St Oggs

St Oggs is a care home for up to 21 people living with a mental health condition and/or a learning disability. At the time of inspection 17 people were using the service.

The service included one large adapted building and a bungalow which could accommodate two people within the same grounds.

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.

This was a large home, with several communal areas for people. The size of the service allowed people to move freely and have the space they needed. The only indication the service was a care home were the industrial bins to the side of the building. Although staff wore clothing and identification badges to indicate they worked at the service, these were covered or removed when supporting people in the community

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

Staff managed the risks to people, however records to support the management of risk needed to be improved. There were sufficient staff on duty at all times. The environment was clean, however aspects of it needed to be decluttered. Improvements had been made to the management of medicines. Records to support the use of when required medicines and medicines for behaviour needed to be more detailed.

Staff had not received regular supervision and they had not completed all of the training required. We have made a recommendation about this. People were supported with their health and well-being needs, however records to support with these were not up to date. The provider had an improvement plan in place to address the updates needed to the environment.

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 did not support this practice because they led staff to carry out mental capacity assessments despite people having capacity.

Some quality assurances measures had led to support being put in place to make improvements, such as with medicines and training. However, quality assurance measures to support the quality of record keeping needed to be improved. Staff at all levels were visible and were open and transparent. Staff worked well with professionals to ensure the needs of people were met.

People received individualised care and support from staff. However, detailed records were not in place to support staff. They did not review people's independence or strengths. Records relating to end of life care had not been completed. People were supported with their social interests. People knew how to raise a concern if they needed to.

Staff treated people with kindness and compassion. People said they received good care and staff knew them well. Staff were responsive when people were distressed. People were involved in their care and staff supported them to understand information given to them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. As a result, people were able to live fulfilled lives and achieve good outcomes in all aspects of their lives.

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 22 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance at this inspection. This included the quality of record keeping and quality assurance measures.

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

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.

St. Oggs is situated in a residential area of Morton, Lincolnshire. The service provides accommodation for up to 21 people whose needs are associated with their mental health. There is a bungalow within the grounds of the home which enables up to two people to live a semi-independent lifestyle. There were 19 people living in the home at the time of our inspection.

There was an established registered manager in post at the time of the 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 2008 and associated Regulations about how the service is run. The registered manager was not available during the inspection. A senior support worker who acts for the registered manager in their absence was available throughout the inspection.

People were happy living at St Oggs. They were supported to maintain a safe lifestyle and have as much control over their lives as they wanted and were able to have. They were involved in planning and reviewing their care and encouraged to express their views about how they wanted to be supported. People were supported to maintain their privacy and were treated with fairness and respect. They were able to express their choices about their leisure time and were supported to maintain their hobbies and interests.

People were supported and encouraged to maintain a healthy lifestyle. They had timely access to the healthcare services they needed. People enjoyed their meals and had enough to eat and drink.

People’s rights were respected in accordance with legislation such as the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the Equality Act 2010. They were supported to make decisions for themselves wherever they were able to do so. Where this was not possible they were supported through a best interests decision making process.

CQC is required by law to monitor the operation of the MCA and DoLS and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way in order to protect themselves. No-one who lived in the home at the time of the inspection required authorised restrictions to their freedom. Staff understood when an application to restrict a person’s freedom may be necessary and they knew how to make such an application.

We found that people had developed trusting relationships with the staff who supported them. Staff had a detailed knowledge of people’s individual needs and wishes and provided support in line with them. Staff recognised the importance of maintaining people’s privacy and dignity and upholding their rights to equal treatment.

Staff were well trained and supported to manage people’s individual needs, and to keep up to date with good practice and relevant legislation. They were able to identify and manage any potential risks to people’s health, safety and welfare. The provider had systems in place to ensure that people were protected from the risk of abuse and staff knew how to contact other agencies to report any concerns of this nature.

The provider had systems in place to ensure that they only employed staff who were suitable and safe to work with people who lived in the home. They and the registered manager ensured there were enough staff with the right skills to provide people with appropriate care and support.

The provider and the registered manager maintained systems to enable people to raise concerns or complaints and have them resolved. People also had opportunities to provide their feedback about the quality of the service by way of questionnaires and house meetings.

Systems were in place to ensure that any shortfalls in the quality of the services provided were identified and improved in a timely manner. The systems included regular audits of the key areas of support and practice.

We found that support workers demonstrated they had a very good understanding of the needs, routines and preferences of the people they cared for. They encouraged people to express their views and ensured people were actively involved in making decisions about their care and support options

People told us they were provided with a good choice and variety of food and drink that met their individual needs. Comments included, 'It's a great place and we are all fed well.'

We found that staff were only employed once an effective recruitment and selection process had been undertaken and people felt the staff had the right qualifications, skills and knowledge to perform their duties.

People told us they felt confident in reporting any issues or concerns to the registered manager and any complaints they might have would be dealt with appropriately.

We spoke with four people who lived at the home and two staff members. We also spoke with the providers Director of Adult Services who was present at the home on the day of our visit. The registered manager was not available on the day so we spoke with her on the telephone.

We saw that people were cared for and treated with dignity and respect. We observed staff communicating with people about activities and support. One person told us "I can make a drink whenever I like.' Another person said 'It is excellent here. I have a very nice room.'

Where appropriate, we found evidence that relatives of people who used the service were involved in reviews about peoples care and treatment.

We also found that the provider monitored the service and gained views on the service from relatives and from people who used the service. This was done by sending questionnaires to families and by enabling people who used the service to complete satisfaction surveys. Regular meetings with people who used the service also contributed information to be used to improve quality.