Sternhill Paddock

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

We found the following examples of good practice.

•The service had a robust system in place for all visitors which included a temperature check, hand sanitising and the requirement to wear a face mask before entering the home. Detailed information was displayed around the home to remind people how to wash their hands effectively, the importance of social distancing and why people wear Personal Protective Equipment [PPE].

•The service displayed signage in easy read format ensuring the information is accessible for everyone within the home. Staff had created hand washing pictures with people using the service and these were displayed around the home.

•Staff had undertaken specialist training in Infection Prevention and Control which includes how to put on PPE correctly and how to take it off, some of the people who use the service also requested to join in the training which staff encouraged.

•People and staff were supplied with sufficient PPE when in the home and also when accessing the community. There are a number of PPE points around the home, ensuring PPE is easily accessible.

•The Registered manager had registered for ‘whole home’ testing for COVID-19, this is embedded within the home and all staff and people using the service participated in this. Staff are supported to isolate if needed.

•Risk assessments were in place to detail the impact of COVID-19 on people and staff. Risk reduction measures were in place where needed.

•The service had strengthened cleaning schedules in place, touch points such as light switches, door handles and TV remotes were cleaned twice daily.

•The service had updated the infection control policy to reflect COVID-19, emergency contingency plans had been reviewed in anticipation of a COVID-19 outbreak.

Further information is in the detailed findings below.

Sternhill Paddock accommodates up to six people in one building. During our inspection there were five people living at the home. This is the service’s second inspection under its current registration. The service was rated as ‘Requires Improvement’ after the last inspection. This rating has now improved to ‘Good’.

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.

A registered manager was present during the inspection. 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.

At the last inspection on 24 July and 2 August 2017 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed. After this inspection we asked the provider to send us an action plan to inform us how they would make the necessary improvements to ensure they complied with the fundamental standards.

At this inspection we checked to see whether improvements in these four areas had been made and found they had.

People were now supported by staff in a way that protected them from avoidable harm and abuse. Risks to people’s safety were now appropriately assessed and acted on. There were enough staff in place to support people and to keep them safe. Robust recruitment procedures were now in place that ensured the risk of people being supported by unsuitable staff was reduced. People’s medicines were managed safely. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. Accidents and incidents were now regularly reviewed, assessed and investigated by the registered manager and the provider’s senior management team.

People received care and support in line with their assessed needs and in accordance with current legislation and best practice guidelines. Staff were well trained, received regular supervision of their role and were encouraged to develop their careers through the completion of nationally recognised qualifications. People were supported effectively with their meals and contributed to choosing the menus. People had access to support from external health and social care agencies. The home environment was well maintained and adapted to support people with a learning and/or physical disability. 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 support this practice.

People liked the staff and we saw clear examples of warm, positive, kind and caring interactions. Staff supported people with dignity, respect and compassion. People were supported by staff who understood their needs and supported them with making decisions about their care. People’s diverse needs were respected. People were provided with information about how they could access independent advocates. There were no restrictions on people’s friends or relatives visiting them. People’s records were handled appropriately and in line with data protection legislation.

People were supported with a detailed transition process when moving to the home. Support plans were person centred and focused on people’s choices and personal preferences. Staff communicated effectively with people. Support records were regularly reviewed to ensure they continued to meet people’s changing needs. People were treated fairly, without discrimination and systems were in place to support people who had communication needs. No complaints had been received since our last inspection, but systems were in place to ensure they were responded to in line with the provider’s complaints policy. Efforts had been made to support people with how they wished to be cared for at the end of their life.

The service now had robust quality assurance processes in place that enabled the registered manager to make the necessary improvements since our last inspection. The registered manager was supported by a senior management team to enable them to carry out their role effectively. People, relatives and staff liked the registered manager and felt they had made a positive impact at the home. Staff felt valued and enjoyed their role. People, relatives and staff were encouraged to give their views about how the home could be improved and developed.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found that people were not always protected from risks associated with their care and support. Staff did not always follow guidance in care plans and incidents were not thoroughly reviewed to prevent the risk of repeat events. Although people’s relatives told us they felt their relations were safe, appropriate action was not always taken to ensure that people were protected from the risk of abuse and improper treatment. People were not supported by staff who had been safely recruited. People’s medicines were not always stored or managed safely, although immediate action was taken to address this.

We were not assured that people would be protected from the use of prolonged physical interventions and records relating to physical inventions required improvement to ensure people were supported safely and effectively.

Staff received an induction when starting work at the service and felt supported in their role. On the whole, staff had access to training to meet people’s needs. Improvements were underway to ensure that staff received training in a timely manner. We found that there were not always enough staff available to meet people’s needs and ensure their safety. Swift action was taken to increase staffing levels following our feedback.

The principles and application of the Mental Capacity Act were understood by staff and where people lacked capacity to make decisions for themselves their rights were protected. People had enough to eat and drink and were provided with assistance as required, however improvements were required to ensure that people were supported to maintain a healthy diet. People’s day to day health care needs were met and people had access to support from specialist health professionals. There was a risk that people may not receive appropriate support with specific health conditions, although action was underway to improve this.

People were given choices about their care and support and staff acted upon this to ensure that support was based on their individual needs and wishes. People had access to advocacy services to help them express their views if needed. Staff understood how people communicated and people were supported to maintain their independence. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. Staff also respected people’s right to privacy.

Staff had a good understanding of how to support people. There were care plans in place detailing the care people needed, although these required some improvement to ensure they were clear and easy to use. People spent their time doing things that they enjoyed and this was based on their individual interests. They had the opportunity to get involved in activities in the home and the local community. People knew how to complain and complaints were documented, investigated and action was taken to address concerns raised.

We identified some shortfalls in the way the service was monitored. There were not sufficiently robust or comprehensive governance systems in place to ensure people were provided with safe and effective care that met their needs. Appropriate action was not taken to investigate incidents which posed a risk to the health and wellbeing of people who used the service. The provider and registered manager were responsive to feedback and took swift action address the areas of concern raised at this inspection.