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Disabilities Trust - 22 Woodlands Road Good

Reports


Inspection carried out on 17 August 2017

During a routine inspection

The inspection took place on 17 August 2017 and was announced. Disabilities Trust - 22 Woodlands Road provides accommodation with personal care for up to three people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were three people living there.

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 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.

We last inspected the service in June 2016 and found that medicines were not always safely managed. We also found that the systems in place to monitor the quality of the service had not been analysed to identify areas for improvement. At this inspection we found improvements had been made. People’s medicines were managed safely and there were systems in place to monitor the quality of the service and to highlight where action was needed.

Relatives said they were confident that the service was safe. Staff were aware of their responsibilities to keep people safe. Risks to people's safety were appropriately assessed and managed.

Staff understood how to identify any safeguarding concerns and knew the process of reporting such concerns. Medicines were administered, recorded and stored in line with current guidelines.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to keep people safe.

The registered manager was knowledgeable about The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The MCA Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

Records showed that staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People had regular access to healthcare professionals. People’s individual preferences regarding food were always taken into account and they were supported to eat a healthy diet.

We observed that people had positive relationships with staff and were treated in a caring and respectful manner. Staff delivered their support in a calm, relaxed and considerate manner. People and their relatives were actively encouraged to participate in the planning of people’s care. Staff were empathic when dealing with people's privacy and dignity.

We found the service was extremely responsive in promoting a person-centred lifestyle. Optimising communication was seen as key to making a difference to people’s quality of life. People were supported by staff that were proactive in finding imaginative ways to help achieve their goals. Care plans were person-centred and ensured the care and support suited people’s needs and expectations. People’s own preferences were reflected in the support they received.

The management encouraged, appreciated and acted on people's and relatives’ opinions on the service. Such information was used to implement changes and enhance the functioning of the service. People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service. There were systems and processes in place to help monitor the quality of the care people received.

Inspection carried out on 14 June 2016

During a routine inspection

The inspection took place on 15 June 2016 and was announced.

Disabilities Trust - 22 Woodlands Road provides accommodation with personal care for up to three people with learning disabilities or autistic spectrum disorder.

There was no registered manager in post at the time of our inspection. 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. The provider had appointed a manager who was due to start at the service in July 2016. The new manager would be applying to register with CQC. 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.

Relatives we spoke with were positive about the team leader and assistant manager who were responsible for the management of the service. Relatives gave many examples of person-centred care and it was clear that people were at the centre of all the service did.

Medicines were not always managed safely and systems in place to monitor the quality of service had not identified the issues found in relation to medicines management. Questionnaires to monitor the quality of the service were sent out to people and staff, however there was no system to identify areas for improvement. There were sufficient staff deployed to meet people's needs.

Staff were knowledgeable about their responsibilities to identify and report concerns relating to safeguarding vulnerable people. The provider had a safeguarding policy and procedure in place. Any safeguarding concerns were investigated appropriately. The provider carried out safe recruitment practices to ensure staff were suitable to work with vulnerable people.

People's care records were personalised and where risks were identified plans were in place to manage the risks. Care records identified the importance of positive risk taking and promoting independence. People were supported to maintain relationships with people who were important to them and had access to activities that interested them. People were encouraged to eat a healthy diet and were involved in shopping and cooking.

Staff had the skills and knowledge to meet people's needs and were supported through regular supervision and training. People were supported by staff who were caring and knew them well.

Staff had a clear understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People were supported in line with the principles of the act and where people were assessed as lacking capacity, decisions were made using a best interest process.

Inspection carried out on 17 July 2014

During a routine inspection

22 Woodlands Road is a residential care home providing care and accommodation for up to three people who have autism and accompanying learning disabilities. On the day of our inspection three people, who were all female were living at the home. During the inspection we were unable to communicate directly with people that used the service but observed the care people received and interactions with care staff. We also conducted a SOFI (Short observational framework for inspection). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with two people�s relatives and looked at three people�s care files. We spoke with five staff including three care workers the senior team leader and the registered manager. We reviewed documents made available by the provider. One inspector carried out this inspection. The focus of the inspection was to answer five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and/or what we observed as well as records we looked at.

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

Is the service safe?

We found this service was safe. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in safeguarding.

Care and treatment was planned and delivered in a way that was intended to ensure people�s safety and welfare. We looked at the care file of one person who �presented behaviours of concern�. We saw that the psychologist had been involved in creating this persons support plan.

Is the service effective?

We found the service was effective. People who used the service were given appropriate information and support regarding their care. We saw that care guidelines were clearly explained in people�s files and families were actively encouraged to participate in maintaining this information. We also saw that the service had regular �interaction meetings� throughout the week. These meetings enabled the people that used the service to make key decisions about their immediate environment and the running of the home. People were also supported in promoting their independence and community involvement.

Some people didn�t have the mental capacity to give informed consent. The provider had ensured that arrangements were in place to ensure that decisions made in relation to consent were lawful.. We saw that capacity to make decisions in relation to activities of daily living had been assessed on arrival and this was reviewed annually. Capacity assessments were conducted by the organisations psychologist. Where people were assessed as lacking capacity to make decisions, best interest meetings were held. These involved family members and other professionals. People�s files contained goals that encouraged community involvement and maintained their independence. These goals were created with the person and the person�s relatives and were reviewed monthly.

Staff we spoke with felt supported and received regular training. Staff had access to appropriate professional development.

Is the service caring?

We found the service was caring. People�s relatives felt people were well cared for. One person�s relative told us, �care is what they are all about, staff are very caring and committed�. Another relative told us, �as soon as you walk in you can see there is not only care but love in the home�.

Throughout our inspection we saw that people were both respected and involved. We observed a number of respectful and meaningful interactions throughout the day as people walked freely around their home. For example, people who used the service were supported to access the garden swings and enjoy playing with activities in the lounge. One person�s relative told us, �we are very, very pleased, it answered our prayers to find somewhere that respected our daughter as an individual�.

Is the service responsive?

We found the service was responsive. People expressed their views and were involved in making decisions about their care and treatment. People and their relatives were involved in developing support plans. They attended regular reviews along with a multi-disciplinary team that included key care staff and a psychologist. We saw in care files that people�s relatives were actively involved in the ongoing review process and were encouraged to engage. Annual reviews showed the same level of involvement. One person�s relative told us, �the reviews are very good and very clear, they focus purely on our daughter, we can�t fault them�.

We saw that when people�s care needs changed the service responded. For example, we saw that one person had started to become restless at night and presenting behaviour that challenged and put them at risk. We saw that the service had involved family and the psychologist in creating a support plan for these occurrences. The plan contained clear guidance for staff. Staff we spoke with were able to tell us about this plan and how they would respond. This meant this person was protected from the risks of inappropriate care and treatment.

Is the service well led?

We found this service was well led. The provider had an effective system to regularly assess and monitor the quality of service that people receive. The home had a series of audits carried out by a number of different staff within the organisation. Monthly Provider audits were conducted by other service managers within the organisation. These audited care files, people finances, medication and staff training. Where issues were identified the manager took appropriate action.

Inspection carried out on 4 January 2014

During a routine inspection

At the time of our inspection the provider did not have a registered manager in post.

We used a number of different methods to help us understand the experiences of people who use the service. This was because the people who use the service had complex needs which meant they were not able to tell us about their experiences. We spent time observing what people did during the day. We also used observations of the interactions between people who use the service and the care workers to inform the judgements reached within this report.

We found people were provided with a choice of suitable and nutritious food and drink. We saw that people who use the service were able to choose what they ate and drank. People could choose from a menu with suggested options for the week or they could ask for an alternative meal of their choice .

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We saw the provider had invested in the estate to ensure the premises were fit for purpose for people who use the service.

We found there were effective recruitment and selection processes in place. We spoke with the service manager who confirmed that new applicants were required to complete an application form and provide a CV, undertake an interview and provide necessary documentation prior to being offered a position of employment with the home

At this inspection we found there were enough qualified, skilled and experienced staff to meet people�s needs. We looked at the staffing levels for the location.

People�s complaints were fully investigated and resolved, where possible, to their satisfaction. We saw the provider had a robust complaints management mechanism in place based on an extensive policy which was reviewed regularly.

Inspection carried out on 17 September 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke to relatives of two people who told us of a consistent approach by staff and of a family atmosphere within the home.

One relative said, �The manager is great, we are very fortunate to have her and her team looking after our daughter�. Another relative said, �We are very pleased with our daughters support plan and the way this is adapted to suit her needs".

We spoke with relatives about the numbers of staff to support people living in the home. Relatives told us that they have observed a decrease in staff numbers at the weekend, mostly to one staff on Sundays. They told us they were confident staff had the experience and skills to manage people's behaviours presented as challenging. They told us staff have always kept them informed and were confident staff would tell them if they had any concerns.

We spoke with staff and looked at people's support plans and supporting documents that included staff rotas. We found there were not always enough staff to meet people�s needs, and this had placed people at risk.

The home had a good system of quality monitoring, but this had failed to note staff numbers were decreased mostly at the weekend and had put people at risk.

Reports under our old system of regulation (including those from before CQC was created)