Anna S Proctor House Care Home

Anna S Proctor House Care Home is a residential care home providing personal care to up to 14 people with a learning disability. At the time of inspection 9 people were living at the home, which is based in one adapted building.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People did not always receive the right support with their medicines. Staff focused on people’s strengths and promoted what they could do, so they had fulfilling and meaningful lives. Staff supported people to take part in activities and pursue their interests in their local area. 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.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity and understood how to protect them from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet the person’s needs and keep them safe. Staff and people worked together to assess risks and staff encouraged and enabled people to take positive risks.

Right Culture: Staff evaluated the quality of support provided, but this was not always effective at improving standards. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well. Staff placed people’s wishes, needs and rights at the heart of everything they did.

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 4 February 2020).

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 the provider remained in breach of regulations.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anna S Proctor House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and governance processes at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Systems were in place to prevent visitors from catching and spreading infections.

• People were isolated and shielded when needed.

• People were supported by staff who knew them well, which helped to reassure them about infection prevention and control systems.

• Stocks of personal protective equipment (PPE) were in place and staff were trained in its use.

• The wellbeing of people and staff was carefully considered and supported in the provider’s infection prevention and control systems.

• People and staff were regularly taking part in the Covid testing programme.

Anna S Proctor House is a residential care home providing personal care to up to 14 people who lived with a learning disability. At the time of inspection 10 people were living at the home.

Services for people with learning disabilities and or autism are supported

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. Ten people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

Records could not demonstrate that medicines were administered safely or correctly. We observed a medicine round and found the staff member did not follow best practice. The risks to people’s health, safety and welfare had been identified. However, risk assessments and care records were not fully updated in a timely manner.

Fire drills were not completed effectively. People were protected from abuse by staff who understood how to identify and report any concerns. Staffing levels enabled people’s needs to be met safely, and ensured people received consistent and reliable support. The registered manager sought to learn from any accidents and incidents involving people.

Staff were recruited safely and received appropriate training and support to enable them to carry out their role effectively. People chose what food they wanted and were happy with what was provided. People’s needs were assessed before coming to live at the home. The provider was in the process of a full refurbishment plan.

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 home supported this practice.

Staff were caring and treated people with kindness and respect. Independence was encouraged, and care plans supported this.

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.

People had person centred care plans which detailed their life history, likes, dislikes and their goals for the future, both short term and long term. People were confident to raise any concerns they had with staff. There were plenty of activities available to people and they chose what they wanted to do. People were provided with information in a way they understood. End of life care plans needed further development.

People and staff felt supported by the registered manager. Quality assurance systems were completed but were not effective. They had not identified the concerns identified during this inspection.

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

Rating at last inspection

The last rating for this service was Good (published 15 September 2017).

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Enforcement

We have identified breaches in relation to the safe management of medicines, risk assessments, fire drills and records at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ann S Proctor House is a care home located in Shotley Bridge. It is registered for the regulated activity of accommodation for persons requiring nursing or personal care. It can accommodate up to 14 people who have a learning disability. At the time of our inspection 11 people were using the service.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

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.

People told us the service kept them safe. People’s support needs were regularly reviewed to identify any risks to them. The premises and equipment were regularly reviewed to ensure they were safe for people to use. People were safeguarded from the types of abuse that can occur in care settings. People’s medicines were managed safely. Staffing levels were monitored to ensure they were sufficient to provide safe support. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

People were supported to access external professionals to maintain and promote their health. Staff were supported with training and regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) were protected and promoted. People were supported to maintain a healthy diet.

People, their relatives and friends consistently gave very positive feedback on the service. We saw numerous examples of very kind and caring support and interactions between people and staff. The manager and staff said providing high quality, personalised care was at the heart of what the service did. People had very close but professional relationships with people. The emphasis and ethos of the service was of it being people’s home. Principles of equality and diversity were applied by staff when planning and delivering care. Staff encouraged people to be as independent as possible while also being available to provide support when needed. Independence was emphasised in people’s care plans. People’s privacy and dignity was protected at all times. Policies and procedures were in place to support people to access advocacy services should this be needed.

People received personalised care based on their assessed needs and preferences. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service. Staff said they felt supported in their role and involved in the running of the service. The manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was regularly sought from people using the service and their relatives. The manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We were able to observe the experiences of people who used the service. For instance, we spent time with people as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff encouraged people to make their own choices and decisions. We saw staff understood each person's different needs, for example, when they required additional support.

We saw that staff supported people to make choices about how they spent their day and the range of activities offered. On the day of our visit some of the people who used the service went out to various day centres and clubs. We saw staff had supported people as they got ready to go out.

We saw that staff treated people with dignity and respect. People had freedom of movement around their home and could spend time in their bedrooms whenever they wanted.

We saw that each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet people's physical needs.

We observed that staff respected people's privacy and knocked before they entered their rooms. We saw that the staff communicated well and appropriately with people in a way that was easily understood.

People told us that there had been activities in the home if they wanted to take part. Some people preferred to go out. One person told us, 'I am going to my day centre today, and I go to my friendship club on Friday'.

The manager had carried out a survey of people who used the service, the staff, and relatives. In the survey everyone said that the care at the home was very good, the staff felt they had been supported and the people who used the service felt safe.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people who used the service had their care and welfare needs met.

We found that staff were well supported to deliver care and treatment safely. We were able to speak with two staff on duty at the home. Both of the staff told us they were well supported by their manager.

We found that people's views were important and listened to. We found that there was an effective complaints system in place.