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Reports


Inspection carried out on 20 February 2020

During a routine inspection

About the service

The Foam is a residential care home providing care to 2 people with learning disabilities and autism at the time of the inspection, the service can support up to 3 people. People received care in a bungalow with individual bedrooms, a shared bathroom and communal spaces.

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 autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People said they felt safe and care was delivered in a way that managed risks whilst enabling people to do activities they wished to. People received their medicines as planned and staff ensured people lived in a clean and safe home environment. Staff understood how to identify and respond to suspected abuse and systems were in place to ensure any incidents could be documented and learned from.

People told us they liked the food staff supported them to prepare. Staff ensured people’s healthcare needs were met and people attended appointments as required. Staff were trained to carry out their roles and had regular supervision and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they liked the staff who supported them and we observed pleasant interactions between people and staff. People were involved in their care and supported in a way that helped them to develop skills and be independent. Staff provided care in a dignified way which was respectful of people’s privacy.

People received personalised care and attended activities each day with staff which matched their interests. Care plans were regularly reviewed and information had been gathered about end of life care. People knew how to complain and there were systems in place to respond to issues people raised.

People got on well with the registered manager and there were systems in place to gather people’s views and involve them in decisions about the service. Staff said they felt supported by management and their ideas were taken seriously. There were a variety of checks and audits in place to monitor and assure the quality of care people received.

The service applied the principles and of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 5 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 24 March 2017

During a routine inspection

This inspection took place on the 24 March 2017 and was unannounced. The Foam provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. Although the service is not accessible to people in wheelchairs it had been adapted in areas to better suit the needs of people with mobility issues. At the time of our inspection three people were living at the service.

The previous inspection on 25 and 26 November 2015 found five breaches of our regulations, an overall rating of requires improvement was given at that inspection. The provider had not ensured staff that were lone working had the right skills, information or competency to provide support to people. Robust recruitment processes had not been completed to ensure staff were suitably employed. Medicines had not always been managed safely and the environment posed a risk to people’s safety. Peoples care plan documentation had not been kept up to date and the support people received did not always meet their needs. The providers systems for monitoring the service was not effective and feedback had not been responded to appropriately. The provider sent us an action plan following this inspection to tell us how they would improve. The provider had resolved the issues raised at the previous inspection which were no longer a concern at this inspection.

The service had a registered manager in post. The registered manager also had oversight of two other services. A registered manager is a person who is 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. The registered manager was present throughout the inspection.

The service is a small single storey style house. People’s bedrooms were all located on the same floor as the communal living/dining room, bathroom, kitchen, and office which was also used as a sleep in room for staff. There was a large enclosed garden to the rear of the property.

Staffing was sufficient and flexible to meet people’s needs and staff had appropriate training and experience to support people well. Recruitment processes were in place to protect people and ensure staff employed were suitable for their roles.

There were safe processes for storing, administering and returning medicines. Staff were trained to administer medicines and had descriptive guidance to follow to support people with their individual needs.

Robust safeguarding and whistleblowing guidance and contact information was available for staff to refer to should they need to raise concerns about people’s safety. The registered manager reviewed safeguarding information on a regular basis to ensure staff had the most current information to refer to.

People were supported to manage their individual behaviours and staff demonstrated they had the right skills and knowledge to respond to this appropriately. Throughout the inspection when people became anxious staff were able to defuse the situation and prevent a further escalation of anxieties. Risk had been assessed and action taken to reduce the risk of harm people may be exposed to. Appropriate checks were made to keep people safe and safety checks were made regularly on equipment and the environment.

There was good management and oversight of accidents and incidents. The registered manager and provider analysed reports to determine satisfactory action had been taken to prevent repeating incidents and to identify any patterns which may require further monitoring.

Parts of the environment had been refurbished and decorated creating a more homely environment for people.

The registered manager demonstrated a clear understanding of the process that must be followed if people were deemed to lack capacity to make t

Inspection carried out on 25 & 26 November 2015

During a routine inspection

This inspection took place on the 25 and 26 November 2015 and was unannounced.

The Foam provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. Although the service is not accessible to people in wheelchairs it had been adapted in areas to better suit the needs of people with mobility issues. At the time of our inspection the service was full.

The service is a small single storey style house. People’s bedrooms were all located on the same floor as the communal living/dining room, bathroom, kitchen, and office which was also used as a sleep in room for staff. There was a large enclosed garden to the rear of the property.

The service had a registered manager in post at the time of our visit and was present throughout both days of the inspection. The registered manager also had oversight of two other services. 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 and associated Regulations about how the service is run.

The Foam was last inspected on 19 and 24 March 2015 and had been rated as requires improvement at that inspection. The Care Quality Commission (CQC) issued nine Requirement Actions after this inspection. Areas of concern were: the support people received with their activities as a sufficient number of staff were unavailable, risk assessments were not kept updated and staff did not always adhere to risk measures implemented, robust systems to mitigate the risk of staff lone working were not in place, feedback was not being acted on to drive improvement, medicines were not managed safely, peoples food preferences were not being respected, an accessible complaints procedure had not been displayed and complaints had not been acted upon, documentation and records were not up to date, accurate or completed at all times, staff recruitment files were missing the required information according to our regulations, and staff were not in receipt of regular supervision to provide them with support and identify areas of improvement in their work. We asked the provider to submit an action plan to us to show how and when they intended to address these shortfalls.

We found that while improvements had been made in some areas, this inspection highlighted that the provider had not fully met the previous Requirement Actions.

The provider had not ensured staff had received sufficient induction training or completed essential training before working alone and without supervision. The provider could not be assured that agency workers had the right skills to be able to deliver support to people in an appropriate way as no spot checks or competency checks were made.

Recruitment files continued to lack the required information as outlined in schedule 3 of the Health and Social Care Act 2008. This had been the case at the previous inspection and was a breach of the Commissions regulations.

Processes for managing medicines safely were inconsistent. We found gaps in safety checks and recordings which had not been satisfactorily investigated. Robust medicine auditing had not been implemented meaning the shortfalls found at this inspection had not been identified sooner.

Risk assessments had been implemented to help safeguard people but not all assessments had been updated when new risks had been identified. Although staff could tell us what action they took to mitigate risks, recorded risk assessments lacked this information.

One person had been assessed as being at risk of dehydration. Staff were not given information to help them understand the amount of fluids this person should receive daily. Recordings of fluid intake were inconsistent and missing which meant this person was at risk of receiving insufficient support with this health requirement.

Peoples care files contained good detail but were not always up to date with the most current information. This meant staff did not always have information which reflected the needs of people to inform their practice.

The service was lacking in leadership. Where shortfalls had been identified in this inspection internal audits had failed to identify these areas in need of improvement. The provider had not taken action in all areas following the pervious inspection meaning some regulations were still being breached.

Staff had a good understanding of safeguarding people and the process which should be followed to report concerns inside and outside of the service. A safeguarding policy was accessible to staff should they need to raise concerns including who to contact and what action should be taken.

People were offered a variety of meals and drinks; we observed staff engage people in making their own choices about their preferred meals. Picture guidance was available to help people understand the choices available. This was an improvement from the previous inspection where people’s choices were not being respected.

People were able to participate in activities which they enjoyed. The previous inspection had identified that a lack of staffing meant people were unable to go out as much as they enjoyed. At this inspection we found that additional staff had been deployed during the day so people were able to go out more and engage in activities of their choice.

People were involved in making their own decisions and assessments of capacity were made to comply with the Mental Capacity Act 2005. People were given information in different ways to help them understand the impact of the choices they made. Staff understood people had the right to make their own choices and they would support them through this.

We observed staff talk to people in a caring way. People were relaxed in the presence of staff and there was good rapport. When people became anxious or distressed staff took the time to support the person manage their behaviours and did this in an unhurried, dignified way.

People were able to complain and policies and processes had been implemented which people could use. When people had complained about the service recorded action had been documented.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Inspection carried out on 19 & 24 March 2015

During a routine inspection

This inspection visit was carried out on 19 and 24 March 2015 and was unannounced. The previous inspection was carried out in July 2013 and there were no concern.

The service offers accommodation and personal care support to three people with learning disabilities. At the time of inspection there were two people living at the service. The service is not accessible to people in wheelchairs but has been adapted in some areas to better suit the needs of people with mobility issues. Staff in the service work alone on shift.

There is a registered manager who has oversight of this and two other services and also works shifts in the service. 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.

People told us they felt safe but that there were not always enough staff to support them to do the things they wanted to do. A relative said they had visited for a number of years and had no concerns other than they felt there was a lack of staffing to provide the activities their family member wanted. They told us they always found staff kind, friendly and welcoming.

Our inspection showed that whilst the service offered people a small homelike environment, and that their basic care needs were being supported, there were shortfalls in a number of areas that required improvement.

Records maintained by staff were not always completed or accurate and some processes were not followed; this could place people at risk. For example, not all safety checks were recorded as completed. Staff recruitment files lacked the full range of information they are required to have to ensure the recruitment process was conducted thoroughly. People’s involvement in decisions about their care was not well documented, and recent care review information was not available. Risks identified in regard to the service environment were not monitored.

There were opportunities for people to comment about the service through face to face meetings with a staff member or through house meetings, but the frequency of these was inconsistent, recording was poor and made no reference to actions taken in respect of comments made by people, to show their concerns were addressed or record in detail what their concerns were.

Systems were in place to ensure staff had appropriate induction and training to undertake their role. Staff told us that they felt well supported by the registered manager who they found approachable. However, staff were lone working and did not receive regular face to face support from the registered manager, where they could discuss their work and development or have their practice monitored.

People were supported to access routine and specialist healthcare appointments and received visits to the service from health professionals where needed. However, feedback from a social care professional informed us that the service had been slow to respond to a health need for one person and staff had not taken action early enough in respect of someone with a significant weight loss.

Peoples preferred choice of meals was not always adhered to or changes in their preferences recorded. Information about menu’s and complaints was not in accessible formats or displayed for people to view.

Medicines were managed appropriately although some recording around this was not well maintained.

Assessment and monitoring audits of service quality were undertaken but were not sufficiently robust to identify shortfalls identified at inspection. Staff were not always kept informed of changes in regard to people they supported. People had opportunities to express their views but there was no clear evidence of how these were used to improve the service.

Staff demonstrated a good understanding and awareness of safeguarding adults and the processes to follow to keep people safe. The service had made use of best interest and Deprivation of Liberty Safeguards but records around this were not well maintained.

The premises were being upgraded to meet people’s reduced mobility. Annual safety checks of the electrical and gas installations were completed and portable electrical appliances were also checked for safety. Fire equipment and the fire alarm system were serviced.

There was a low level of accidents and incidents and records showed that staff were handling these appropriately.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 16 July 2013

During a routine inspection

The people we spoke with were positive about the service. People told us that the staff were nice and one person told us that they felt safe living at the service. They said �The staff do a very job of that�. One person told us in respect of their goal to move towards independent living, �It is good now because it is all written down�.

We saw that the provider had systems in place to obtain consent from people in relation to people�s care and support.

We saw that people�s care records had been updated to include decisions and guidance for staff to be able to respond to people�s behaviour effectively and consistently.

We saw that people were protected from the risk of abuse because staff knew how to recognise potential abuse and what action to take if they suspected abuse.

Staff told us they were supported in their role, we saw that staff received supervision, attended staff meetings and knew the systems to support them working alone.

We saw that there were systems in place to regularly monitor the quality of the service.

Inspection carried out on 12 February 2013

During a routine inspection

Overall, people gave us positive feedback about the service. People told us they were happy living at the service, the staff were nice and treated them with respect. One person said the service was �rubbish� because of the way it was run; there were not enough staff on duty to support them in their goal to live independently. We saw they were involved in updating their care plan to reflect this goal during the inspection. Relatives told us "The staff there are excellent". Relatives, staff and people had not always been given information around changes to staffing levels showing how service delivery was to be maintained.

We saw that people were involved in making decisions around day to day matters. Decisions were not always recorded on people�s records to show their rights were being upheld and decisions were reviewed. A person did not always receive consistent responses from staff to their behaviour. The manager said the guidance needed reviewing.

There was a system in place to monitor staff training. Staff told us they did not always feel supported in their role because they were unclear about their duties, supervision and staff meetings were not always frequent and they were not aware of systems to support them lone working. This meant that staff were not always supported to care for people safely.

We saw that the environment was suitable for people�s mobility needs and adequately maintained. There were systems in place to regularly monitor service delivery.