Broadstreet House

Updated 21 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 October 2017. We gave 12 hours’ notice of the inspection so that people may be less anxious by our presence in their service. The inspection team consisted of one inspector and two experts by experience. An expert by experience is a person who has had personal experience of using services or of caring for someone who uses this type of care service. One of the experts by experience had a learning disability and was supported during the inspection by a job coach. The experts by experience observed care and talked to people to gain their views of the service provided.

Before the inspection, the provider completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications about important events that had taken place at the service, which the provider is required to tell us by law. We looked at previous inspection reports and notifications about important events that had taken place at the service, which the provider is required to tell us by law. We checked that the provider had followed their action plan.

We observed the care provided for people. We spoke with four people about their experience of the service. We looked at feedback about the service the provider had gathered from relatives as part of their quality audit processes. We spoke with twelve staff including the registered manager, the deputy manager, a senior care worker and two care workers. We asked for feedback about the service from two health and social care professionals.

We looked at records held by the provider and care records held in the service. This included four care plans, daily notes; safeguarding, medicines and complaints policies; the recruitment records seven staff employed at the service; the staff training programme; medicines management; complaints and compliments; meetings minutes; and health, safety and quality audits.

Updated 21 December 2017

The inspection was carried out on 26 October 2017 and was announced.

The service provides care and support for up to 18 people with a mild to moderate learning disability or autistic spectrum disorder. At the time of our inspection there were 18 people using the service. The accommodation was situated over two floors and a new ground floor extension. People had access to extensive grounds and gardens.

There was a registered manager employed at the service. 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.

We carried out our last comprehensive inspection of this service on 24 and 25 August 2016. At that inspection we found breaches of the legal requirements of the Health and Social Care Act Regulated Activities Regulations 2014. The breaches related to Regulation 11, Need for consent; There had been a failure to follow the Mental Capacity Act 2005. Regulation 12 Safe Care and Treatment; Medicines management was not always safe. Regulation 17, Good governance; Quality audits had not been affective.

At this inspection we found there had been improvements.

Staff had attended training courses to improve their knowledge of the Mental Capacity Act 2005 and the registered manager had attended a conference about the MCA 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act 2005 Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The management and auditing of medicines had been reviewed and changed. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Where people could retain the information, they had been supported to understand what their medicines were for and when they needed to take them. This was reinforced by staff who administered medicines.

Quality auditing systems in the service had been fully reviewed and were now effective.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities. Each person had a key worker who assisted them to learn about safety issues such as how to evacuate the building in an emergency and to speak to if they felt unsafe. The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The registered manager and staff used their experience and knowledge of caring for people with learning disabilities effectively. Staff assessed people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed within the service, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified. The provider’s policies and management plans were implemented by staff to protect people from harm.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy and diabetes.

We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. We observed people being consulted about their care.

The registered manager involved people in planning their care by assessing their needs when they first moved in and then by asking people if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. People could involve relatives or others who were important to them when they chose the care they wanted. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again.

The registered manager had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained to promote safety.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The registered manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills. Staffing levels were kept under constant review as people’s needs changed. The registered manager ensured that they employed enough staff to meet people’s assessed needs.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. Pictures of healthy food were displayed for people and dietary support had been provided through healthy eating plans put in place by dieticians.

The registered manager produced information about how to complain in formats to help those with poor communication skills to understand how to complain. This included people being asked frequently if they were unhappy about anything in the service. If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

The management had demonstrated a desire to deliver a good quality service to people with a learning disability by constantly listening to people and improving how the service was delivered.

People and staff felt that the service was well led. They told us that managers were approachable and listened to their views. The registered manager of the service and other senior managers provided good leadership. The provider and registered manager developed business plans to improve the service.