Southdown Housing Association - 52 Mill Lane

52 Mill Lane is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home had a registered 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection on 21 August 2017 identified four breaches of regulations and rated the service as requires improvement. We asked the provider to complete an action plan to show what they would do, and by when, to make improvements. At this inspection on 15 November 2018, we found that staff had followed the action plan and the overall rating for the service had improved to Good.

People were living with a range of complex needs. Risks to people had been identified, assessed and managed. Care plans were comprehensive and provided clear guidance which was being followed by staff to keep people safe. There were enough staff with suitable skills and experience.

Staff understood their responsibilities for safeguarding people from abuse. People were receiving their medicines safely. The home was clean and staff protected people by the prevention and control of infection. Monitoring of incidents and accidents ensured that lessons were learned and improvements were made when things went wrong.

Staff received the training and support they needed to care for people. They understood their responsibilities to gain people’s consent for care and treatment. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were receiving the support they needed to have enough to eat and drink. Staff ensured that people had access to the health care services they needed. The home had adaptations that supported people’s independence and met their individual needs. The home has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were supported by staff who knew them well. Staff were kind and caring and respected people’s dignity and privacy. A relative told us, “The staff are very good. They create a great atmosphere at the place, people are happy there.”

People were supported to be involved in decisions about their care and support. Staff were effective in supporting people with their communication needs.

People were receiving a personalised service and staff were focussed on enriching people’s quality of life. People were leading full and active lives according to their interests and preferences.

Staff were responsive when people’s needs changed and reviewed risk assessments and care plans regularly. Staff were responsive to complaints and feedback.

Management systems and processes were robust and improvements had been made to meet all breaches of regulation that were identified at the last inspection on 21 August 2017. The registered manager provided clear leadership and staff spoke highly of the management of the home. Staff understood their roles and responsibilities and described positive working relationships and good communication both internally and with external agencies.

The home had a new manager who had been in post since May 2017and had applied to become the registered 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection on 15 June 2016 we rated the home as Requires Improvement overall because we found some areas of practice that needed to improve. People’s medicines were not always recorded and stored safely. Mental capacity assessments had not always been completed and where people lacked capacity to consent, decisions that were made in their best interest had not always been recorded. At this inspection we found that whilst some improvements had been made there remained areas of practice that required improvement. We identified five breaches of the regulations and other areas of practice that needed to improve.

A relative told us that they felt their relations were safe at the home. One relative said, “They are very, very safe there because there are always staff around.” Our observations were that people appeared to be relaxed and comfortable with staff members. Staff had a good understanding of how to keep people who had profound physical and learning disabilities safe. However, some incidents had not been identified as possible safeguarding concerns and the required alerts had not been sent to the local authority. This was identified as breach of the regulations.

Most risks had been identified and plans were in place to support people safely. However, some risks to people had not been assessed and clear guidance was not in place for staff. This meant that staff did not always have the guidance they needed to care for people safely. We identified this as a breach of the regulations.

People were receiving their medicines safely and staff were gentle and vigilant when giving medicines. However guidance for PRN (as required) medicines was not in place to ensure consistent and safe administration. This was identified as an area of practice that needed to improve.

Staff had received training in the Mental Capacity Act 2005 and understood their responsibilities with regard to gaining consent before providing care and treatment. However, where conditions had been attached to Deprivation of Liberty Safeguards (DoLS) authorisations, staff had not always taken appropriate actions. Staff had not given full consideration to issues of consent and DoLS when people were temporarily moved to accommodate refurbishment at the home. People’s capacity to consent to receiving medicines had not been considered and documented in line with the relevant legislation. These shortfalls were identified as a breach of the regulations.

Management systems were not always effective in identifying shortfalls and this had led to some inconsistent practice. This was identified as a breach of the regulations. The provider had not notified CQC about people’s temporary move from the home when renovation work was undertaken. This was a breach of registration regulations. The manager was committed to developing and improving the service and had introduced some new processes which were not yet fully embedded.

A relative told us that they had confidence in the staff, they said, “The staff are very good, they know exactly what to do.” Staff were receiving training relevant to people’s needs and supervision was provided. Staff said they felt well supported, their comments included, “There has been a huge improvement in support,” and, “The new manager has been great.”

People were supported to have the food and drink they needed. A relative told us “The food is good, people get what suits them.” People were supported to access health care services. A health care professional told us that staff were helpful and knowledgeable about the people they were looking after. A relative told us, “My (relation) is very well looked after.”

Staff had developed positive relationships with people and knew them well. They were skilled in communicating with people using a range of techniques, and supported people to be involved in making choices about their care. Staff held the people they were supporting in high regard and took care to protect their privacy, rights and dignity. People were relaxed and happy in the company of the staff and the atmosphere of the home was calm and cheerful. Care was provided with kindness and staff allowed people the space and time they needed.

Care records were detailed and personalised and reflected the care that was provided. People were supported to lead full lives with regular access to the local community. One staff member said, “We try and get people out and about as much as possible, doing things that they enjoy.” A relative told us, “They are always going out to concerts and things, they go out a lot.” People’s preferences were considered and staff had a good knowledge of what people enjoyed doing and things that they preferred to avoid.

There was a complaints process in place and staff encouraged feedback from people’s relatives and visiting professionals. Where issues had been raised actions had been taken to make improvements. Staff described improvements in the leadership of the home and felt that their views were valued. There was a clear management structure and staff were motivated and understood their roles and responsibilities.

We identified five breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Southdown Housing Association - 52 Mill Lane is a detached house in Portslade, close to Brighton. The service is one of six residential care homes run by Southdown Housing Association Limited, a not-for-profit specialist provider of care, support and housing services in Sussex.

The service had a registered manager. A registered manager is a person who has registered with the 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 home is run.

Medicines were not managed safely and in accordance with current regulations and guidance. Systems in place had not ensured that medicines were recorded and stored appropriately. We have identified the issue as an area of practice that needs improvement.

The registered manager and staff had received training and were knowledgeable about of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, mental capacity assessments were not always completed in line with legal requirements. Mental capacity assessments were needed for people who may not be able to consent to, for example, bed rails. We have identified these issues as an area of practice that needs improvement.

People appeared happy and relaxed with staff. Relatives told us they considered their loves ones were safe. A relative told us, “If we saw [our relative] unhappy we would not hesitate to talk to [the registered manager] but it’s never happened. We chose Mill Lane and we know it’s a lovely place.”

There were sufficient staff to support people. The registered manager said, “We have just amended staffing levels based on the needs of one of the clients. We used to have sleeping night staff, but due to the complex night time care needs of one of the clients, we agreed we needed waking night staff.”

Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff took time to talk with people and followed practice that was caring and supported the value of dignity. We saw support provided by staff that staff that was kind and compassionate. We were told the following, “The care of [my relative] is very good. Staff are fantastic and adore my daughter. [Named keyworker] genuinely seems fond of all the residents. I’ve heard them sing and provide touch, which is so important, they have taken the time to really build up a bond with residents.”

People had access to appropriate healthcare professionals. Staff worked in cooperation with other

health and social care professionals to ensure that people received appropriate care and support. Staff told us how they had regular contact with the GP if they had concerns about people’s health.

Some people needed specialist support with complex healthcare needs, including PEG feeding. This was required when people could not maintain adequate nutrition with oral intake. Nutritional assessments were in place that identified what food and drink people needed to keep them well and what they liked to eat.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Arrangements for the supervision of staff were in place. Staff told us they felt supported. A staff member said, “I get regular supervision and I had a really good induction.”

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided.

People’s relatives and staff told us it was well-run and organised service. The service was small enough that the registered manager knew each person and staff member well. Staff and family members were positive and spoke highly of the registered manager and their leadership, they described the management style of the service as open. A relative said, “The manager is very approachable and I feel communication is very good here.”

There were four people living at 52 Mill Lane at the time of our visit. People we observed and spent time with indicated they were happy.

During our inspection we spoke with three members of staff. These were a senior support worker an acting senior support worker and a support worker. We also looked at review records and meeting records to help us understand the views of the people who use the service.

Staff we spoke with enjoyed working at the home and one person told us 'we are a good team and I love working here'. Another member of staff told us 'It is a lovely atmosphere in the home and we really focus on person centered support'. The staff we spoke with felt supported by their manager and received regular supervisions and guidance.

Feedback we read from relative comment cards included 'thank you for all the care and attention you give' and 'the amount of support my relative receives is wonderful, I would like to convey my thanks to all the staff involved'.

We looked at care plans and staff records and observed levels of staff. We saw the service had enough experienced and skilled staff to meet the people's needs.

People had their needs and wishes assessed and recorded in order to ensure that the home could meet their individual needs.

Each person living in the home had a detailed plan of care in place that included people's individual needs and wishes and also recorded people's physical and emotional healthcare needs.

The home's staff worked with a variety of healthcare professionals including local doctors, dieticians and the learning disability team. We were shown that advocates and specialist consultants were used where appropriate.

We spoke with staff and reviewed records which showed us that people were protected from abuse and their care was planned and delivered in a safe manner.

People attended a variety of day care and social activities that were tailored to their individual choice.

People were protected by their being a robust staff recruitment and selection process in place. Staff had the experience and skills they needed to safely support people

There were quality audits undertaken and recorded in order to ensure that the home was kept under regular review.

Comments we received from a healthcare professional included. 'There is a stable staff team and a good manager. There are never any concerns and they work with people in an imaginative way.'