Archived: Belstead Villa

Belstead Villa provides accommodation, care and support for up to four adults with a learning disability, autistic spectrum conditions and associated complex needs. There were four people living in the service when we inspected on 24 January 2020.

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 were supported by sufficient numbers of staff that had been recruited safely and had checks undertaken to ensure they were suitable for their role. People had their medicines on time and all areas of service were clean and tidy.

Staff had suitable training and experience. People had their health needs identified and supported. Menus were flexible and based on people's likes and dislikes. The staff team were aware of their responsibilities under the Mental Capacity Act 2005. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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.

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 received a service that was caring. Staff knew people well and treated them with respect and kindness. Staff knew people's needs well and were responsive and supportive.

The service was well managed by a very experienced registered manager. They involved people, staff, and relatives in the way it was run and kept them up to date with developments, progress and changes. The registered manager was proactive in researching the latest developments in support for people who have a learning disability and/or autism.

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 18 August 2017). You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Belstead Villa on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

At our last inspection 14 April 2015 we rated the service as overall good, however well led was rated as requires improvement. At this inspection we found that previous shortfalls in this area such as not having a registered manager had been addressed and effective systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. These improvements contributed towards people consistently receiving safe, effective, compassionate and high quality care.

A registered manager was 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.

The atmosphere in the service was friendly and welcoming. People received care and support that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with them in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences. Relatives were complimentary about the care provided and the approach of staff and the registered manager.

People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk. Regular assessments had been carried out and care records were in place which reflected individual needs and preferences.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. Retention of staff was good and supported continuity of care.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with relevant professionals to maintain their health and well-being. Where people required assistance with their dietary needs there were systems in place to provide this support safely.

People and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Staff listened to people and acted on what they said.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Staff understood the need to obtain consent when providing care. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice

People were encouraged to maintain relationships that mattered to them such as family, community and other social links. They were supported to pursue their hobbies and to participate in activities of their choice. This protected people from the risks of social isolation and loneliness.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. There was visible leadership within the service and a clear management structure.

Effective systems and procedures had been implemented to monitor and improve the quality and safety of the service provided. Identified shortfalls were addressed promptly which helped the service to continually improve.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

Staff were knowledgeable in safeguarding vulnerable adults procedures and were able to recognise signs of potential abuse. The service had a system to respond to allegations of abuse and had details of the local safeguarding team.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications had needed to be submitted.

Is the service effective?

The staff had the skills and experience required to meet the needs of people who used the service. The team had access to training courses to update their knowledge and become familiar with any changes in policies or procedures. Staff told us that they had access to training and had attended training in the past year.

The service undertook assessments with the people who used the service or a relative prior to admission to identify their support needs.

Is the service caring?

People who used the service or a relative were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. Staff told us, "We always ask [people who used the service] what they want."

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People's individual needs were assessed and staff were aware of their needs.

Is the service well-led?

We saw evidence that there were processes in place to monitor and improve the quality of service delivery.

We saw from a review of records that the provider had taken steps to assess and manage risk relating to the health, safety and welfare of people who used the service. We saw that care planning took account of people's rights to choice and supported the planning of their lifetime goals and aspirations.

We observed staff interacting with people and saw that interactions were positive. Staff were seen to promote people's independence, offering people choices which were respected.

We looked at recruitment records for four members of staff. We saw that the provider had effective recruitment and selection procedures in place.

As part of our inspection we carried out a tour of the premises and reviewed records in relation to maintenance of the building including health and safety. We found that the provider's management monitoring systems ensured that people lived in a safe, well maintained environment.

We looked at the care records of four people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

In this report the name of a Registered Manager, Adele Irons, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.