Archived: Sampson House

We inspected the service on 29 and 30 November 2017. Our inspection was announced.

At the time of our inspection there were 30 people using the services provided by Boultham Park. Eighteen of the people received support through the regulated activity ‘personal care’. We reviewed the arrangements in place to care for and support six of those people.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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. In this report when we speak both about the company the area director, the registered manager and the acting manager we refer to them as being, ‘The registered persons’.

At our last inspection on 20 and 21 October 2016 the service was rated, 'Requires Improvement'. Although there were no breaches of the regulations we found that improvements were needed to ensure that people reliably benefited from using a responsive and well-led service. At the present inspection we found the concerns we had previously raised had been addressed. As a result we have rated the service as being, 'Good'.

In more detail, peoples care and support needs were monitored and kept under review so that any changes in need identified could be acted on in a timely way by the registered persons.

There was a range of audit and review systems in place to help monitor and keep improving the quality of the services provided.

Risks in relation to people’s daily life were assessed and planned for to protect them from harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns they identified. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

We found there were sufficient support staff available to keep people safe and meet their care and needs and the senior and support staff worked well together in a mutually supportive way.

Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Training and supervision systems were in place to provide staff with the support, knowledge and skills they required to meet people’s needs effectively.

Staff were kind and attentive in their approach and people had access to the food and drink of their choice. When it was needed people were also supported to plan, purchase and prepare meals which met their individual needs and preferences in their own homes.

People's properties were serviced and maintained by the registered persons in ways which people told us helped them to be as independent as they chose to be. People also told us the overall wider physical environment and facilities provided by the registered persons generally reflected their individual requirements.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any additional specialist healthcare support they needed. Support workers followed the registered person’s infection prevention and control procedures to ensure people were protected from the risks related to cross infection.

The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests. 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.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a clear management structure which helped support staff to understand their responsibilities so that risks and regulatory requirements were met. The views of people who lived in the service, relatives and staff had been gathered and acted on to help shape any improvements that were made. Quality checks had been completed to ensure people benefited from the service being able to quickly put problems right so that people could consistently receive safe care.

Boultham Park is part of Linkage Community Trust, a national charity based in Lincolnshire. It is registered to provide the regulated activity of personal care. The service is provided mainly to people who have a learning disability, living in their own homes in the Lincoln city area.

We carried out this announced inspection on 20 and 21 October 2016. At the time of our inspection 28 people were using the service 12 of whom received care under the regulated activity of personal care.

There was an established 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 understood how to manage risks and protect people from avoidable harm. They also knew how they would report and follow up on any concerns they identified regarding people’s safety. However, during our inspection we identified some areas in which improvement was required to ensure people who used the service were provided with responsive and well-led care.

The care review processes in place to support people had not consistently been kept fully up to date to reflect the current and changing needs of people and how they should be met.

Although there was a range of audit systems in place the provider had not completed regular quality checks together with the registered manager to make sure that people received the care they needed in a consistent way.

People were involved in making decisions about how they wanted to be supported and how they spent their time. Their choices and decisions were respected and staff respected people’s right to privacy when they wanted it. People also received appropriate support to access healthcare services and to ensure they had good nutrition.

New staff were recruited safely and the registered persons had provided staff with the guidance and training they needed in order to undertake their roles. There were enough staff available who were deployed in the right way to meet people’s care needs.

Staff’s competency to safely support people to take their medicines was regularly assessed and the registered manager had ensured arrangements were in place for ordering, storing, administering and disposing of the medicines people needed.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff had received training in this area and demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves.

People were supported to share their views and opinions about the service and the care they received. People and their relatives also understood how to raise any complaints or issues they had and were confident the right actions would be taken to resolve them.

Arrangements were also in place to enable staff to share any ideas they had regarding the development of the service and to raise any concerns they had direct with the provider so these could be responded to in the right way.

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We looked at three sets of care records for people who used the service. We saw evidence of a range of risk assessments for each person which allowed people to keep safe whether at home, in the community or specifically whilst using public transport. We saw that all people had been assessed to determine their ability to receive their medication safely, either of their own volition or with help.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Some of the people receiving support were vulnerable to exploitation and we saw that their support plans and risk assessments identified this and contained guidelines to minimise the risks for them.

Is the service effective?

Observations throughout our inspection showed that support packages were being delivered in total and on time but were flexible to meet with people's immediate wishes. For example, one person wanted to go out into the community, therefore staff changed the planned support to allow this to happen.

Is the service caring?

Some people who lived at the service had Autistic Spectrum Disorders (ASD). We saw staff interacted with people with a structured and helpful approach. Staff helped people to develop social skills and manage stress. We saw the service used schedules and timetables to give the necessary structure and visual cues to people with ASD.

We observed staff talking to people and saw that staff knew people well and understood them as individuals. We saw people being encouraged to maintain their independence and being given guidance to develop their skills in daily living.

During our visit we saw the atmosphere in each person's accommodation was calm and relaxed. People appeared comfortable and were well dressed and clean, which demonstrated staff took time to assist people where necessary with their personal care needs.

Is the service responsive?

We reviewed three people's support and care records and found they included assessments of their individual needs and contained clear guidelines for staff to follow. This ensured people's health and personal care needs were met. People's records included a life history and a record of the individual's needs and preferences.

We saw that support plans were changed to reflect changing needs and people and their relatives were involved in the review process.

Is the service well led?

We found the service had systems in place to assure the quality of care they provided. The way the service was run had been regularly and robustly reviewed.

We were satisfied that the recruitment systems the service had in place ensured people working at Boultham Park had been suitably vetted for their posts. This meant people who received support from the service were protected from the risks associated with unsuitable staff.

Staff told us they were clear about their roles and responsibilities and could competently describe the organisation's lines of communication and accountability. Staff told us the leadership at the service was inclusive and their views were taken into consideration. The service benefited from effective leadership.

We saw systems were in place to assess and monitor the quality of the service provided and people who used the service felt confident that if they raised issues with staff they would be addressed. There were effective systems in place to identify and manage complaints.

People said staff understood their needs and they felt safe with the care provided. We found staff had had less training opportunities this year but the organisation is changing systems to address this. Staff told us they were well supported and had sufficient skills to provide care and support to people. People said things like, 'The staff are fine'. Other comments indicated people felt satisfied with the service they received which was mostly reliable.