Archived: Fiddlers Rest

Fiddlers Rest is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and care for up to seven people who have a learning disability and/or autism. At the time of the inspection there were four people living at the home.

The property is located within woodland close to the village of Nuthurst a short distance from Horsham. It is a modern, single storey building which has an annex and a bungalow both of which were designed specifically to meet the needs of people that can present with challenging behaviour. The property has level access throughout and each bedroom has an en-suite bathroom; some have a separate kitchen and living room. As well as providing personal care, people are supported to maintain and develop independence and to lead a full life.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Care staff had a good awareness of the principles of safeguarding people. We observed staff supported people safely and in a way that encouraged their independence. Risks to people were assessed and there was guidance for staff on controlling risks to people. Sufficient numbers of well-trained staff were provided so people’s needs were met. Checks were made to ensure newly appointed staff were suitable to work in a care setting. Medicines were safely managed. The premises were safe and well maintained. Accidents and incidents were reviewed to see if any changes in service provision were needed. The home was clean and hygienic.

Staff were well trained and received a good standard of training and supervision to ensure people’s care needs were met.

People were involved in devising the menu plan and in preparing meals to develop their independent living skills. People’s health care needs were monitored and arrangements made for people to receive health care checks and treatment.

Staff supported people to make their own decisions and to have as much control over their lives as possible. Staff were trained in the Mental Capacity Act 2005 (MCA) and in the Deprivation of Liberty Safeguards (DoLS) and demonstrated their understanding of this legislation.

People were supported by kind and caring staff. Staff were observed helping and supporting people who were distressed. People were consulted and involved in decisions about their care and support. Independence was promoted and people’s privacy respected.

People received care which was responsive to their needs and preferences. Each person’s needs were assessed and care plans gave staff clear guidance on how to support people. These ranged from support with people’s emotional and behavioural needs to support in developing their life skills. People were supported to attend a range of activities of their choice. Arrangements were made to assist people to communicate in their preferred way, such as pictures and prompts; staff were trained in communication skills that met people’s needs.

Robust processes were effective for auditing and monitoring the quality of the service and complaints were responded to appropriately in line with the provider’s complaints procedure.

Further information is in the detailed findings below.

The property is located within woodland in the Village of Nuthurst a short distance from Horsham. It is a single storey building which has an annex and a bungalow both of which were designed specifically to meet the needs of those that can present with challenging behaviour. The property has level access throughout and each bedroom has an en-suite bathroom.

This inspection took place on 29 January 2016 and the provider was given one days’ notice. This was to enable the provider to arrange for sufficient numbers of staff to be available to facilitate the inspection without disrupting the daily routines of the people who lived there. The last inspection of this service took place on the 30 January 2014 at which no concerns were identified.

At the time of the inspection the registered manager was on a leave of absence from the service and was due to return to the service later in the year. The day-to-day management of the service was being overseen by a manager who is referred to as the acting manager throughout this report. 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.

People were supported by kind, caring staff that knew them well and understood the importance of supporting people to follow their daily routines.

People’s independence was promoted and they participated in a range of activities of their choice. A staff member told us “(Person’s name) can make his own choices and we encourage this”. Information was available to people in a format that was accessible to them and was illustrated with pictures and symbols.

People could choose and were supported to prepare their own meal and drinks. A staff member told us “(Person’s name) likes to cook the same meal most of the time but we encourage them to try different things to add a bit of variety”.

People were supported to maintain relationships with people that mattered to them. Relatives were kept informed of their loved one’s wellbeing and any changes in their needs. A professional involved in the care for one person confirmed they were kept up to date with any changes to the person’s care and of any incidents that had occurred.

People’s needs had been assessed and planned for. Plans took into account people’s preferences, likes and dislikes and were reviewed on a regular basis. Staff worked in accordance with the Mental Capacity Act (MCA) and associated legislation ensuring consent to care and treatment was obtained. People were supported to make their own decisions and where people lacked the capacity to do so, their relatives and relevant professionals were involved in making decisions in their best interest.

Medicines were ordered, administered, stored and disposed of safely by staff who were trained to do so. Referrals were made to relevant health care professionals when needed and each person had a health action plan in place.

Staff received the training and support they needed to undertake their role and were skilled in supporting people with autism and who displayed behaviour which challenged. Staff had a good understanding of each person’s communication needs and of how some people communicated their feelings through their actions. They were able to recognise when a people were feeling anxious and took appropriate action to minimise or where possible remove the source of these anxieties.

Staff knew what action to take if they suspected abuse had taken place and felt confident in raising concerns. Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency.

The service followed safe recruitment practices and staffing levels were sufficient to meet people’s assessed needs, including spending two to one and one to one time with people.

The management of the service were open and transparent and a culture of continuous learning and improvement was promoted. The provider had ensured there were robust processes in place for auditing and monitoring the quality of the service and complaints were responded to appropriately.

We found people's nutritional needs were being met and supported.

We noted warm and respectful interaction between people who lived at the care home and staff who supported them.

We observed that the environment was clean, bright and well decorated using art work of people who lived there and photographs documenting enjoyable shared activities and holidays. This meant that people were well supported and the environment was safe, suitable and homely.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

We spoke with two people who told us that they were very happy living in the service and had no concerns. They spoke positively about their activities and the staff who support them. One person said, "It's the best place I have lived. I like it here".

Staff told us they felt supported in their work and had a good level of training and development. Records that we saw confirmed this.