Archived: Sue Ryder - The Chantry

People’s experience of using this service:

The staff were outstandingly responsive to the needs of people at the service, by providing a wide range of person-centred activities. Arrangements for social activities were innovative, met people's individual needs so people could live as full a life as possible. There were strong community links and people accessed the community regularly.

Since our last inspection, the service in response to identifying people’s assessed needs and working with the local hospital had developed a rehabilitation service. This meant as well as supporting people with long term needs, the service was supporting people with respite and rehabilitation from the local hospital as a step on the way to returning to their own home.

The staff were dedicated to providing a family orientated and a homely environment for people. Staff had developed strong relationships with people and knew them exceptionally well. People, their relatives and external health professionals overwhelmingly told us that the staff made them feel included and part of a large family.

There continued to be a positive, enabling culture to support people to live their lives as they desired. Staff continued to find innovate and creative ways of supporting people to overcome perceived limitations. This included the use of virtual reality so that people could use equipment to simulate experiences of the northern lights or being on a safari.

Staff knew people exceptionally well and delivered care and support in a way that met those needs and promoted equality. People and their families were involved in planning their lives, and the service ensured that care was always personalised to meet the needs of each individual living there.

The service continued to be outstandingly well-led. People told us they had trust in the managers and staff who frequently consulted with them and supported them to live their lives as they chose.

People continued to be consulted and were invited to be involved in the continuous planning of their care. People continued to organise residents committee meetings and work closely with the staff regarding the running of the service.

Continuous learning was embedded in the service culture and staff were caring and committed to providing individual person-centred care to each person.

The cohesive management team continued to demonstrate outstanding, strong values with a desire to learn about and implement best practice throughout the service. The service continued to provide a sufficient skill mix of staff to support people.

The management team used effective systems to continually monitor the quality and safety of the service and take any necessary action as required. The senior staff continued to have a shared vision to care and support people to live as full a life as possible.

People’s care plans were sufficiently detailed including risk assessments for the staff to be able to provide care in line with people’s assessed needs and desires for how their care was to be delivered.

Staff continued to have extensive understanding of managing risks while supporting people to live their lives in a manner which promoted their independence. People were put at the centre of the support and staff having established how they wished to be treated supported people with those quests.

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; the policies and systems in the service supported this practice.

Staff used positive communication techniques with people so that they felt listened to and valued according to their individual needs. People’s unique communication styles were understood and respected by staff.

People were supported by staff who were highly skilled, and knowledgeable in caring for people with complex needs. There were enough staff assigned to each shift to operate the named nurse and keyworker system designed to support people with their individual needs and staff supported people with a calm and empathic approach, that demonstrated their skills and confidence.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed. People living at the service were involved with the recruitment process.

The service ensured that care delivery was safe, with risks to people continually assessed to ensure both their home environment, and outings in the community were safe. The premises was well maintained and people had been consulted with regard to adaptations to the service.

Rating at last inspection:

At our last inspection on 2 November 2016 the service was rated good overall with the well-led question rated outstanding. The report was published on 14 December2018.

Why we inspected:

This inspection took place as part of our planned programme of inspections.

Follow up:

We will continue to monitor this service according to our inspection schedule.

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

The service is registered to provide accommodation and nursing care for up to 31 people. On the day of our inspection there were 29 people living at the service.

The service provides nursing and personal care support to people who have a neurological condition, such as acquired brain injury or chronic neurological disease and including the care of people living with dementia.

The service 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.

This service was previously inspected in October 2015 and was rated as ‘Requires Improvement’. The provider sent us their action plan describing the action they would take to meet regulatory requirements.

At this inspection we found that improvements had been made. For example, staffing levels had improved. The provider had improved their system for logging all concerns and complaints. The employment of a new clinical lead had meant that staff received the support and clinical oversight they needed. Audits to check that people received safe and effective care had been further improved and managed effectively.

There was a positive, enabling culture in the service. Staff found innovative and creative ways of supporting people to overcome perceived limitations and enable people to take as much control over their own lives as possible. Discussions with the senior management team and staff demonstrated a passionate approach to looking at ways to improve the quality of the service provided.

Staff had extensive understanding of managing risks whilst supporting people to live their lives in a manner which promoted their independence, autonomy and choice with a view to enabling people to reach their full potential despite physical and emotional challenges. People were supported to access healthcare professionals when they needed them.

People were consulted and invited to be involved in the continuous planning to improve the service. For example, through their involvement in setting up and running their own committee meetings, dignity meetings and a regular review of their care and review of support plans.

Staff were caring and committed to providing quality care. People were treated with respect and their dignity was maintained. The atmosphere was friendly and there were positive, enabling relationships between staff and the people who used the service. Staff worked collaboratively as a team with their primary focus meeting the neds of people whilst enabling them to maintain their independence.

There was a strong emphasis on person centred care. People were supported to plan their support, were involved in the pre-admission process and in the planning for all aspects of their care and received a service based on their personal needs and wishes. People’s care was regularly reviewed with their key nurse and involvement of friends and relatives according to their choice.

People had positive relationships with their support staff who knew them well. There were enough staff available to meet people’s needs and people were supported to follow a wide range of interests and hobbies including access and involvement in the local community.

Staff understood their roles and were well supported by the management team. Staff were encouraged to develop their skills further and provided with opportunities to access specialist training which provided them with the skills and knowledge they needed to meet the complex health and communication needs of the people they supported.

The cohesive management team demonstrated outstanding, strong values with a desire to learn about and implement best practice throughout the service. Staff were highly motivated and proud of where they worked. The provider managed to maintain sufficient numbers of qualified nursing staff which ensured continuity of care. The service had a positive culture that was person centred, open, inclusive and empowering. Links had been developed with other organisations that helped the service to develop best practice. The management team used effective systems to continually monitor the quality and the safety of the service with ongoing plans to provide for continuous improvement. The manager said that the vision was to care and support people to live as full a life as possible in spite of their experienced limitations and disabilities.

We observed that the staff were attentive to people's needs. We saw that staff respected people's privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

The provider had effective recruitment procedures in place to ensure that they employed people that were of good character and had the qualifications and skills to work with vulnerable people with complex needs.

We talked with three of the people who used the service. They told us that they were comfortable and liked living there. One person said, 'I am comfortable here.' Another person told us that staff, 'Work hard, but are kept really busy.'

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from infection and that staff had received training in infection control and food hygiene.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

When we did visit the service in April 2012, people told us that they liked being at The Chantry, and that they felt well supported and were treated as individuals. They also told us that they felt safe and well cared for.

During this inspection we saw that all the actions in the action plan that had been sent to us after the previous inspection, had been carried out. We sampled the care records of two people and found that they were of a good quality, were detailed, person centred and that all the areas that had caused us concern during our previous inspection had been addressed. The service is now compliant in this outcome.