We carried out a review of the data available to us about 1 & 2 Flax Cottages on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 1 & 2 Flax Cottages, you can give feedback on this service.
1 & 2 Flax Cottages is a care home for people with a learning disability. There were six people living at the home at the time of the inspection.
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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service consisted of two bungalows. It was registered to provide accommodation, care and support for up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people, was mitigated by the building design which fitted in well within the residential area where it was located. In addition, staff did not wear anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
There were systems in place to protect people from the risk of abuse. People appeared relaxed and comfortable with staff. There were enough staff deployed to meet people’s needs. Safe recruitment procedures were followed.
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. The registered manager was strengthening their documentation relating to mental capacity assessments and best interests’ decisions to ensure all areas of the process were evidenced.
People had a choice and access to sufficient food and drink. People were supported to have access to a range of healthcare professionals to help ensure they remained healthy.
People were treated with kindness. One health and social care professional stated, “They are very caring and prompt to react to any changes in the clients’ care.” Staff respected people’s privacy and dignity and promoted their independence.
People's care was developed around their wishes, preferences and goals. People’s social needs were met. More joint activities and events were going to be planned with people from the provider’s other care home which was situated next door.
A range of audits and checks were carried out to monitor the quality and safety of the service.
The service applied the principles and values 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 8 September 2017).
Why we inspected
This was a planned inspection based on our inspection programme.
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.
The inspection took place on 22 and 26 June 2017 and was unannounced. This meant the provider did not know we would be visiting. We also contacted relatives by telephone on 14 July 2017 to gather their views of the service.
The service had a registered manager in place. 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.
We checked the management of medicines and found improvements had been made to ensure medicines were stored and administered correctly, with clear instructions for staff.
Regular checks on the safety of the premises and equipment were carried out. The home was clean and generally well maintained. We were made aware that repairs and improvements that needed to be carried out in collaboration between the provider and separate landlord organisation, could take a long time. We have spoken to the provider about this and made a recommendation that the timeliness of repairs is monitored.
Staff received regular training including maintaining the health and safety of people and the safeguarding of vulnerable adults. Training was provided and competency assessed before staff were able to use specialist equipment used by people. Infection control procedures were followed by staff and personal protective equipment was in use.
There were suitable numbers of staff on duty and safe recruitment procedures continued to be followed. There had been a high turnover of staff but we were advised this was now settling. New staff told us they enjoyed working in the home.
Individual and general risks were assessed and a record of accidents and incidents was maintained.
Staff received regular training, supervision and appraisal and told us they felt well supported to carry out their roles. Training about specific conditions had been provided to staff to support people with particular health conditions.
The service was operating within the principles of the Mental Capacity Act 2005. People had 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.
People were supported with eating and drinking. Personalised meal plans were in place which contained information about special diets and the level of support people needed. People with specialist nutritional needs were supported by relevant health professionals.
People’s bedrooms were homely and personalised. Support had been provided to allow people to display their belongings and to make their room reflect their interests and personality. Discreet and modern storage had been provided to disguise medical equipment in bedrooms to ensure the environment was relaxing and non-clinical.
Staff were caring and attentive to people. We observed staff having fun with people and supporting them to feel relaxed and safe. The privacy and dignity of people was promoted and independence encouraged.
Person centred care plans were in place and people’s likes, dislikes, needs and preferences were recorded.
People had access to a range of activities inside and out of the home. There were plans to improve the range of activities available and people’s individual activity plans were under review at the time of the inspection.
A complaints procedure was in place. There had been no formal complaints received by the service since the last inspection. People were supported to share their views and feelings at regular meetings and on a one to one basis with staff.
Relatives and staff told us they thought the service was well-led. They described the registered manager as approachable and helpful. Staff told us they were completely person centred and ensured the service revolved around the needs of people.
Regular audits of the quality and safety of the service took place and feedback mechanisms were in place to obtain the views of people, staff and relatives.
We last inspected the service in September 2014 where we found that they were meeting all the regulations we inspected.
1 & 2 Flax Cottages are a purpose built bungalow complex with an adjoining access corridor and shared laundry facilities. They provide places for up to nine people with learning disabilities who need care and support.
There was a registered manager in place. She had moved from one of the provider’s other services several weeks before our inspection. Relatives, staff and health care professionals spoke highly of her management skills and dedication to people and 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.
Relatives did not raise any concerns about their family members’ safety. There were safeguarding policies and procedures in place. Staff had completed safeguarding training and were knowledgeable about what action they would take if abuse was suspected. A local authority’s safeguarding officer informed us that there were no organisational safeguarding concerns with the service.
People’s bedrooms were personalised to meet their individual preferences. The manager told us that a range of environmental checks were carried out by the landlord who owned the property. She did not have access to the results of some of these tests at the time of the inspection. She sent us copies of the electrical installations test, Legionella risk assessment and asbestos report following our inspection. No concerns were noted.
We found some concerns with the storage and recording of medicines. The manager told us that she would address these issues immediately.
Relatives did not raise any concerns with staffing levels at the service. On the day of the inspection, we saw that people’s needs were met by the number of staff on the day of the inspection. There was a training programme in place. Staff told us that dementia care training would be appreciated. In addition, training in equality and diversity had not been completed. The manager told us that she was in the process of organising this training. We have made a recommendation that the provider sources training to meet the needs of all people who used the service.
Staff told us that they were a small supportive team. All staff told us that they felt well supported by the manager. Supervision and appraisals were carried out.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The manager was unclear whether any DoLS applications had been submitted to the local authority to authorise in line with legal requirements. She was also strengthening the service’s records with regards to the documentation of any decisions relating to mental capacity to ensure that it was clear how the MCA was followed.
People were supported to receive a suitable nutritious diet. We observed that people were cared for by staff with kindness and patience.
Support plans were in place which aimed to meet people’s health, emotional, social and physical needs. They gave staff information about how people’s care needs were to be met.
People were supported to access the local community, go on holiday and pursue their individual hobbies and interests. An enabler was employed to help meet people’s social needs. Some relatives told us that not having a vehicle sometimes restricted people’s access. The manager told us that she was raising this issue with people’s care managers.
There was a complaints procedure in place. Some relatives told us that it was not always clear what action had been taken in response to certain issues they had raised. The manager told us that she was strengthening the records relating to any feedback to ensure it was clear what action had been taken in response to all concerns, complaints and feedback
We found that improvements were needed in certain areas of the service. The manager had already identified many of these issues herself. She had not however, had time to address these issues due to the short period of time she had been in post. She assured us that they would all be actioned.
We found one breach of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. This related to safe care and treatment [medicines management]. You can see what action we told the provider to take at the end of the full version of the report.
' 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?
Environmental risks were identified and managed through the provider's quality assurance and auditing systems. The provider's system of assessing and planning care took account of risks to people's safety and management plans were in place to address these.
Is the service effective?
It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Relatives told us they were consulted and one described the service as, "on the ball" concerning the care of their family member.
Is the service caring?
Staff interacted with people with warmth and good humour. Relatives of people we spoke with were extremely complimentary about the care provided at the service. One relative commented, "I am very happy with the home and the way care is given. A lot of work has been done by the new provider on the care plan. We have been fully involved in this and we are kept informed. The staff are nice and approachable, they have a great attitude."
Is the service responsive?
People's needs had been assessed before they moved into the home. Records confirmed people's preferences and individual daily routines. Care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their relatives.
Is the service well led?
The home had a registered manager and a well-established staff team. We saw the provider had systems in place for checking the quality of the service and for taking action to make improvements where necessary.