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Inspection carried out on 29 October 2019

During a routine inspection

About the service

Fiorano is a residential care home providing accommodation and personal care to people who have a learning disability or autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Six younger men were using the service when we inspected. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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.

There were enough staff on duty to enable people to remain safe and receive care in a timely way. Staff were safely recruited, they knew how to keep people safe from avoidable harm. Accidents and incidents were analysed to prevent re-occurrence. People were supported to take their medicines in a safe way. The environment was safe, and people had access to appropriate equipment where needed. The premises were clean, and staff followed infection control guidelines.

People were supported to have 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.

People had access to health professionals when needed. People were supported to maintain a healthy diet and support was planned to meet the assessed nutritional and health needs. Staff received specialist and accredited training to ensure they could meet the needs of people living at Fiorano. Staff also received intensive supervision and support so that they could learn and reflect on their practice to ensure people with very high support needs received safe care and treatment.

Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

People were supported to pursue their hobbies and interests including volunteer work roles within the local community, and holidays abroad. The provider had a clear complaints system, relatives told us they felt able to raise concerns, and that these were dealt with quickly.

The registered manager provided staff with leadership and was visible and approachable. Staff were motivated and enjoyed strong team work. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

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 3 May 2017)

Why we inspected

Inspection carried out on 23 February 2017

During a routine inspection

This comprehensive inspection took place on 23 February 2017 and was unannounced. Fiorano is an eight bedded service for people with a learning disability and supports people to live within their community. On the day of our inspection there were five people using the service. There was a second similar service located on the same site managed by the same provider.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 03 February 2016. At the inspection in February 2016, we had found two breaches of legal requirements in relation to Regulation 12 and 18. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. The overall rating from the inspection in February 2016 was Requires Improvement.

At this inspection we found improvements had been made to meet the relevant requirements.

There was a newly appointed manager in post at the time of the inspection and an application for registration was in progress. A fit person’s interview had been scheduled for the following week and we received confirmation that the application had been approved on the 06 March 2017. 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 were kept safe by staff who understood how to identify and report potential harm and abuse. Staff were aware of the risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the service. Risks to people’s health and wellbeing were identified, recorded and managed. Staff understood how to keep people safe and they helped people to understand risks. Medicines were managed safely by staff who were skilled to administer medicines.

Care and support plans provided a holistic view of people’s care and support needs. Staff demonstrated they had a good knowledge and understanding of people’s individual needs

People were supported by sufficient numbers of staff who had the skills and knowledge to meet their needs. There were sufficient numbers of staff to meet people’s care and support needs. Staff received regular training and supervision that provided them with the knowledge and skills to meet people’s needs. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed. Staff had received appropriate training and supervision relevant to their roles and felt supported by the manager.

Staff respected and supported people's right to make their own decisions and choices about their care and treatment. People's permission was sought by staff from appropriate people and before they helped them with care tasks. Staff supported people to make decisions about their care by helping people to understand the information they needed to make informed decisions. People who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People were supported to eat and drink enough to maintain good health. People told us they enjoyed the food, had plenty to eat and drink and had lots of choice. Where people needed support with eating, staff provided the level of support that each individual person required. Following assessment and as part of their enablement plan some people prepared their own meals.

People had access to other healthcare professionals as required to make sure their health needs were met. People were treated with kindness, consideration and respect and staff promoted people’s independence and right to privacy. P

Inspection carried out on 3 February 2016

During a routine inspection

The inspection took place on 3 February 2016 and was unannounced.

Fiorano is an 8 bed service for people with a learning disability and supports people to live within their community. On the day of our inspection there were four people using the service. There was a second similar service located on the same site managed by the same provider.

There was no registered manager in post at the time of the inspection but the newly appointed manager was present at this inspection. 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 that they liked living at the service. The building was purpose built with a flat for one person created on the first floor. Some of the internal original doors had been replaced with metal doors with spy holes that were locked and unlocked by staff. This did not meet the needs of the majority of people who used the service. There were systems in place to reduce the risks to people and there were clear plans in place for emergencies. However, recent events within the local community had occurred due to the deployment of inexperienced staff who had not been following the care plans in order to reduce risks relating to people. Members of the public had been concerned for their safety. Staffing levels were said to be now more flexible and were adjusted to take account of the needs of the individuals who used the service and their access to day time activities and the wider community.

Medicines were safely managed. Staff understood people’s health needs well people were supported to access health professionals. Relatives were involved when appropriate. Staff were trained in a range of areas including medication, safeguarding and first aid. New staff had not been trained in Studio III [techniques to support people who may be anxious and challenge] before they were placed on shift.

Individuality was respected by staff. Choices were promoted and people were involved with planning their aspirations and future. People’s privacy was not promoted as actively as it was needed to be and people’s dignity was compromised on occasion. People were encouraged to be independent and to exercise choice in how they were supported. People had good access to transport and community facilities. Complaints were investigated and responded to.

The manager was accessible for staff and they were motivated and most felt well supported. Staff understood the aims and objectives of the service and worked towards and in line with these. They were clear about what was expected of them and there were systems in place to review the care provided. These could further be enhanced by developing a range of ways to consult people who have an interest in the service and people who live here.