Four Winds

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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

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There was a registered manager in post. 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.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff understood what action they should take if they were concerned people may be at risk. The registered manager informed us a current safeguarding investigation was being undertaken and the service was liaising with the local authority. Appropriate action had been taken to ensure people remained safe.

The provider ensured sufficient numbers of staff had been subject to pre-employment checks were deployed in the service. Trained staff safely managed people’s medicines. There were processes in place to protect people from the risk of acquiring an infection. Accidents and incidents were analysed for trends by the registered manager and provider and lessons learnt to reduce instances of accidents or incidents occurring again.

Staff were well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively. 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. Menus were planned with input from people, based on their personal preferences and choices.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were all supported to contribute and to be part of the local community. We found care plans were in place which included information about how to meet a person's individual and assessed needs. People's cultural and religious needs were respected when planning and delivering care. The service had a complaints procedure in place.

Staff told us the registered manager was approachable and supportive. The service had various quality assurance and monitoring mechanisms in place.

Further information is in the detailed findings below.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived at the service indicated and staff told us people were safe. There were systems and processes in place to protect people from the risk of harm. These included safe staff recruitment processes, staff training and systems for protecting people against the risk of abuse. There were procedures in place for managing medicines safely.

Staff were caring and supportive to people throughout our visit. There were enough suitably trained staff to meet their individual care needs. We saw staff spent time with people and provided assistance to people who needed it. Staff were available to support people to go on trips or visits within the local and wider community.

Training was available to ensure that staff had the necessary skills and knowledge to be able to support people appropriately and safely. There were systems in place to ensure that staff received support through supervision and an annual appraisal to review their on-going development.

Staff understood they needed to respect people’s choice and decisions if they had the capacity to do so. Assessments had been made and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were taken in ‘their best interest’ with the involvement of family members where appropriate, and relevant health care professionals. This meant the service was adhering to the Mental Capacity Act 2005. Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people. People were supported effectively with their health needs and had access to a range of healthcare professionals. People were involved in making decisions about what kind of support they wanted where they were able.

People had developed caring relationships with staff and were treated with dignity and respect. Staff told us they valued the people they cared for and strived to provide a high quality of care. Staff were caring and we saw positive interactions between staff and people. People, where able were enabled to have choice and control over the things that were important to them.

The manager was a visible presence within the service and welcomed open and transparent communication processes. People, relatives and staff were confident that they could raise concerns or complaints and they would be listened to. Staff and relatives felt able to speak with the manager and provided feedback on the home. They knew how to make complaints and there was a complaints policy and procedure in place. We found complaints were dealt with appropriately and in accordance with the service’s policy.

There were effective systems in place to monitor and improve the quality of service through feedback from people who used the service, staff meetings and a programme of audits and checks.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Staff had

received appropriate training and guidance. Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person said, "I feel my relative is safe here."

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well. Relatives we spoke with told us that, "Staff had excellent knowledge about the people they support."

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The training that staff had received equipped them to meet the needs of the people who used the service. Staff were aware of people's preferred method of communication such as pictures and symbols that they used to obtain people's consent before providing care and treatment.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said, "The staff worked well with my relative they listen to their wishes.'

Is the service responsive?

The manager had regular contact with the relatives of people who used the service. People told us that they had specific agreements regarding frequency of contact. Both relatives told us that the communication between them and the staff was excellent.' Where shortfalls or concerns were raised these were addressed promptly.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One relative told us, 'The home had arranged for a dietician to be involved in developing a healthy eating plan for my relative.'

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

Care plans were individual to people and up to date. We found that people were supported to access a range of activities that promoted their well-being and independence. We also found that safeguarding procedures were in place.

We saw that there were enough trained staff to meet people's needs and the provider ensured their continuing professional development. Overall, the wide variety of records we reviewed during our inspection were accurate, accessible and held securely.

We observed that the staff interacted with people in a friendly, respectful and professional manner and were attentive to people's needs. We saw that staff sought people's agreement before providing any support or assistance. The people we saw were relaxed and engaged with their surroundings.

We saw that appropriate measures were taken to ensure that the people living in the service, their visitors and the staff were protected against the spread of health care associated infections.

People were encouraged and supported to make complaints. We saw that complaints that had been received were dealt with in line with the provider's complaints procedure. Staff on duty told us that they tried to ensure that complaints were dealt with informally.