Broadstreet House

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.

Broadstreet House provides accommodation with personal care for up to 18 adults with a learning disability or autistic spectrum disorder. There were 17 people living at the service at the time of the inspection. Building works were taking place to provide each person with an en-suite bedroom which involved rebuilding part of the home. There were two communal lounges, a quiet room, dining room and a large garden surrounding the home.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service had identified shortfalls in the management of medicines and had introduced closer monitoring. However, when a medicines errors had occurred, immediate action had not been taken to minimise the potential risks.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The service had not fully consulted the local authority with regards to making DoLS applications, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. There was some inconsistency in assessing people’s capacity to make some decisions which required further investigation to ensure the principles of the Mental Capacity Act were appropriately applied.

Systems were in place to review the quality of the service but they were not always effective in identifying shortfalls. Feedback was sought from people who lived in the home, their relatives and staff. The results of these surveys were that people were satisfied with the care provided at the home.

Staff knew how to identify and report any safeguarding concerns in order to help people keep safe. Checks were carried out on all staff before they supported people, to ensure that they were fit and suitable for their role.

There were enough staff who were sufficiently qualified and competent to support the people at the service. A core team of staff had worked at the service for a number of years and so helped ensure consistency of care.

A schedule of cleaning was in place to ensure the service was clean and practices were in place to minimise the spread of any infection.

Staff felt well supported and received staff with regular supervision and an appraisal which offered them the support and learning to help with their development and to improve care for people. There was a rolling programme of essential training to ensure staff had the skills and knowledge to care for people effectively.

People had their health needs assessed and clear guidance was in place to ensure they were effectively monitored. Specialist advice was sought and acted on when it was required

People were offered a choice of food based on their preferences and mealtimes were informal and seen as a social occasion where people and staff chatted to one another.

Staff were kind, caring and compassionate and valued people’s contributions. They treated people with dignity and respect, spoke with them as equals and understood their individual needs and interests. People were involved in making decisions that affected their daily lives.

People’s care, treatment and support needs were clearly identified in their plans of care and people had been involved in writing their own care plan which included what was important to them and how they wanted to live their life. Guidance was in place for staff to follow to meet people’s needs which included information about people’s choices and preferences. Staff knew people well which enabled them to support people in a personalised way.

The service prioritised ensuring people had active fulfilling lives. People undertook a variety of educational, creative and work based activities which reflected their interests and abilities. People were supported to be members of the local community through voluntary work and joining local clubs.

People’s views were sought in a variety of ways and they felt able to raise any concerns with staff. Information was available about how to follow the complaints process, should they need to use it.

The registered manager was approachable and the atmosphere in the service was relaxed and informal. The registered manager was supported by a staff team who understood the aims of the service and were motivated to support people according to their choices and preferences. There was good communication in the staff team and a low staff turnover.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with told us that they were happy with the care and support they received. One person told us "I like living here; I have a nice bunch of friends'. Another person said 'staff are so lovely and chatty'.

People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided.

We found that care plans were individualised and contained details about people's choices and preferences. People had also been supported to develop their own 'personalised' plans. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that people enjoyed the food and were able to make choices about the meals provided. Staff were aware of people's dietary needs and helped to ensure people were protected from the risks of inadequate nutrition and dehydration.

We found that the home had arrangements in place to protect people from the risk of abuse and people told us that they felt safe.

We found that the staff felt supported by the provider and were able to undertake appropriate training and achieve relevant qualifications. One member of staff told us 'it's a lovely place to be; I am privileged to work here'.

People told us they were supported to make decisions in their lives and to be as independent as possible. One person said 'They listen to me'. People were involved in the running of the service and were encouraged to learn new skills that would help them to be independent. We saw that staff had a positive relationship with people and treated them with respect.

People told us they led busy lives and were supported to do things that interested them. One person said 'I like my friends here'. We saw that people were occupied during the day doing things they enjoyed.

People told us they felt safe in the service. Risks to people's safety were checked and staff took action to keep people safe from harm. Staff knew how to respond to any concerns about people's safety and people using the service knew who to talk to if they were worried about anything.

The provider of the service ensured that the quality of care provided was checked regularly and that action was taken quickly to make any improvements. People and their families were asked for their views of the service.