The inspection took place on 22 September 2017. The inspection was unannounced but we telephoned the service before we left to ensure people were in. The service was last inspected on 25 July 2016 and was rated requires improvement with two breaches for regulation 12: Safe care and treatment and regulation 11, Consent. We had concerns about the safe administration of medication and poor documentation for people who lacked capacity to make their own decisions. At this inspection we found the necessary improvements had been made. The service was registered in April 2013 and this was only the second inspection. It was registered for five people who had a learning disability. At the time of our inspection there were four people using the service. There was a registered manager, who was also one of the five directors. The directors had known each other for many years and set up the service together. All took an active role in managing and developing the service and this was their only care home.
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.
This was a highly individualised service where the needs of people using it were paramount. The staff knew people really well and people had continuity of care and support. People had previously lived at home with parents and this was their first home since reaching adult hood. Each person had their own room and an individual activity programme around their needs. Staff recognised people’s anxieties and behaviours and supported people accordingly.
There were systems in place to reduce risks people faced from day to day tasks and from people’s associated learning difficulty. Risks were well managed but without stifling people’s opportunity or lessoning people’s independence. The environment was well maintained and risks from potential hazards such as fire were well controlled.
Medicines were administered to people as and when required and there were safe systems to do this. Staff were well trained and audits were in place designed to ensure people received their medicines as intended.
Staff received training necessary for their role and continued professional development. Staff understood different types of abuse and said they would raise any concerns if they suspected a person to be at risk from harm or actual abuse. There were clear policies for staff to follow. Robust staff recruitment processes helped ensure that only suitable staff were employed and did not have a criminal past which might make them unsuitable.
Staff were supported in their role and although the directors were always available staff had both informal and formal support.
People were supported to stay healthy and had adequate diet and fluids for their needs. Staff monitored people’s health and there was a plan in place to ensure people received regular health care as needed. People had support around their needs in association with their mental health and associated behaviours.
Staff understood mental capacity and supported people to make day to day decisions and where people were unable to make more complex decisions staff acted in their best interest and followed due processes. This meant staff acted lawfully in terms of supporting people who lacked capacity. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.
Staff had sufficient understanding of legislation underpinning human rights, equality and diversity and mental capacity. They demonstrated this through their approach to person centred care.
The culture within the home was very positive and we saw that people were relaxed and supported to spend their time as they wished. Staff understood and respected people and showed genuine warmth for them. The service was inclusive and involved people’s families and wider circles of support. People were consulted as much as possible and able to choose on a daily basis.
People’s needs were assessed and planned for. Clear documentation was in place which showed clearly the plan of care and how people’s needs were being met on daily basis. It also showed the activities people had participated in and how people’s health care needs had been met.
There was an established complaints procedure and feedback was taken into account in the way the service was run.
The service was well led and was highly individualised. A lot of time and passion had gone into creating a home for people where they felt safe and valued and had time to develop their confidence and increased their opportunities .People were not rushed but over time had made significant progress towards greater independence and a more positive outlook where they were able to manage their anxieties and reduce some of their more negative behaviours.
Staff felt supported and wanting to stay within the care professional and develop their professional careers. They had opportunities to do so. The directors had a really strong relationship with each other and created an environment which was a good place to live and work.
There were systems in place to measure the quality of the service provided. It took into account feedback from people and other stake holders about the service provided and how it could be improved upon. It was a progressive service but they were not able to evidence excellence in terms of how they exceeded the key lines of enquiry which form the basis on any CQC inspection. Although it was clear this was a very good service we identified some areas where we believed the service could improve. However these were addressed immediately by the service.