Arthur

At the last inspection in February 2016 the service was rated Good overall. 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.

Why the service is rated Good.

Dame Hannah Rogers Trust is a charity organisation which provides both children and adults with safe, effective, compassionate and high-quality care from a number of sites in south Devon. Arthur was run by Dame Hannah Rogers Trust and provided care to young adults who had access to the Trust’s facilities and activities.

The people who lived in Arthur had a wide variety of needs and health conditions. All the people living in Arthur at the time of our inspection were young adults with learning disabilities and complex physical disabilities. Some people required more significant support than others and most were wheelchair users. The people who lived in Arthur were provided with high quality, safe, caring, person centred support which was responsive to their needs. People received highly personalised support and there was a clear understanding of seeing each person as an individual, with their own social needs.

The service focussed on wellbeing and ensuring people had a sense of purpose and enjoyment. The care service had been developed and designed in line with the values that underpin “Registering the Right Support” and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service could live as ordinary a life as any citizen.

Staff demonstrated to us they cared strongly about people’s wellbeing in every aspect of their lives and worked towards improving each person’s happiness and wellbeing. Staff promoted people’s equality, diversity and ensured their human rights were upheld. Staff spoke confidently to us about how they fought for people’s rights and gave us examples which demonstrated they put people’s individuality and personal wishes before all else.

Staff received thorough training in all areas relating to people’s individual health needs and holistic activities. Staff also received support from external healthcare professionals to best care for people. People were encouraged to socialise, pursue their interests and hobbies and try new things in a wide variety of innovative ways. For example, one person was supported to create their own celebrity fashion page in the organisational newsletter as this was an interest of theirs.

People were involved in all aspects of their care and were supported by staff to communicate their wishes, likes, dislikes and decisions. People were supported through the use of verbal communication, pictorial forms and electronic aids.

People were protected from risks relating to their physical and mental health and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff received regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice.

Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people were supported individually to ensure their specific needs around food and drink were met.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines was regularly checked. Staff told us they felt comfortable raising concerns.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below.

The home was previously inspected in February 2016 was rated ‘good’ in all five key questions.

The service had a 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.

This unannounced focussed inspection was undertaken on 15 February 2017. We had received information of concern from the local authority and we wanted to be sure staff had been safely recruited and were provided with safeguarding training. This report only relates to the key question of safe.

At the previous inspection in February 2016 we found the home had safe recruitment practices in place as well as detailed policies and procedures in relation to safeguarding and whistleblowing. At this inspection in February 2017 we found these processes remained safe and in place.

Records showed newly employed staff had undergone all the necessary pre-employment checks including obtaining proof of identify, references from previous employers and a disclosure and barring (police) check. Staff were provided with training in safeguarding adults who may be vulnerable due to their circumstances and records showed staffs’ responsibility towards safeguarding people was discussed at staff supervision and appraisal meetings. Care files and daily care notes described the care and support people required and received to maintain their safety.

You can read the report from our previous inspections, by selecting the 'all reports' link for Arthur on our website at www.cqc.org.uk.

The inspection took place on the 17 and 23 February 2016 and was unannounced.

The service provides care for people with a physical disability, and can provide care for up to seven people. When we inspected six people were living at the service.

The service had a 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.

The atmosphere in the home was calm and welcoming and people were observed to be happy in the company of staff. Relatives said they felt people were happy living at Arthur, one commented “The care is exceptional, the staff really care about people”. Professionals we spoke with said they had observed lovely relationships and positive interactions between people and staff.

We saw people laughed and smiled as they were being assisted by staff. For example, with daily routines such as eating, drinking and when they were being supported with transfers prior to personal care or as they were getting ready to go out. People’s responses and body language indicated they felt safe and comfortable with the staff supporting them.

There was a positive culture within the service. The management team provided good leadership and led by example. Staff were clear about the values of the service and spoke in a compassionate and caring way about the people they supported. Comments from staff included, “Our big responsibility is about encouraging people to make choices” and, “I feel very proud to work at Dame Hannah Rogers Trust, people have a good quality of life”. The management team were organised and the service was well-run. People’s risks were monitored and managed well. Accidents and safeguarding concerns were managed promptly. There were effective quality assurance systems in place. Incidents related to people’s behaviour or well-being were appropriately recorded and analysed. Audits were conducted, action points noted and areas of the service improved where needed. Relatives and professionals said the management team were approachable and they did not have current concerns about the service.Staff received supervision, annual appraisals and training relevant to the needs of people they supported.

Staff supported people in a caring and compassionate way. When people showed signs of distress or feeling unwell staff responded promptly and sensitively to ensure they remained comfortable and happy. Staff included people in their conversations and were seen bending down to ensure people in wheelchairs were at eye level with them when talking. As staff moved around the home they knocked on doors and informed people of what they were doing. This demonstrated staff understood the importance of privacy, dignity and respect.

We saw staff were visible in the communal areas and responded instantly when people required assistance. Equipment to maintain people’s safety was visible, close to them and well maintained. A range of specialised equipment was available to meet people’s individual care needs and to keep them safe and comfortable.

Care records were personalised, and focused on people’s current needs and wishes and encouraged people to maintain their independence where possible. Staff responded quickly to changes in people’s needs. People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support.

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. All staff had undertaken training on safeguarding adults from abuse; they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

There were sufficient numbers of staff to meet people’s need and to keep them safe. Systems were in place to regularly review staffing levels to ensure they remained appropriate. Staff had time to sit and spend time with people and this was considered as important as daily tasks and household chores. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to make sure they were fit and safe to work with vulnerable people.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. People were supported to maintain good health through regular check-ups and visits to the GP, dentist and opticians. People’s health was closely monitored and any changes addressed as a matter of priority.

People were supported to have their dietary needs met. Risks in relation to eating and drinking were known and understood by staff. Where possible people were involved in choosing their meals and supported to eat as independently as possible; using specialist plates and cutlery when required.

People were encouraged to live active lives and were supported to participate in community life where possible. Activities and outings were meaningful and reflected people’s interests, age and choice.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Many of the people living in Arthur were not able to communicate with us. We spent time observing people, talking to staff and speaking to relatives.

We found care and treatment had been planned and delivered in a way that was intended to ensure people's safety and welfare. For example, we saw detailed assessments of the person's needs and a wide range of risk assessments had been completed. We saw that where people had been assessed as being at risk due to medical conditions, for example epilepsy, suitable emergency medicine protocols had been put in place to minimise the risk of harm to people.

We saw that where people needed support to take their medicines it was managed safely and arrangements were in place to protect people's medicines. For example each person had a lockable cupboard in their own private bedroom.

One member of staff who had not worked at the home long, told us 'It's lovely here. Absolutely no concerns about what (care) I see'.

Is the service effective?

We saw that people received effective support to maintain or support their health and wellbeing. As an example we followed through one person's care plan in relation to nutritional support. We saw that the plan had been actioned with specialist support from the speech and language therapy services. This told us the care plan and support had been effective.

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. Staff we spoke with told us what they did to support people and knew what to do for them if they needed any additional support. For example, all the people living in Arthur had a physical disability, learning disability and some had medical needs. The staff were able to tell us how some people needed their food and fluid in a particular way, for example pureed food and thickened liquids. This meant people's particular nutritional needs were met.

Is the service caring?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, we saw that where people had been assessed as needing help with personal care, there was evidence in the daily records that this help had been given.

During our observations and conversations with staff and people we saw and heard examples of staff being respectful and treating people with dignity.

We observed people being supported to eat their breakfast and their lunch. We saw people were treated with respect and affection. As an example, we saw that each person required one to one support with their meals. We saw staff members supported and encouraged people to eat. We saw all of the staff members sat with people and made good eye contact whilst keeping the person's focus on eating to ensure they had enough food. We saw that people responded well to the members of staff who were patient and staff supported people at their own pace. This demonstrated to us that the staff were patient and caring towards the people who lived at the home.

Is the service responsive?

People's needs were assessed prior to them receiving care from the provider. Care plans were developed and updated alongside people and their families. This told us the provider respected the views of people and their relatives and considered their involvement important. Care plans reflected people's preferences and diverse needs. Where necessary the provider liaised with external agencies to receive specialist advice and support to meet people's changing needs. We saw evidence that healthcare professionals such as occupational therapists visited to assist with people's mobility issues.

We saw that the home responded quickly to changes in people's needs. We saw for example that care plans and assessments were reviewed regularly to identify changes in people's condition. We saw that people's GPs were called when needed if people were unwell.

Is the service well-led?

The Registered Manager of Arthur was also the Registered Manager of another home a short distance from Arthur. The Registered Manager visited the home most days and was available to us throughout the inspection. During this inspection the senior care staff member assisted us.

We saw the Registered Manager and the senior staff member of the home were experienced and knowledgeable. Staff we spoke with told us they enjoyed working at the home. They told us they felt they were well supported. They understood who was in charge and their individual roles. Staff told us 'Everyone muddles in and helps everyone out'. Another staff member said when discussing the management team, 'Very supportive'. We found that management systems were effective and ensured the quality of the service that people experienced.

The Registered Manager had worked for the company for some time and there was a consistent staff team. Staff were aware of the needs of the people living at the home and were able to meet them.