Walnut Close

• Walnut Close is a small specialist service providing care and support to people living with complex needs. The service is operated by Hexagon Care Services. The property is owned and managed by a Registered Social Landlord and each person living at Walnut Close is considered a tenant and therefore subject to a tenancy agreement. At the time of the inspection three people were living at Walnut Close.

People’s experience of using this service:

• The service continued to provide people with safe care which met their needs and wishes. People had been involved in assessing risks and determining how these would be addressed.

• The provider had systems in place to safeguard people from abuse. Staff were aware of what action to take, should they suspect or witness any abuse. Safeguarding information was clearly displayed within the service and written in a way which made it accessible to everyone.

• Staff had all received initial and ongoing training, to ensure their knowledge and skills were up to date. Completion of external qualifications was encouraged and promoted.

• Staffing levels were determined by people’s plans and activities. Rotas demonstrated sufficient staff had been deployed to support people to do the things they wanted to.

• 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.

• Care files contained personalised information about the people using the service and how they wished to be supported. People had been involved in setting up their care plans and completed regular reviews to ensure information was accurate and reflected current needs.

• People’s social, recreational, educational and employment needs were promoted and supported. People had been assisted to enrol and complete college courses, voluntary work and attend social events of their choosing, with an emphasis placed on integrating safely and successfully within the local community.

• Both people and staff’s views on the service were sought through meetings and questionnaires, with action points generated and shared.

• The service had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Action plans had been completed to promote continuous improvement.

• The service met the characteristics for a rating of ‘good’ in all key questions.

• More information is in the full report.

Rating at last inspection:

• At our last inspection the service was rated as ‘good’. The last report was published on 28 April 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected.

Follow up:

• We will continue to monitor information and intelligence we receive about the service to ensure care remains safe and of good quality. We will return to re-inspect in line with our inspection timescales for good services, however if any information of concern is received, we may inspect sooner.

This inspection was the first comprehensive rating inspection since the service first registered.

At the time of our inspection visit there was a registered manager 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.

A total of three people used the service at Walnut Close at the time of our inspection visit. Staffing levels were safe and sufficient to meet people’s individual needs. People who used the service were well supported by two residential support workers during the day and one residential support worker at night.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. The service maintained a corporate safeguarding policy and associated local procedures. Staff demonstrated a good awareness of safeguarding procedures. People who used the service spoke confidently about how to report abuse.

Support plans contained a wide range of comprehensive individual risk assessments which were completed with the agreement of people who used the service.

Recruitment and selection of staff was robust with safe recruitment practices were in place. This was evidenced through our examination of employment application forms, job descriptions, people’s proof of identity, written references, and Disclosure and Barring Service (DBS) checks. These helped ensure potential employees were suitable to work with vulnerable people.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

Health and safety records relating to buildings and premises were complete and up to date. Emergency equipment was maintained and records kept. Gas and electrical safety certificates were up to date. The service had a business continuity plan to be implemented in the event of a domestic emergency such as flood, fire or loss of power. This included guidance for staff and emergency contact numbers.

Medicines were ordered, stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The staff induction programme was robust and included mandatory training, opportunities for shadowing of more experienced staff and direct observations of practice before new employees were able to work unsupervised with people who used the service. Existing staff were well supported with opportunities for on-going training and professional development.

Staff supervision sessions were undertaken on a regular basis with each member of staff expected to agree a supervision contract. Annual appraisals were also completed

We looked at the how service supported people with eating and drinking and found that staff demonstrated a good understanding of people’s likes and dislikes, dietary preferences and personal requirements. Staff we spoke with also clearly understood the importance of encouraging people who used the service to maintain a healthy balanced nutritious diet whilst acknowledging that individuals were able to make their own choices.

People who used the service told us staff were kind and caring. Some people had lived at Walnut Close for a number of years and knew the staff members well.

‘Supported persons’ meetings were held every two months and records were completed which gave details of the discussions held during these meetings. People who used the service were also regularly encouraged to complete feedback questionnaires.

We found that improvements were needed be made across a number of key areas within peoples’ individual support plans. In each of the three support plans it was not clearly evidenced how people who used the service had been involved in planning and agreeing the type of support to be provided. We also found that the section of peoples’ support plans entitled ‘outcomes and reviews’ did not provide sufficient information to effectively demonstrate what the actual individual outcomes for people were and how this was linked to support plan reviews.

New referrals to the service were assessed before people were accepted. The registered manager told us they personally screened all new referrals and completed all pre-admission assessments to ensure the service could meet people’s individual needs.

We looked at how the service managed complaints and concerns. We found the service had an appropriate complaints policy and information about how to make a complaint was readily available. The service also maintained records of compliments received into the service and we found a number of examples where people had been complimentary about the service provided at Walnut Close.

Walnut Close benefited from an established manager who had been in post for a number of years and knew the service well. This was reflected in the positive feedback we received when we asked people if they thought the service was well-led. Additionally, the vast majority of staff had also worked at the service for a number of years which meant there was a stable workforce who knew each person who used the service well.

Audit and quality assurance was completed on a regular basis and covered a variety of topics. We saw that where internal audits had identified issues, action was taken and practice was improved. We also looked at how accidents and incidents were managed and found accident and incident forms were completed correctly and prevention measures or remedial action was taken by the service to reduce the likelihood of such events happening again.

Staff told us they felt valued, respected and involved in wider decisions about how services should be delivered. Each of the three people who used the service at Walnut Close agreed the service was well-led.