Stonepit Close

Stonepit Close provides personal care for up to 10 adults. At the time of the inspection, there were 10 people receiving a service. The service is spread across two houses, Holly House and Jan Norton House. The houses have separate entrances and facilities but are connected by a large communal area containing an office. No person who used the service had contracted COVID-19. The service had a robust testing regime, which included people and staff doing two lateral flow tests per week, as well as a weekly PCR test in line with government guidance.

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

Family members told us their relative was safe. Staff understood their roles in safeguarding people from harm. Risks to people were assessed and identified. There was guidance for staff on how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns. There were enough staff to meet people’s needs and safe recruitment practices were in place. Medicines were safely managed.

Staff had the skills and knowledge to meet people's needs and preferences. They had received specialised training, regular supervision and attended team meetings to ensure they were confident in their roles. People's nutritional and hydrational needs continued to be met and they were supported by health and social care professionals as required.

Family members and staff told us the registered manager promoted an open culture of communication and staff confirmed they felt well supported. The provider used effective systems of quality assurance and governance which improved people’s experience of care. The building was checked through regular audits as well as regular health and safety checks by staff and external professionals.

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. People's views were continually sought, and they were encouraged to be as independent as possible and to be involved in decisions about their care.

Quality assurance processes were robust to give oversight of the service. The registered manager and team leader had ideas of how to continuously improve people's lives and valued working in partnership with others to achieve this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Stonepit Close offers accommodation to 10 people with learning disabilities and autism. This is larger than current best practice guidance. However, the home is spread between two separate side by side houses, which are similar to other privately owned homes in the area and there were no identifying signs to indicate it was a care home. The care home is located within walking distance of local shops and amenities. Staff were observed to enable people to make day to day choices, including around food and activities and to access the community. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• Staff understood people’s specific care needs and preferences and supported people in a person centred way. We saw that people’s dignity was respected and any personal care required was done so discretely and the person’s dignity was not compromised. Staff enabled people to make choices about how they wished to be supported in any given activity. People had been supported to personalise their own rooms and communal areas.

Right culture:

• The leadership team and staff showed commitment to those whom they supported. They spoke with passion and knowledge about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us they viewed themselves as visitors to the home and as such, the needs and views of those whom they supported were paramount and must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 August 2019) and there were two breaches of regulation. We served requirement notices for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stonepit Close on our 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.

The accommodation consists of two houses, known as Holly House and Jan Norton House. The houses have separate entrances and facilities but are connected by a large communal area containing an office.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

There were five vacant posts at Stonepit Close. Two staff were in the process of being recruited at the time of this inspection. Staffing levels had been lower than planned on many occasions in the past year. The registered manager had been required to provide care and support on a regular basis for several months to cover staff vacancies. Regular and consistent agency staff were used on shifts as well as the service’s own bank staff.

There were activities provided for people by staff at the houses, in the community and at day centres, which people visited through the week. However, some families indicated that staffing numbers sometimes limited activity opportunities for people at weekend. Staff confirmed that staffing levels were sometimes lower than planned at weekends.

Supervision and appraisals had not been provided according to the policy held at the service. The registered manager did not have an accurate up to date overview record of staff training requirements. The provider held a matrix which showed some training. However, this did not provide the registered manager with the completed training status for each member of staff.

Risk assessments provided staff with enough guidance and direction to provide person-centred care and support. However, not all risk assessments had been clearly documented as have been regularly reviewed. It was unclear when the next review was due in some care plans. The service’s fire risk assessment was out of date.

The provider had recently shared an infection control concern identified at an inspection of one of the providers other services. This information had been shared with staff. However, there was no named lead for infection control and the service did not hold a copy of the Department of Health Guidance for Infection Control and Prevention in Care Homes as required.

Everyone living at the service had a care plan. However, some care plans were not reviewed as required.

The service had a registered manager who had worked at the service for 20 years. People, families and staff were very complimentary about the registered manager.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. There were no authorisations in place at the time of this inspection.

People were supported to have their medicines as prescribed.

Staff were kind. People had their privacy and dignity protected.

People were provided with the adaptations that they had been assessed as needing to meet their needs.

Staff were recruited safely.

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 received many compliments and thank you cards. The service had not received any complaints.

Rating at last inspection:

At the last inspection the service was rated as Good (report published 15/09/2016))

Why we inspected:

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Effective and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full 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.

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

Stonepit Close is a purpose built residential home registered for up to 10 young adults diagnosed with autism or Asperger’s syndrome. The accommodation consists of two houses, known as Holly House and Jan Norton House. At the time of the inspection the service was providing support to 10 people.

The service had a registered manager at the time of the 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.

People were safe because staff were trained and understood their personal responsibilities within the provider’s safeguarding procedure. People’s risks of avoidable harm were reduced by the service’s assessments and plans put in place to mitigate them. Staff supporting people were recruited safely as a result of the provider’s use of appropriate interview, vetting and identity checking procedures. People received their medicines safely and in line with the prescriber’s instructions. Staff demonstrated good hygiene practices and the manager audited the cleanliness of the service.

People were supported effectively by a trained, supervised and appraised team. People gave their consent to the care their received and their rights under mental capacity legislation were upheld. People’s communication needs were assessed and creatively met. People chose what they ate and were supported with healthy eating options. People had timely access to health and social care professionals and the design and layout of the service met people’s needs.

Staff were caring in their delivery of care and support to people. People were supported to nurture relationships and were encouraged to be independent. People made decisions about how their lives and their privacy were respected.

The quality of people’s lives was enhanced by the excellent way in which the service responded to people’s individual needs. People were supported to be a part of their community and to publicly celebrate their achievements. The service supported people to build their confidence and to view themselves positively. People’s diverse interests and hobbies were supported and best practice was used to manage people’s behavioural support needs which reduced considerably as a result.

Good leadership was in evidence at the service. People, relatives and staff held the management team in high regard. The registered manager ensured that frequent auditing of service quality was undertaken and actions were put in place to address areas in need of improvement. The service ensured the on-going involvement of health and social care professionals in meeting people’s needs.

We found the provider acted in accordance with legal requirements where people did not have the capacity to give their consent.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care from staff who had been suitably selected to perform their duties. People received their medicines at the times they needed them from staff qualified and skilled to do so. Suitable precautions were in place to protect people and staff from cross infection of health care associated infections. People were aware that the information about them that was being transferred to other care providers.

We found that the provider had not acted in accordance with legal requirements where people did not have the capacity to give their consent.

People said their treatment included their total involvement in their care. They said the one to one sessions had helped them to open up and discuss their feelings. They told us they liked the support they received from their support worker, therapist, psychiatrist and manager.

People told us they were able to eat and drink adequate amounts of food and drink to meet their needs. They said they had what they liked for breakfast, sometimes a cooked breakfast and sometimes a continental breakfast. Staff told us the week's menu was planned after the menu planning meeting where each person in both house was able to choose the main meal for one day.

One person who used the service told us there were always enough staff on duty to help them and that they had their own named carer. One person said, 'The staff are polite and speak to me in a respectful way.' People told us they were very happy with the care they received at the service.