St Brigas Residential Home For Adults with Learning Disabilities

We found the following examples of practice that required improving

During our inspection we found some improvements were required to how Personal Protective Equipment (PPE) was disposed of. As not all clinical waste bins were pedal bin types. This meant people and staff could be exposed to a risk of cross infection. People during our inspection did not always have access to paper hand towels. Staff were responsible for ensuring paper hand towels were topped up when supplies run out. Records confirmed staff had been re-filling paper towel dispensers daily however on the day of our inspection we found not all communal bathrooms and toilets had paper hand towels available for people to use.

We found the following examples of good practice

People were being supported by staff who had received training in infection prevention control. People were supported by staff who had a good understanding of how to use (PPE) safely. Throughout the home staff had access to personal protective equipment and hand sanitiser. People were encouraged to wear a surgical face mask whilst attending activities or within the local community. Risk assessments had been completed identifying individual risks relating to Covid-19 and how their care and support should be provided whilst accessing their local community.

People were supported to keep in regular contact with their loved ones. This was through phone calls, newsletters, emails, face to face meetings and home visits. People and relatives were happy with the visiting arrangements in place. One person when asked if they speak to their family, replied, “Yes, my dad”. Another person said, “I speak to my mum”. One relative told us, “I’ve been to visit, they keep us up to date. Very very pleased. Very good can’t fault them”.

Another relative told us, “They put a visiting pod back last year, that worked well”. Another relative said, “The key worker kept me up to date. Fabulous can’t fault them”. Risk assessments and policies were in place for visiting.

Systems were in place to ensure visitors and health care professional visits were undertaken in line with government guidance. This included showing a negative lateral flow test, having their temperature checked and asking if the visitor or health care professional could have been exposed to Covid-19 in the last 2 weeks. One health care professional told us, “There is a procedure in place to check vaccination status and lateral flow testing”. Records confirmed these checks were completed by the service.

People were happy with their care and support. One person when asked if they were happy living at St Brigas Residential Home For Adults with Learning Disabilities replied, “Yes”. Another person when asked if they felt safe, told us, “Yes”. People and staff had received their Covid-19 and flu vaccinations. Where people lacked capacity to make decisions relating to vaccines, best interest decisions had been made with relevant health professionals and or family members. Relatives confirmed their views had also been sought. One relative told us, “They kept me updated and asked me about [Name] having their vaccines and flu jab. I was really glad”.

People were supported by regular staff who knew them well. Staff were flexible at undertaking additional shifts if the situation arose. Staff morale was good, and staff felt supported by the management team. One member of staff told us, “Moral is really good. Staff support is really good, we’ve all pulled together”. Another member of staff told us, “We’re really lucky. We don’t use agency staff”.

The service is 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 17 people. 16 people were using the service. This is larger than current best practice guidance. Although the size of the property didn’t seem to affect the service they received the building was identifiable as a care home. Identifying signs included the front gate being locked, and industrial bins indicating it was a care home. Staff wore normal clothing that helped not to identify the home as a care home.

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

Staff and people felt the service was safe. Staff had a good understanding of abuse and most knew who to go to if they had concerns. People received their medicines safely and by enough staff to meet their needs. People and staff had access to effective hand washing facilities. Improvements had been made to the environment including covering radiators and checking hot water temperatures.

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 were supported by staff who felt supported and who received regular supervisions, training and an annual appraisal. People’s nutritional needs were met including an appropriate diet to meet their individual needs. People were supported with accessing health care professionals when required and they received an annual health check. People’s rooms were personalised including the décor and pictures and photos.

People were supported by staff who were kind and caring. Staff promoted people’s independence, gave people choice and control and encouraged people to maintain relationships that were important to them.

Care plans were person centred and confirmed people’s like, dislikes and routines. Regular reviews were undertaken to ensure care and support was still adequate. People were happy with their care and the service had an easy read complaints policy.

Rating at last inspection

The last rating for this service was requires improvement (published 11 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found most improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

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 Brigas provides accommodation and personal care for up to 17 people with learning disabilities. At the time of the inspection there were 16 people living at the home. We undertook this unannounced inspection of St Brigas on the 9 and 11 April 2018.

The care service is not in line with the values that underpin the Registering the Right Support and other best practice guidance. This is because the service is currently registered for 17 people which is over our best practice guidance of registering six people or less.

At the last inspection the service was rated as Requires Improvement. At this inspection we found the service remained Requires Improvement.

At our last comprehensive inspection we found two breaches of legal requirements. We used our enforcement powers and served a Warning Notice on the provider following this inspection. This was a formal notice which confirmed the provider had to meet the legal requirements. We followed up this warning notice and found some improvements had been made but there was still a breach of legal requirements. At this inspection we reviewed these breaches and found improvements had been made in following the principles of the Mental Capacity Act. However quality assurance systems had failed to assess, monitor and mitigate risks relating to the health, safety and welfare of service users which arise from carrying on the regulated activity.

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.

People could be at risk of cross infection, due to lack of liquid hand soap and paper towels at the point of care.

Environmental risks to people posed by hot surfaces and the lack of checks to hot water temperatures were not managed in line with the Health and Safety Executive’s guidelines.

People received their medicines when required although medicines were not always stored at the manufacturer’s recommended temperatures. Medicines records did not always reflect the person had received their topical medicines and medicated toothpaste as required.

People's care plans contained guidelines for staff to following relating to people's individual needs and risk assessments were in place.

People were support by staff who had suitable checks prior to working with vulnerable people.

People were supported by staff who were able to identify abuse. People and relatives felt staff were kind and caring and relatives felt able to visit whenever they choose.

People were supported by staff who had received supervision and an annual appraisal and training to ensure they were competent in their role. Staff and relatives felt able to raise any concern with the registered manager and that they were approachable.

Staff demonstrated how they provided people with privacy and dignity.

Care plans had important information relating to people's individual needs, although information could be recorded about people's individual end of life wishes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

St Brigas Residential Home for Adults with Learning Disabilities provides accommodation and personal care for up to 17 people with learning difficulties, autism spectrum disorders, mental health conditions and other complex diagnosis.

At the time of the inspection there were 15 people living at the home. The accommodation is arranged over three floors with some office space at the top of the house. There is an area set up as a day centre on the ground floor which includes a kitchen, art room and music room. In the residential part of the ground floor there are a number of communal spaces including a lounge, further kitchen, wet room and dining room.

A registered manager was responsible for the service. This 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 carried out a comprehensive inspection of this service on 12 and 14 October 2016. Breaches of legal requirements were found as there were ineffective quality assurance systems in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we used our enforcement powers and served a Warning ¿Notice on the provider on the 18 November 2016. A Warning notice is a formal notice which confirmed the ¿provider had to meet the legal requirement in relation to effective ¿quality assurance systems, by 22 February 2017.¿

We undertook this focused inspection to check they now met this legal requirement. This ¿report only covers our findings in relation to these requirements. This means the rating of these key questions remain the same. ¿You can read the report from our ¿last comprehensive inspection, by selecting the 'all reports' link for on our website at ¿www.cqc.org.uk

We found some actions had been taken to improve how well ¿led the service was.

The provider had a new recruitment policy in place and a new quality assurance system for ensuring satisfactory checks were in place prior to new staff starting. There was a twice a day medication check which ensured stock control and records were accurate relating to medicines management. Care plans were being evaluated to ensure they were current and up to date.

Although some improvements had been made we found at the time of the inspection the provider had not met all the legal requirements relating to our Warning ¿Notice. Quality assurance tools were not in place for overseeing all the quality relating to medicines management and care plans which were actions needed following the notice. Quality audit tools are important as they support the provider to identify areas for improvement. We fed this back to the deputy manager who took action following the inspection and sent us examples of audit tools they planned to use.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

St Brigas Residential Home for Adults with Learning Dissabilities provides accommodation and personal care for up to 17 people with learning difficulties, autism spectrum disorders, mental health issues and other complex diagnosis. Most people at the home were unable to communicate verbally and some found it difficult to interact with visitors. During the inspection there were 15 people living at the home. The accommodation is arranged over three floors with some office space at the top of the house. There is an area set up as a day centre on the ground floor which includes a kitchen, art room and music room. In the residential part of the ground floor there are a number of communal spaces including a lounge, further kitchen, wet room and dining room.

At the last inspection, in July 2015, we found breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider was not recording all recruitment checks or accidents and incidents. Some people did not have risk assessments to reduce the risk of harm. The provider was not following the principles of the Mental Capacity Act 2005 when people lacked capacity to make decisions. Staff were not using personal protective equipment when handling soiled laundry and there were no systems to keep this separate. We found the home was not well led because the auditing systems which were in place had not identified all the shortfalls found. Since the last inspection, the provider shared changes they had made in the home. They told us all concerns had been rectified. Although there had been some improvements, we found there were still concerns.

The registered manager was also the provider and they were only present on the first day of inspection. A registered manager is a person who has been registered with the Care Quality Commission to manage the service. They are a ‘registered person’. 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 supported by a deputy manager and team leaders.

People told us they felt safe but we found there were risks to their safety. There were concerns about the medicine management in the home. Medicines taken ‘as required’ rather than regularly did not have written protocols for staff to follow and there were medicine errors which had not been identified by the provider’s audits.

Where people lacked capacity to make decisions the principals of the Mental Capacity Act 2005 were not always followed. This meant some people were at risk of having their human rights breached.

There were quality assurance systems in place, but these had not picked up all concerns found on this inspection.

Staff and relatives told us there were enough staff to support people. There was a recruitment process in place but the provider had missed some checks which increased the risk of harm to people. Staff told us they had an induction and had received a lot of training. There was good understanding of how to support people.

Staff knew how to protect people from avoidable harm or abuse and had received training in safeguarding. They told us they would be confident reporting any concerns to the management and staff knew who to contact externally. The provider understood when they were responsible for informing the local authority and CQC about safeguarding.

Staff and the provider had understanding about Deprivation of Liberty Safeguards and what process to follow.

Staff supported people to see a wide range of health and social care professionals to help with their care. Staff supported and respected the choices made by people. Staff knew how to respect people with different religious needs.

People had a choice of meals, snacks and drinks, which they showed us they enjoyed. When people expressed they wanted something different it was provided. People were involved in preparing some of their food. When people required special diets these were met. Staff encouraged people to provide feedback on the food even if they were unable to verbally communicate.

People and their relatives thought the staff were kind and caring and we observed positive interactions. The privacy and dignity of people was respected and people were encouraged to make choices throughout their day.

There were care plans for all individuals including their likes and dislikes. These plans made people central to their care and any decisions made. The needs of people were reflected within their plans. Staff had excellent knowledge about people’s care needs.

People and relatives knew how to complain or had the information available if required. There had been no formal complaints since the last inspection. The registered manager and deputy manager demonstrated a good understanding of how to respond to complaints.

The registered manager had a clear vision for the home and had systems in place to communicate this. Relatives and staff were aware of these visions.

We have made a recommendation about staff recruitment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Observations demonstrated that staff offered people choices in all aspects of their support. Staff interacted positively with people and had a good understanding of people's needs and preferences.

We looked at four people's care records and saw that people's needs were assessed and care plans implemented to meet these needs. Care plans we viewed showed evidence of being reviewed and updated appropriately.

We found that people's needs in relation food and drink were being met by the home. One person told us 'the food is lovely here'. We observed the lunchtime meal and saw that people were supported by staff to maintain their independence in this area.

The home had effective systems in place to manage medications safely. Although we found that the administration of some types of prescribed medications were not being recorded appropriately.

The provider has effective systems in place to monitor the quality of the service provided. This included collecting and acting upon the views of people and their relatives about the service.

We spoke with six staff during our inspection. All the staff we spoke with told us that the service was managed well and communication was good. They said their views were listened to by the provider and suggestions they made to improve the service were considered and acted on.

From the records that we viewed and the observations we made, we saw that people's care was personalised and that staff were knowledgeable about the people they were supporting. People were treated respectfully and there was evidence of positive relationships between staff and people being supported.

Where people may have concerns or complaints, there was a procedure for managing them and we saw examples of how this was done. Where people indicated that they may be unhappy through their behaviours, these were recognised and addressed.