Archived: London Borough of Richmond upon Thames - 26 Cross Street Residential Care Home

The home provides care and accommodation for up to four people with learning disabilities. It is located in the Hampton Hill area.

At the time of our 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 and associated Regulations about how the service is run.

In May 2014, our inspection found that the service met the regulations we inspected against. At this inspection the home met the regulations.

People said and their body language showed that they enjoyed living at the home and the way that staff provided care and support for them. People chose their activities, when they wished to do them and with whom. There were a number of activities available to choose from. They felt safe in the home and in the local community. When we visited there was a warm, welcoming atmosphere with people freely coming from and going to activities. People using the service interacted positively with each other and staff during our visit.

The home records were accessible, kept up to date and covered all relevant aspects of the care and support that people received. This included the choices they made, activities they attended and way their safety was protected. People's care plans were completed and the information contained was regularly reviewed. This enabled staff to perform their duties competently and efficiently. People were encouraged by staff to discuss their health needs and had access to GP’s and other community based health professionals. People were supported to be healthy by choosing nutritious, balanced meals that promoted a healthy diet whilst taking into account their likes, dislikes and preferences. This meant people were protected from nutrition and hydration associated risks. People told us they liked the meals available and we saw that they were of good quality with plenty of choice.

People were familiar with the staff as they had been supported by them over a long period of time. They said they liked the staff and enjoyed the way that staff supported them. People were provided with information about any activities taking place so they could decide if they wanted to join in. Staff provided care and support in a professional, friendly and supportive way that was focussed on people using the service as individuals. They told us they knew people who use the service and their likes and dislikes well. Staff were well trained, had appropriate skills and were accessible to people. They said they enjoyed working at the home and had received good training and support from the manager.

People said the manager and staff were approachable, responsive and listened to them. The quality of the service provided was consistently monitored and assessed.

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

Is the service safe?

During our visit we saw that people were treated with dignity and respect by staff. This followed the London Borough of Richmond's dignity and respect policy, procedure and training provided. People did not tell us if they felt safe or not. The care practices we saw were delivered in a safe and caring way. Safeguarding procedures were robust, staff understood how to safeguard the people they supported and had received training. Specific areas of concern or circumstances under which people may be particularly vulnerable were recorded in their support plans.

We saw that there were robust quality assurance systems that enabled the manager and staff to learn from events that included accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced risks to people and enhanced the opportunity for the service to continue to improve.

The home had working policies and procedures in regarding the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) although no applications had been submitted. Relevant staff had been trained to understand when an application was required and how to submit one. This meant that people were safeguarded.

The service was safe, clean, hygienic and the equipment used was well maintained and serviced regularly. This reduced risks to people.

The staff rotas were flexible, indicated there were enough staff on duty at all times to meet people's needs and took their individual care needs and routines into account when deciding how many staff and what particular skills and experience were required. This helped to ensure that people's needs were always met.

No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

The 3 case files we looked at contained health and social care needs assessments. The records provided information that was person centred and enabled people to have a fulfilling and good quality life style. The support plans we looked at were up to date and there was written evidence that people's care reviews were taking place. Information included likes and dislikes, hobbies and interests and any specialist health, dietary, mobility and equipment requirements. People told us "I'm going on a barge with my brother" and "This is my room".

There was an advocacy service available if one was required and this meant that people could access additional support.

The service enabled people to move around freely, safely and met their physical needs.

Visitors were able to see people in private and visiting times were flexible as demonstrated by the policy and procedure in place.

Is the service caring?

The care practices we saw demonstrated that people received appropriate support provided by well trained, attentive and caring staff. We saw that staff were patient, encouraging and people were supported to make their own choices.

People's preferences, interests, hobbies and diverse needs were recorded and updated within their person centred support plans. Activities were also recorded in their daily notes. Much of the information was presented in a pictorial version that better enabled people to understand the care and support they received and ensure it met their wishes.

Is the service responsive?

People were engaged in a range of activities at home and outside the service during our visit. We saw that this was the home's usual routine and was reflected in the records kept, what we saw and what people told us. The activities were based upon people's preferences and interests. The home had access to transport, that enabled people to take an active part in activities within their local community.

There were annual satisfaction surveys sent out centrally by the London Borough of Richmond who ran the service. If service shortfalls or concerns were raised, they were addressed and house meetings took place giving people an opportunity to give their views, suggestions and opinions.

People said that any problems they had were generally sorted out on the spot or during house meetings. We looked at how complaints were investigated and found the system was satisfactory. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The home's management structure was incorporated within that of the London Borough of Richmond and there were clear management links of responsibility and culpability. People said and we saw that the home's management team was pro-active, listened to their needs, opinions and acted upon them. The service worked well with other agencies and services as demonstrated by the relationships built with community based health services such as GPs and the 'Hospital passport' information provided by the home if people had to visit hospital.

We saw that staff treated people with dignity and respect. They were friendly, supportive and people were relaxed and engaged with them throughout our visit.

They were equally enabled and encouraged to make their own decisions and choices. This included choosing activities they wished to do in a safe and risk assessed environment.

The home was kept clean, tidy and well maintained. It was fit for its stated purpose and people had personalised their bedrooms to their own taste.

There were enough staff to meet the needs of people using the service when at home and to accompany them on activities outside the home as required.

The home operated the London Borough of Richmond complaints procedure that had been customised in a pictorial version to make it easier to understand and more accessible for people using the service.