Archived: Sunderland City Council - 2 Fenwick Close

People’s experience of using this service: The outcomes for people using the service reflected the principles and values of Registering the Right Support through promoting choice, involving people in their local community and promoting their independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received a highly personalised service. Relatives gave very positive feedback about the care provided and we observed many positive interactions between people and staff.

Both relatives and staff felt the home was safe. Staff were aware of the safeguarding and whistle blowing procedures and knew how to raise concerns. Previous safeguarding concerns had been dealt with appropriately. Staffing levels were appropriate and new staff recruited safely.

Incidents and accidents were monitored closely and the findings used to identify trends.

Infection control was maintained to a high standard. Relatives gave very positive feedback about cleanliness and the environment. Health and safety and infection control checks ensured a clean and safe environment.

Medicines were well managed to ensure people received the medicines they needed.

Staff received the support and training they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had an excellent understanding of people's needs and used this to support people to make choices and decisions. People were supported with their nutritional and healthcare needs as needed.

In-depth assessments, which included considering religious, social and lifestyle needs, were used as the baseline for developing individualised care plans. People were supported to engage with meaningful activities which matched their interests.

Staff and relatives confirmed the home was well-led. Although relatives did comment that due to the provider restructuring its services, there had been regular changes in staffing. There was a structured and effective approach to quality assurance. There were regular opportunities for people, relatives and staff to give feedback.

Rating at last inspection: Good (the last report was published on 12 July 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Sunderland City Council - 2 Fenwick Close provides care and support for up to three people who have a learning disability. The home is one of three homes situated in its own small close that is set in its own landscaped grounds. There is one manager responsible for the management of all three homes in Fenwick Close. They have an office base on the close. The close is for the sole use of people living there, their families and staff. The home does not provide nursing care. At the time of the inspection there were two people living at the service.

The manager had been in post since February 2015. At the time of the inspection they were not registered with the Care Quality Commission. The last registered manager cancelled their registration on 18 April 2016.

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 manager was aware of their responsibilities in managing the service and ensuring a quality assurance system was in place to ensure people received high quality care. They said, “I want people to have the best lives they can.”

A relative told us communication from the staff and manager was good, and they felt involved in planning their family members care and support.

Care plans and routines were person centred and contained detailed information about the times staff needed to offer support and how this should be managed. Where people were able to support themselves this was identified so staff were able to support people to maintain some independence.

Risks to people had been appropriately assessed and measures were in place to minimise and manage any risks. Risk management plans included emergency contingency plans should they be needed.

Staff knew people well, and had the training, skills, knowledge and experience to support people in an appropriate and safe manner. Staff told us they were well supported by the manager and they attended regular team meetings were they could raise any issues.

People had authorised Deprivation of Liberty Safeguards (DoLS) in place and understood what they meant for peoples’ care. Best interest decisions were recorded within the DoLS authorisation. Some restrictions were in place but they followed the principles of the Mental Capacity Act and were the least restrictive options.

Staff had warm and caring relationships with people and knew how to safeguard them from harm and abuse. Reporting mechanisms were in place but they had not been needed. Complaints policies and procedures were also in place; again these had not been needed.

Staffing levels meant people could be supported appropriately. A relative and staff told us staffing levels were sufficient to meet people’s needs. Some staff said they needed more clarity about roles and responsibilities. The manager explained this was due to a recent restructure but work was being done on this.

Safe recruitment practices were in place. People had attended training in recruitment so they could be part of the process of interviewing for new staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

The service was safe, there were effective checks in place when employing main and agency workers.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was exploring with the local authority the possibility that one person may need a DoLS application in the light of recent court judgements relating to restricting their liberty.

There was suitable risk assessments in place that were reviewed when they needed to be. Staffing levels were adapted to meet changes in need and the presentation of people who used the service.

Is the service effective?

The service was effective. The service assessed people's needs and the risks associated with their care.

One family member told us that their relative had made good progress since moving into the service. She said 'He was becoming calming and taking greater control over his life'

Is the service caring?

The service was caring. Our observations concurred that people received constant attention. The attention people received was appropriate to their needs and supportive of the things people wanted to do.

The manager told us that she considered the wider context of the provision she managed. 'She said that she considered that services were there to meet the needs of the people who used the service and also to support their relatives and friends in maintaining links and involvement in the lives of people living there'. This was confirmed in discussions with relatives.

Is the service responsive?

The home was responsive. We saw records that showed changes to the way people worked that kept up with people's development. Where one person's health was facing a slow steady decline, there were records showing what professional help had been sought, and that plans were in place to continue with training to keep up with any changes that were needed with their care.

Is the service well-led

The service was well led. The manager was experienced at working with people with profound learning disabilities. She had systems in place to monitor what happened in the home and was observed to be an active presence within the home.

You can see our judgements on the front page of this report.

We were supported on this inspection by two experts by experience. An expert by experience is a person who has personal experience of using, or caring for someone who uses this type of care service. We asked the experts by experience to spend time with the people living in the service to find out their views about what it was like to live there.

They told us that there was a good atmosphere in the house and that they had been made to feel like friends and visitors. One of the experts by experience told us that although the people had a communication impairment, there was good communication between them and the staff. They found that the people were given a choice of activities and they were in the process of planning a trip away.

The experts by experience told us that they had found the staff to be very respectful of the peoples' personal space and their belongings. They told us that they found that the people at the home were encouraged to help with the chores and cooking.

The experts by experience told us that they found the home comfortable and the rooms contained personal items. They told us that there was enough room to move around if you used a wheelchair. The told us that the garden was nice and there was a greenhouse, vegetable plot and football goal.

During the inspection, the staff members on duty were observed speaking to people in a kind and respectful way. We also observed that the people were clean and well groomed.