autism and had made arrangements with the local learning disability team to access this.

People were supported to eat and drink enough to ensure they maintained good health. We spoke with people about their meals and observed the lunchtime meal and saw everyone enjoyed the meals provided and staff supported people appropriately.

There was an ongoing programme of maintenance at the home with work going on at the time of the inspection to replace carpets and refurbish some rooms. The home was clean and odour free. The home was decorated and furnished in a comfortable, homely way. The service had sought input from a specialist healthcare professional to assess the suitability of the environment for people with autism and whether any adaptations were needed. This work was planned but had not happened at the time of the inspection.

There was clear leadership from the registered manager and people and relatives had confidence in them. Quality monitoring systems were in place to help the service to maintain standards of care and to promote continuing service improvements. However these had not identified the issues we found during the inspection. We discussed why this might be with the registered manager. They were open and honest in their appraisal of the situation and acknowledged they had fallen behind.

We identified one breach of regulation at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found improvements had been made. We looked at staff recruitment files which contained all of the required information. The registered manager had introduced a checklist to ensure they carried out all relevant checks when they employed support workers. This meant people who lived in the home were protected from the potential risk of harm.

Staff were knowledgeable about people's personal, behavioural, social and health needs. Staff knew the content of people's plans of care and how to put the guidelines that these plans contained into practice demonstrating they understood the care plans.

We saw that the service had taken into account the different needs of people living in the home by ensuring that information was provided in different ways. User friendly formats were used for the activities timetable and the complaints procedure as well as words.

Appropriate arrangements were in place in relation to obtaining, storage, administering and disposal of medicine. We saw that the medication keys were stored securely in the key-box in the office.

There were no effective recruitment and selection processes in place. We looked at recruitment files for five staff members. We found that four out of the five files had absences in the documentation.

The provider had appropriate systems in place to address complaints.

Comments from staff included 'I would not to work in care if it wasn't here' and I don't know what I would do if I did not work here'.

People said they felt safe and that support workers were 'fun' and 'great'. People told us they enjoyed living in this home. They said they liked the emphasis on physical activity and on doing different activities. People told us they played football, went to pubs and clubs, went out for meals and trips, and went rock climbing and on holiday.

Support workers were employed in sufficient numbers, and received training and supervision to support them to meet people's needs. Training included safeguarding vulnerable adults, first aid, managing challenging behaviour and food hygiene.

Systems were in place to monitor the quality of the service provided and to assess and manage risk. People told us they felt fully involved in the running of the home. They said it was like living with family.