Archived: Creative Support - Balshaw Respite Service

Creative Support - Balshaw is a residential short-term break service that provides care to up to five adults with learning difficulties. Some people may have other disabilities. At the time of the inspection there were two people staying at the service with three more people booked in to visit on the second day of the inspection.

People's experience of using this service and what we found:

People were supported to be safe and said that they felt safe.

Staff received robust safeguarding training and had a good understanding of the principals involved in taking action when abuse was suspected.

The provider had a robust recruitment process that meant staff were recruited safely.

Medicines were managed safely.

There was an open and transparent culture in relation to accidents and incidents and they were used as opportunities to learn and reduce risks.

People's needs were met through robust assessments and support planning.

The service worked with healthcare and social professionals to achieve positive outcomes for people.

Staff and carers had good knowledge and skills which helped to ensure people's needs were well met.

We saw good examples of when people had been supported to maintain a healthy and balanced diet

People told us carers and staff were compassionate and kind.

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.

Staff and carers expressed commitment to ensuring people received high-quality care.

Carers and staff knew people well.

People received care and support that was person-centred.

We saw good examples of how the care and support people received enriched their lives through meaningful activities.

The service was proactive in its response to concerns or complaints and people knew how to feedback their experiences.

The registered manager planned and promoted holistic, person-centred, high-quality care resulting in good outcomes for people.

The values and culture embedded in the service ensured people were at the heart of the care and support they received.

Staff told us they received good support from management. They told us they were proud to work for the service.

There was an open and transparent culture and people were empowered to voice their opinions.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways -

People's support focused on them having choice and as many opportunities as possible in a respite setting. e.g. People had choice in the food they ate or at what times meals were served and could continue with their activities and interests whilst living at the home.

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

Rating at last inspection:

At the last inspection, the service was rated good (published 3 December 2016).

Why we inspected:

We carried out this inspection based on the previous rating of the service.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

The purpose of the service is to provide respite care on a short term basis for up to five people. Patterns of people's stays can vary. Some people will choose to use the service for a few days on a regular basis where as other people may decide to take less but longer stays.

There are some amenities and public transport links close by. The city of Preston, the market town of Chorley, Bamber Bridge village centre and Leyland are within easy reach. Limited on road parking is permitted.

The last inspection of this location was conducted on 14 May 2014, when all five outcome areas assessed at that time were being met. This inspection was conducted on 30 September 2016. We gave the home short notice of our visit. This was to make sure someone would be at the home on the day of our inspection.

A registered manager was not in post at the time of our inspection, but a temporary manager was managing the day to day operation of the home. We were told that steps were being taken to appoint a suitable permanent manager. 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 of the Health and Social Care Act and associated regulations about how the service is run.

The care planning system was, in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed periodically. However, we noted some occasional gaps in the signing and dating of records and although the care plan for one person showed regular family involvement it had not been agreed in writing by the individual’s appointee or representative of the home. We have made a recommendation about this.

Risks to the health, safety and wellbeing of people who used the service had been appropriately assessed and managed effectively. Where risks were identified these were addressed through robust care planning. However, we noted an occasional gap in dating, signing and recording of information. We have made a recommendation about this.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided good information about how people needed to be assisted from the building, should the need arise.

A range of internal checks were regularly conducted and environmental risk assessments were in place, showing that actions taken to protect people from harm had been recorded. However, some of the fire doors did not fit well into the door frames, which created a fire hazard. We were told this issue was being addressed by the company. We have made a recommendation about this.

Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer’s recommendations. This helped to protect people from harm. Evidence was available to demonstrate that good infection control protocols were being followed in day-to-day practice.

Records showed that Mental Capacity Assessments had been conducted, in order to determine capacity levels. However, it was not always clear how outcomes had been achieved. We have made a recommendation about this.

The rights of people who were not able to consent to their care was consistently protected as the service worked in accordance with the Mental Capacity Act and associated legislation. People's privacy and dignity was consistently respected.

The service had reported any safeguarding concerns to the relevant authorities. However, there was an isolated incident where staff had noticed a bruise of unknown origin on a person's arm. This had not been referred under safeguarding procedures because the individual was bumping into furniture very regularly. We have made a recommendation about this.

Suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well-being of those who used the service was adequately protected.

There were effective systems in place for monitoring the safety and quality of the service. Audits viewed had identified any areas which were in need of improvement and action was taken to address these shortfalls.

Complaints were managed well and people we spoke with were aware of how to raise concerns, should they need to do so. Systems were in place to ensure that any complaints received were responded to in a timely manner and a thorough investigation was conducted.

Procedures for managing people's medicines were found to be satisfactory. This helped to protect people who used the service from the unsafe management of medications. The service worked well with a range of community professionals. This helped to ensure that people's health care needs were being appropriately met.

People we spoke with were highly complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the activities, which they were supported to enjoy.

Regular meetings were held for those who used the service. This enabled people to discuss topics of interest in an open forum and people's views were also gained through processes, such as satisfaction surveys.

We did not find any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Risks to the safety of people who used the service were identified and addressed. Staff had clear guidance to help maintain people's safety.

There were clear policies and staff guidance in place relating to important health and safety areas, such as infection control. Staff were provided with training in these areas to help ensure they had the skills to support people in a safe manner.

Care was taken to ensure that appropriate background checks were carried out for any new staff member. This helped ensure people received their care from staff of suitable character.

Systems were in place, which enabled managers to identify risks and learn from adverse incidents such as accidents or safeguarding alerts.

Is the service caring?

We spoke with three people who used the service or their main carers. People told us they were satisfied with the standards of care provided at the service. People said they were confident in the staff to meet the needs of their loved ones. One comment we received was, 'It is a real comfort to be able to leave (name removed) with the staff and know that she will be well cared for. We don't have to worry about anything.'

People were satisfied with the way staff kept them informed and felt they would always be kept up to date about any significant events. One person told us that staff always sent home a diary of the activities his relative had taken part in, which he appreciated.

There was only one person using the service at the time of our inspection. This person was not able to tell us her views verbally but we noted that she appeared comfortable and relaxed in her surroundings. Staff were seen to support the service user in a kind and respectful manner.

Daily records showed that support staff encouraged service users to make decisions and express choices.

Is the service effective?

Comprehensive care plans were in place for each service user, which had been developed following a through pre-admission assessment. This meant staff had a good level of information about people's needs and the support they required.

Daily care records demonstrated that staff provided support in accordance with people's individual needs and wishes.

Evidence was available to show that the service worked effectively with external professionals, such as community health care workers. The service had recently received an award for effective joint working.

There was a detailed programme in place for the induction and training of all staff. This helped ensure that staff had the necessary skills to perform their duties.

Is the service responsive?

All the main policies and procedures for the service were available in an easy read format. This demonstrated that the provider had taken the needs of people who used the service into account when producing information.

We found that managers and staff actively sought the views of people who used the service and their representatives. There were a number of forums designed to ensure that people received up to date information and were able to express their views and opinions.

There was a complaints procedure in place which had been developed to meet the needs of people who used the service. There were systems to ensure that any lessons from complaints or adverse incidents were learned.

Is the service well led?

The service had a manager, who was registered with the Care Quality Commission.

Training programmes within the service included induction training for new managers, which helped ensure they had the necessary supervisory skills.

There were a variety of systems in place to enable managers to monitor quality and identify risk. This helped ensure that people continued to receive a safe and effective service.

The manager responded to feedback from people, such as suggestions for improvement.

Adverse incidents such as safeguarding alerts and accidents were monitored by senior managers. This helped ensure that any patterns or themes were identified and addressed.

The manager reported any issues of concern, such as safeguarding concerns to the correct authorities and in a timely fashion.

'They take him out on all kinds of activities.'

'Excellent staff!'

'I am so grateful. I couldn't fault any one of them.'

One service user said, 'The staff are kind to me, they always do their best for me.' Another, when asked if he liked staying at the home said, 'Oh yes! Of course I do!'

During this visit we looked at a number of areas including capacity and consent, care and welfare of people who used the service, medicines management and staff training. We had identified concerns about some of these areas during a previous inspection. We found that the provider had taken robust action in response to our previous concerns and that they were compliant in all the areas we inspected.

We observed staff supporting the service user in a cheerful, friendly manner. We saw that he interacted comfortably with staff and was content in their company.

We contacted the main carers of three people who use the service and asked them about their experiences.

The feedback we received was extremely positive. Comments included;

'Fantastic, brilliant!'

'I would give them 100%.'

'It's worth so much to be able to go away and be secure, knowing I don't have to worry.'

'He doesn't speak but I know by his face he's completely relaxed there and happy when he sees the staff.'

No one that we spoke with had any concerns about the service. Everyone said they would feel able to raise any concerns that did arise. People described staff and the manager as very approachable. One person said; 'I would have no hesitation in picking up the phone if I was worried about anything at all.'

Whilst we received very positive feedback from people who used the service we did identify some concerns in relation to the way the service approached the assessment, care planning and staff training in relation to people with complex health care needs. These areas of concern are detailed in the report under the relevant outcome areas.