Archived: Baldock

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, the right support and best practice was not always promoted.

Baldock Services provides a service for up to 20 people who have a learning disability and or physical disability and associated mental health needs. People lived in four separate houses in Baldock. Each person had their own personalised bedroom with shared bathrooms/shower facilities, lounge, dining area and kitchen. There were 18 people using the service at the time of this inspection. . The registered manager’s office was located in a separate building located in Baldock.

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.

Identified and potential risks to people’s health and well-being were reviewed but not always managed effectively and goals set did not always have a support plan in place.

People felt safe, happy and looked after at the homes. Staff received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

The provider had safe and effective recruitment practices to help ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

The provider had plans and guidance to help staff deal with unforeseen events and emergencies. Staff checked the environment and equipment to help ensure they were maintained and safe to use.

Trained staff helped people to take their medicines safely and at the right time.

People were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People had access to health and social care professionals when necessary. Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them well.

People were involved in the planning, delivery and reviews of the care and support provided. Confidentiality was promoted. Information about people’s medical and personal histories was kept secure around the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

The provider had systems in place to recorded and responded to any concerns or complaints in line with the service policy.

People and staff were complimentary about the registered manager and how the home was run.

Baldock provides a service for up to 27 people who have a learning disability and or physical disability and associated mental health needs in five separate homes within Baldock. The service does not provide nursing care. At the time of the inspection 23 people were using the service. The home had a registered manager. 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.

There were areas of the home that staff were unable to clean properly due to deterioration in seals in toilets and bathrooms.

People felt safe and staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received inductions, training and regular one to one supervision which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The service is a care home without nursing that provides personal care and support for adults with mental health needs and learning and/or physical disabilities who live in five separate houses in Baldock. At the time of our inspection a total of 24 people received personal care and support.

There was a new manager at the service who had only been in post since the beginning of January 2016 and is in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The manager was supported by three team leaders responsible for the day-to-day operation of each property where people received care and support.

The arrangements in place for the maintenance and repair of the central heating system were not as effective as they could have been. This meant that when the boiler broke down people and staff were without central heating and hot water for a significant and unsatisfactory period of time.

Records held about people’s health, care and support needs were not always as accurate, up to date or complete as they could have been in all cases.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS).

At the time of our inspection we found that the provider was working within the principles of the MCA where it was necessary and appropriate to the needs of the people who received care and support. A number of DoLS applications had been made to the appropriate supervisory body in to help staff keep people safe, both at the home and while out and about in the community.

Although safe and robust recruitment processes were followed, staffing levels varied and lacked consistency across the five separate houses that made up the home. However, staff told us and our inspection confirmed, that this had not impacted on the safety or quality of care provided. During our inspection we found that some areas in two of the houses we visited had not been adequately maintained. This meant that, despite frequent cleaning, staff found it difficult to achieve the required standards of cleanliness and hygiene appropriate to the care and support provided.

Staff received training in how to safeguard people from abuse and were knowledgeable about the potential risks and how to report concerns. Plans and guidance were in place to help staff deal with unforeseen events and emergencies in a safe and effective way.

People were supported to take their medicines safely and at the right time by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively but assessments and plans were not always accurate or up to date.

People who lived at the home, their relatives and social care professionals were positive about the skills, experience and abilities of staff. We saw that staff received training and refresher updates relevant to their roles and had regular supervision meetings with managers to discuss and review their personal development and performance.

People were encouraged and helped to maintain good health and had access to health and social care professionals when necessary. They were also supported to eat a healthy balanced diet that met their individual needs.

We saw that staff provided care and support in a kind and patient way that promoted people’s dignity and respected their privacy at all times. Staff had clearly developed positive relationships with the people they cared for and where very knowledgeable about their needs and personal circumstances.

People, their relatives and professionals were involved in the planning and reviews of care. However, this was not always consistently or accurately reflected in plans of care or the guidance provided to staff. The confidentiality of information held about people’s medical and personal histories was securely maintained at the service.

People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences and routines. People, relatives and staff expressed mixed views about the opportunities available to pursue social interests and take part in activities.

Staff listened to people and responded positively to any concerns they had. People were encouraged to have their say about how the home operated at regular meetings and key worker sessions.

People, their relatives, staff and professional stakeholders were all complimentary about the management team and how the home operated. The new management team monitored the quality of services and potential risks in order to drive continuous improvement.

We found two breachs of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.