Archived: 231 Brook Lane

At our last inspection we rated the service 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.

231 Brook Lane is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide care and support for 10 younger adults with learning disabilities, autistic spectrum disorder and or sensory impairment. At the time of our inspection six people were living at the home. Due to people’s complex health needs we were not able to verbally seek people’s views on the care and support they received.

There was a registered manager. 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.

The service followed the principles and values that underpin the Registering the Right Support and other best practice guidance for people with a learning disability living in a care home environment. 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.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the management team.

Medicines were stored safely and securely. Procedures were in place to ensure people received their medicines as prescribed.

The service had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence.

There was a range of activities available to people living at 231 Brook Lane.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments. There were systems in place for care records to be regularly reviewed.

There were effective systems in place to monitor and improve the quality of the service provided. Safety and maintenance checks for the premises and equipment were in place and up to date.

Relatives and staff told us the registered manager was supportive and approachable.

Further information is in the detailed findings below.

231 Brook Lane is registered to provide accommodation and support for 10 younger adults with learning disabilities, autistic spectrum disorder and or sensory impairment. At the time of our inspection five people were living at the home. Due to people’s complex health needs we were not able to verbally seek people’s views on the care and support they received.

The service had a registered manager. 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.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding concerns were raised with other agencies.

Relatives and health care professionals told us people were cared for safely at the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies’ in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Medicines were ordered, stored, administered and disposed of safely.

Staff received supervision and appraisals providing them with appropriate support to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection five people living at the home were subject to a DoLS and the provider was complying with the conditions applied to the authorisation. The manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People were involved in their care planning. Staff supported people with health care appointments and visits from health care professionals. Care plans were updated accordingly to show any changes. Care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

On the second day we spoke with four relatives for people using the service in telephone conversations.

At the time of this inspection, the home was providing accommodation, care and support to six people with autistic spectrum disorders. People using the service had complex needs which meant they were not all able to tell us their experiences.

In this report the name of Amanda Haymer appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found '

Is the service safe?

The service was safe. People's needs were assessed and recorded. Assessments included information about the person's general health, motivation, behaviors, personal care and mobility. There were care plans of how people's needs were to be met. These were written in a person centred way.

There was a safeguarding adults policy in place, which detailed the actions to be taken by the provider to help keep vulnerable adults safe. Support staff were knowledgeable about the homes safeguarding procedures and were able to tell us who they would contact should they suspect abuse. This meant that the provider ensured staff were aware of the procedures involved in raising concerns about the possible abuse or neglect of vulnerable adults.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The deputy manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation before submitting any applications.

We saw regular audits of medication were carried out by management and recorded to make sure that systems were being followed correctly and all medication was in date. Stock levels were monitored and recorded. We saw where people were prescribed 'as required' (PRN) medicines there were care plans in place stating when they should be administered.

Is the service effective?

At the time of our inspection we found the service was not effective. We did not see evidence that 'best interest' meetings had taken place in each of the six care plans we reviewed. There were no records of assessments of people's mental capacity to justify decisions being made on their behalf. We did not see any documentation to show the provider had a mental capacity assessment tool for 'best interest' decision making, which is required by the Mental Capacity Act 2005. This meant that where people did not have the capacity to consent, the provider had not fully acted in accordance with legal requirements.

Where people had specific health needs, care plans had been developed to instruct staff how to support this. For example, one person was at risk of seizures. We saw detailed guidance about how to recognise a seizure, what to do and actions to take should a seizure occur.

Is the service caring?

The service was caring. Support staff were observed to be responsive to each person living there, acknowledging their individual realities and communicating in whatever way each person liked.

Is the service responsive?

The service was responsive. Throughout the visit support staff were observed to be responsive to each person living there, acknowledging their individual preferences and communicating in whatever way each person liked. People living at the home were observed to respond positively to this approach and each seemed happy and contented.

Is the service well led?

The service was well led. The provider (owner) had added a second doorway to a person's bedroom, which allowed the person to walk in a circuit in and out of their own room whenever they chose. This was part of the person's behaviour and we found support plans were in place to ensure that this person was enabled to achieve this.

We saw regular audits of the quality and safety of the service took place and were recorded. The regional director for the provider visited the home and carried out regular audits. We looked at the latest audit dated January 2014. This included reviews of care plans for three people using the service. It also included observations of the building and noted any improvements or repairs that were required.

The provider had taken steps to ensure people's preferences were known and their wishes respected. People were put at the centre of the planning and delivery of care and support. We reviewed care plans for three of the five people at the service and they were detailed and person-centred. People living at the service and staff got on well with each other, and support was observed to be responsive to individual needs.

People were protected from the risks of the risk of abuse because the provider had taken steps to ensure appropriate safeguarding measures were in place.

Effective recruitment processes ensured people were cared for by staff with the right aptitude, skills and qualifications to meet their needs.

There were effective systems for assessing and monitoring the quality of service provided. These enabled the provider to identify and carry out improvements for the benefit of people at the service.