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Inspection carried out on 26 October 2017

During a routine inspection

Care service description

55 Sandwich Road is a residential care home for two people with learning disabilities.

Rating at last inspection

At the last inspection on 12 October 2015, the service was rated Good.

Rating at this inspection

At this inspection of 26 October 2017 we found the service was rated Good and was now Outstanding in Responsive.

Why the service is rated Good.

The service was well-led. The registered manager was passionate and knowledgeable about working with people with complex needs and their vision of an excellent service where people lived their life to the full was shared by the entire staff team. At our previous inspection the registered manager had only been in post for two months. Since then they had installed within the staff team a person centred focus. People were doing things they had never done before as a result. People had lived in residential services for many years, so it was especially impressive they were learning to do new things later on in life. People were supported to cook and clean and have ownership over where they lived. Staff told us that the registered manager’s passion and knowledge had inspired them to provide the best possible care.

The registered manager had implemented a range of checks and audits to ensure they had excellent oversight of the service. They had developed a new system of recording what people did each day, allowing staff to better map what people’s skills were and how they could support them to do learn new things. Staff gave consistent support to people, day in and day out, giving people the time to learn new skills and the confidence to put these into practice.

Staff were kind and caring and passionate about providing the best possible support to people. Staff made sure that people had a ‘good day’ every day. People had been supported to build their confidence and make decisions about their lives.

Staff knew people well and gave people the support they needed to communicate. People required support to make their needs known. As such, any changes in people’s support, such as their behaviour, weight or sleeping pattern was documented and staff looked at reasons why this may be occurring. This in depth analysis ensured staff knew how people were feeling and if they were happy with the service provided. Staff had picked up on subtle changes to people’s mental health and they had received timely and appropriate support as a result. There had been no complaints since our last inspection.

There was detailed guidance in place for staff, which helped to ensure people received consistent support. This had led to improved outcomes for people and they were happier and more settled, and no longer required staff to physically intervene when they became distressed or anxious. Any risks relating to people’s care and support had been assessed and action had been taken to minimise the risks from occurring.

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. People chose what they wanted to eat and were involved in all aspects of shopping for, preparing and serving meals.

There had been no safeguarding concerns since our last inspection, although staff told us they knew how to recognise and respond to abuse. The registered manager regularly liaised with health and social care professionals regarding people’s care and support, taking advice when necessary on any issues that had occurred.

There was always enough staff to make sure people had the support they needed and to support people to activities and events. Staff told us they felt well supported by the registered manager and received regular supervisions and appraisals. They had received training in topics relating to people’s individual needs, such as positive behaviour support. They told us their practice had improved as a result and they were more knowledgeabl

Inspection carried out on 14 February 2017

During an inspection to make sure that the improvements required had been made

Care service description

55 Sandwich Road is a detached bungalow that provides accommodation and personal care for two people with learning disabilities. Each person had their own bedroom, there was a communal lounge and kitchen and a well maintained garden. Each person had access to their own car and were able to access facilities in the local area.

Rating at last inspection

At the last inspection, the service was rated good overall and requires improvement in the ‘safe’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 October 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014, safe care and treatment. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 55 Sandwich Road on our website at www.cqc.org.uk

At this inspection we found the service remained good and is now rated good in the ‘safe’ domain.

Why the service is rated Good

The service had improved since the last inspection. People’s money was now being managed safely, people had access to their monies when they wanted.

Potential risks to people were identified and there was detailed guidance for staff to manage risks to keep people as safe as possible.

Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. People and staff had completed fire drills.

Staff knew how to recognise and respond to abuse. There had been no safeguarding incidents since our last inspection. Accidents and incidents were recorded and analysed to recognise any trends and stop them from reoccurring.

There were enough staff on duty to keep people safe and give them the care and support that they needed. Staff were recruited safely, checks were made to ensure they were of good character and had the necessary skills and experience to support people effectively.

People received their medicines safely and when they needed them.

Inspection carried out on 15 October 2015

During a routine inspection

This inspection took place on 15 October 2015, was unannounced and was carried out by one inspector.

55 Sandwich Road is a privately owned service providing care and support for up to two people with different levels of learning disabilities. People also had some behaviours that challenge and communication needs. There were two people living at the service at the time of the inspection. The house is a detached property set in its own grounds. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The two people each had their own vehicle to access facilities and activities in the local area.

There was a registered manager registered with the Care Quality Commission. 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. However, the registered manager was no-longer working at the service and was now the registered manager of another of the company’s services. A new manager had been appointed and was in the process of registering with the CQC for 55 Sandwich Road. They were also the registered manager of another service. They had been managing the service for two months.

There were policies and procedures in place to protect people’s finances. These procedures were in place to help people manage their money as independently as possible and spend their money to assess activities and going out in the community. The staff were not fully adhering to the company’s policies and procedures when they took people out for meals. We found that, on occasions, staff took people out for meals and they were using people’s money to pay for staff meals as well. Staff told this had been sanctioned by senior management. The area manager and new manager told us this should not be happening and immediately took action to reimburse people. Clear accounts of all money received and spent were available. Money was kept safely and was accessed by senior staff. People could access the money they needed when they wanted to.

Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed. The manager and staff knew how to respond if concerns were raised. The manager monitored incidents and accidents to make sure the care provided was safe. The manager assessed these to identify any pattern and took action to reduce risks to people. Incidents were discussed with staff so that lessons could be learned to prevent further occurrences. The information contained in the forms was used to adjust the person’s support to meet their needs in a better way, the emphasis being on the reduction in the number of challenging incidents by supporting the person to have different, more effective ways of getting their needs met. The latest report indicated that there had been a reduction in the behavioural incidents. The manager was clear staff about the disciplinary procedures they would follow if they identified unsafe practice.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the manager had applied for DoLs authorisations for people who were at risk of having their liberty restricted. They were waiting the outcome from the local authorities who paid for the people’s care and support. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

The care and support needs of each person were different and each person’s care plan was personal to them. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. People appeared happy and content with the care and support they received. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. On the morning of the inspection potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. Staff were able to tell us the action they would take to keep people safe. By the end of the day the manager had reviewed and re-written the care plans and risk assessments. There was now clear guidance in place for staff on how to care for people effectively and safely and keep risks to minimum. Staff were aware of the changes and knew what they had to do to make sure that people received the care and support that they needed.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. The service was planned around people’s individual preferences and care needs. The care and support they received was personal to them. Staff understood their specific needs. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

Throughout the inspection we observed people and the staff as they engaged in activities and relaxed at the service. People could not communicate by using speech and staff understood the needs of the people they supported. Staff were able to understand people through body language, facial expressions and certain sounds and supported people in a discreet, friendly and reassuring manner. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff. When people could not communicate verbally, staff anticipated or interpreted what they wanted and responded quickly.

Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and waited for them to respond. Throughout the inspection people were treated with kindness and respect. People privacy was respected and they were able to make choices about their day to day lives.

People were involved in activities which they enjoyed and indicated that they wanted to do them again. Planned activities took place regularly. People had choices about how they wanted to live their lives. Staff respected decisions that people made when they didn’t want to do something and supported them to do the things they wanted to.

People indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted and were involved in buying food and preparing their meals. If people were not eating enough they were seen by dieticians or their doctor.

People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

Staff had support from the manager to make sure they could care safely and effectively for people. Staff said they could go to the manager at any time and they would be listened to. Staff had received regular one to one meetings with a senior member of staff. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other basic training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. We found that staff had not completed specialist training that were specifically related to people at the service, like epilepsy and Parkinson’s disease. When we pointed this out to the area manager and the new manager they immediately sourced this training and booked it. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. People had their needs met by sufficient numbers of staff. Staff numbers were based on people’s needs, activities and health appointments. People received care and support from a dedicated team of staff that put people first and were able to spend time with people in a meaningful way.

Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Safety checks were done regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

Staff were able to recognise if people were unhappy about something and were able to explain what they would do to support people to make their concerns understood and known. People were taken seriously and action would be taken to resolve any concerns that they had.

There were quality assurance systems in place. Audits and health and safety checks were regularly carried out. The manager had sought formal feedback from people by using a questionnaire.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service. Staff told us that there was an open culture and they openly talk to the manager about anything. The provider had systems in place to monitor the quality of the service. The manager was aware of had submitting notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Inspection carried out on 16 December 2013

During a routine inspection

We reviewed all the information we hold about this provider, then carried out a visit. We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff. People expressed themselves by using sounds, gestures, body language and pointing to objects.

Plans of care followed current guidance of personal centred care (a life planning model to enable individuals with disabilities or otherwise requiring support to increase their self-determination) in that the service promoted people who used the service to improve their own independence. They were supported to have individual long term planning, goals, hopes aspirations and involvement in the service they were receiving.

Medication was being handled appropriately and audits and checks were in place to monitor the service. Whist sufficient staff were on duty during the day some concerns were noted about support at night. The provider responded to our concerns and reviewed staffing levels as a result. Staff benefited from comprehensive training that met the needs of people who used the service. Appropriate checks and audits were in place to monitor the service.

Inspection carried out on 14 August 2012

During a routine inspection

The people that live at 55, Sandwich Road have a learning disability and are unable to communicate verbally therefore they were unable to tell us about their experiences.

Through observation however during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and involved them in many activities.

To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Inspection carried out on 2 December 2011

During a routine inspection

People who use the service were unable to communicate and tell us what they thought of the quality of the care due to their communication difficulties. Through observation however during the site visit we were able to observe staff supporting people who use the service in a respectful way and that staff took time to explain where possible the options available and involved them in many activities.