Living Ambitions Limited - 330 Guildford Road

At the last inspection of 330 Guildford Road on 12 June 2017 we rated the service good. However, we found a breach of regulation of the Health and Social Care Act 2014 as the service did not ensure people were treated with dignity and respect. We also found other areas that required improvement. These included the safety and maintenance of the environment, deployment of staff to ensure people always received the support they needed from staff and staff following risk management plans for people. Following the last inspection, the provider sent us an action plan on how they would improve. At this inspection, we found that the service had made the required improvement and complied with our regulations. We have rated the service Good.

There was a registered manager in post who had worked at the service for several years. 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.

Staff understood people’s needs and treated them with respect, kindness and dignity. Staff communicated with people in the way they understood.

There were sufficient numbers of staff on duty to meet people’s needs. Staffing levels were determined by looking at people’s needs and activities including appointments. Risks to people were assessed and managed appropriately to ensure that people’s health and well-being were promoted. Action plans to manage risks were in place and staff followed them.

The environment was safe and well maintained. Health and safety checks were carried out regularly. Staff followed infection control procedures to reduce risk of infection. There were suitable facilities and adaptations available for people to use.

Staff had been trained in safeguarding people from abuse. Staff demonstrated that they understood the signs of abuse and how to safeguard the people they supported in line with the provider’s procedures.

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 at the service supported this practice. Staff understood their responsibility under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People received their medicines safely. Medicines were administered to people appropriately; clear records were maintained and medicines were stored safely. Staff follow infection control procedures.

People had access to a range of healthcare services to maintain good health. The service liaised effectively with professionals to ensure people received a well-coordinated service. Staff were trained, supervised and had the skills and knowledge to meet the needs of people.

People’s nutritional needs were met. Staff supported people to eat and drink healthy and sufficient amounts for their wellbeing. People’s individual care needs had been assessed appropriately. People received support tailored to their individual needs. People and their relatives were involved in planning their care and their views considered. People’s needs and progress were reviewed regularly to ensure it continued to meet their needs.

People were encouraged to follow their interests and develop daily living skills. There were a range of activities which took place within and outside the home. People were encouraged to be as independent as possible. Staff communicated with people in the way they understood. Staff supported people to maintain relationships that mattered to them. Care records noted people’s religious, cultural and sexual needs.

Relatives and staff told us that the service operated an open and transparent culture. The service held regular meetings with people and staff to gather their views about the service provided and to consult with them about various matters. The service learned from incidents and accidents and when things go wrong. The registered manager reviewed incidents and accidents and took actions to reduce the chances of them happening again.

People knew how to make a complaint if they were unhappy with the service. There were systems in place to monitor and assess the quality of service provided. The service worked in partnership with external organisations to develop and improve the service.

Where required people were supported with their end of life wishes. People’s funeral wishes were recorded in the care records. There was no one receiving end of life care at the time of our visit but the registered manager told us they would work closely with relatives and other professionals to ensure people received appropriate care and support.

The registered manager complied with the requirements of their registration. They submitted notifications of events and displayed the rating of their last CQC inspection as required.

330 Guildford Road provides residential care for up to six people with learning disabilities and physical disabilities. On the day of the inspection there were six people using the service. The accommodation is arranged over two floors.

There was a registered manager in post. 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.

There were usually enough staff deployed at the service to attend to people’s needs in a timely manner. However on the day of the inspection one person did not receive their one to one care for 30 minutes. We have asked the registered manager and provider to regularly review staffing and ensure that the person who requires one to one care always receives it.

Care records contained risk assessments to keep people safe. These were not always being followed and so people were not being protected against potential risks. People were not living in an environment that was always appropriately maintained.

Staff did not always work in accordance with the Mental Capacity Act 2005 (MCA). The provider had not made any DoLS applications for people who were unable to go out on their own safely, or who were being restrained by lap belts or leg restraints. However, this was due to the registered manager being given incorrect advice. The DoLS applications have now been made. Staff were not always aware of the MCA and DoLS and the processes to be followed.

Staff did not always treat people with dignity and respect or demonstrate a caring approach. There was little spontaneous interaction or conversation with people and staff did not spend much dedicated time with people.

The provider had followed safe recruitment practices. Staff understood safeguarding adult’s procedures and what to do if they suspected any type of abuse.

Medicines were administered safely and on time and they were stored securely. There were appropriate plans in place in case of fire.

People were supported by staff who had access to a range of training to develop the skills and knowledge they needed to meet people’s needs. Staff received an induction and on-going training.

Staff had supervisions (one to one meetings) and an annual appraisal with their line manager. Staff were involved in the running of the home and staff felt supported by management.

People’s health care needs were monitored and met. People had health action plans in place. Any changes in their health or well-being prompted a referral to their GP, physiotherapist, occupational therapist, or other health care professionals.

People were encouraged to be independent and helped with the shopping, cooking and tidying up. People’s dietary needs and preferences were met and people supported staff to prepare meals. People enjoyed a range of activities according to individual choice.

People were involved in the running of the home. Regular residents meetings were held where people could contribute. Visitors were welcomed by the home. Relatives knew how to complain.

Care plans were detailed and contained information on people’s lifestyles, preferences, how they communicated and how their needs should be met.

The provider had effective systems in place to monitor the quality of the service and make improvements. Audits were completed on a monthly basis by the manager. Relatives had opportunities to feedback their views about the home and quality of the service.

Accident records were analysed so that staff could take action to reduce the risks to people.

During the inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

Living Ambitions Limited – 330 Guildford Road is registered to provide accommodation for up to six people who have a learning disability or an associated need including autism, behaviour that challenges or epilepsy. At the time of our visit, there were four people living at the home. The accommodation is a large detached house set within its own garden.

There was a registered manager in post. 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.

Staff were not up to date with current guidance to support people to make decisions. Staff did not have a clear understanding of the Mental Capacity Act (MCA) or their responsibilities in respect of this. MCA assessments had not been completed for people around whether they had the capacity to make a decision.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately. However ‘as and when’ medicine was not available people.

Relatives said that they family members were safe. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There were sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Relatives felt there were enough staff. Recruitment practices were safe and relevant checks had been completed before staff started work. Risks assessments for people were detailed and guidance was given to staff on how to reduce the risks of incidents occurring.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that helped with their development. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s needs were assessed on a continuous basis to reflect changings in their needs. Staff understood people’s needs and information was shared with staff when changes occurred.

There was a complaints policy at the home and staff said that they would support people to make a complaint. The registered manager told us that they would ensure that the policy was in an ‘easy read’ format for people.

People had access to activities that were important and relevant to them. There were a range of activities available within the home and outside in the local community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the home.

People’s care and welfare was monitored regularly to ensure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the care provided.

Relatives told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive.

During the inspection we one breach 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 the report.