One adult social care inspector undertook the inspection of The Pastures. At the time of the inspection there were eight people using the service.We were not able to speak with people who used the service because of their complex needs. People's relatives were not available to speak with. We spoke with the deputy manager, one registered nurse and five care staff. The registered manager was not available to speak with us on the day of our inspection. We reviewed three people's care records. We also reviewed a selection of other records that included the provider's policies and procedures, staff files, training records and audit results.
We used the evidence we collected during our inspection to answer five questions.
Is the service safe?
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. We saw evidence that the provider had acted in accordance with the law in relation to the MCA and DoLS. People who used the service had received appropriate mental capacity assessments and a number of 'best interest' decisions were recorded. At the time of this inspection no person living in The Pastures had a DoLS authorisation.
Staff felt that there were generally enough staff on duty to meet the needs of people. However, there was a consensus of opinion that one person should receive 24-hour one to one care due to their complex needs. We highlighted this to the deputy manager. They told us that they agreed with staff and that they were in the process of submitting a proposal for 24-hour one to one care for the person.
People's medicines were appropriately managed to help ensure that they received them safely. We saw the training records for staff who administered medicines. We observed staff administering medicines and saw that this was done in accordance with the provider's medication policy.
We reviewed staff files and saw that the appropriate checks had been undertaken before staff commenced employment. These included Disclosure and Baring Service (DBS) checks.
We saw evidence that the provider's audit schedule was effective. This included regular auditing of the quality of the service, as well as accidents and incidents and environmental risks.
The provider had effective arrangements in place to manage foreseeable emergencies. These included fire and loss of utilities.
Is the service effective?
People's needs were assessed, and care and treatment was planned and delivered in order to meet their needs. Care plans were person-centred. People had complex needs with limited verbal communication. Staff showed a thorough understanding of people's communication needs and demonstrated different communication techniques to help people understand what was being said.
People had effective risk assessments in place to help maintain their safety and welfare. A nationally recognised screening tool had been used to help identify people at risk of pressure ulcers.
The provider worked collaboratively with other health and social care professionals. These included physiotherapists, dieticians and psychologists. This helped to ensure all of people's needs were being met. We saw that the guidance and information provided by specialists was followed by staff. This included the correct positioning of people to help prevent muscle spasms.
During our inspection we observed staff manage two medical emergencies with competence. Care workers sought the assistance from the registered nurse in a timely manner, and the situations were dealt with calmly and in accordance with people's care plans.
Is the service caring?
We could not speak with people about the care and treatment they received because of their complex needs. We did however observe staff interact positively with people at all times. We saw that people enjoyed the interaction and were seen to be smiling and laughing. People's care plans explained the meaning behind the different gestures and vocal sounds they made. It was evident that staff knew the meanings exceptionally well. They responded to people's needs in a compassionate and respectful manner at all times.
The care we observed staff delivering to people was outstanding throughout our inspection. People were included in group activities as well as one to one time. Staff displayed kindness and spoke with people about the different things that they enjoyed. Staff explained about the importance of ensuring people were involved in the community and the 'community spirit.' We saw that people were regularly assisted to participate in different activities in the community and that these were designed to meet people's preferences and interests.
Is the service responsive?
People's care plans responded to, and reflected their physical and mental health needs as well as their social and emotional needs. The registered nurse and care staff responded to people's complex needs in a timely and appropriate manner. We saw that people's individual rooms, the bathrooms and the communal areas were all designed and equipped to assist and support people safely.
Some people could not eat or drink because of the complexity of their needs. They therefore required 'Enteral Nutrition.' This meant that their food and drink was given to them through tubes into their stomach. Staff responded to this by ensuring the correct procedure was followed to help avoid any complications. Staff also followed the speech and language therapist's instruction in relation to people being given a small amount of appropriate 'taster' food so that they could still enjoy the taste of different foods.
The care and support people received reflected and responded to their personal interests and hobbies. One person enjoyed trains and technical items. Staff therefore took them to the railway station so that they could observe the trains and experience the environment of the station. Another person enjoyed different bright colours. The staff therefore used a sensory light that projected different colours on to the wall.
The service had not received any complaints. Staff we spoke with could tell us what they would do if a person wished to make a complaint.
Is the service well-led?
All of the staff we spoke with told us that they felt well supported by the management team. The care staff also said that they felt well supported by the registered nurses.
Staff told us that there were staff meetings and that they were encouraged to raise any concerns or issues. They told us that they always felt listened to by the management team. They said that if they suggested something that could improve the quality of the service then this was usually acted on.
Staff told us that they felt there was 'great team' work within the service. We saw evidence of this during our inspection. Care staff we spoke with understood their roles and responsibilities and knew when they needed to 'escalate' an issue or concern to the registered nurse or the management team. We noted that there was an on-call service. This meant that staff could seek the advice of a senior person or manager during any time of the day.
Quality assurance processes were in place. These included regular audits of all aspects of the service. Accidents and incidents were audited on a monthly basis by the provider's health and safety team. We saw evidence that there was learning from accidents and incidents to help prevent reoccurrences. This included information being shared with staff as appropriate.