22 September 2016
During a routine inspection
This inspection took place on 22 and 23 September 2016 and was announced. The provider was given 48 hours' notice because the location is an independent supported living service for people with learning disabilities and autism spectrum disorder who are often out during the day; we needed to be sure that someone would be in. The inspection was carried out by one inspector.
A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since October 2013. 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.
Not all of the people in receipt of care could communicate with us verbally, but those who could told us they were happy with the support they received. They said they liked the staff team and we saw there was a good rapport between people and staff. Safeguarding policies and procedures were in place to monitor and respond to any matters of a safeguarding nature and we saw that historically these had been dealt with correctly by the registered manager. Staff were aware of their personal responsibility to report incidents of a safeguarding nature and they had received training in safeguarding vulnerable adults. Risks that people had been exposed to in their daily lives and within the environments of their homes had been assessed and mitigated against. Accidents and incidents were monitored, analysed and measures were put in place where necessary to prevent repeat events. General environmental checks were also carried out on a regular basis to ensure people remained safe.
Recruitment procedures were robust and medicines were managed safely and appropriately in line with best practice guidance. Staffing levels were sufficient on the days that we visited the home to meet people's needs and they were determined by the level of support each individual needed. Staff were very knowledgeable about people's needs and effective plans were in place to support them to meet these needs. Care plans and risk assessments were regularly reviewed to ensure they remained current and up to date. They were person-centred and described in detail how staff should support people, the characteristics they would need and people's personal behaviours, likes, dislikes and habits.
Staff were trained in key areas relevant to their role such as emergency first aid and the safe handling of medicines. They were also trained in areas such as epilepsy and breakaway techniques, which was relevant to the needs of some of the people they supported. There was a thorough induction package in place and supervisions, appraisals and staff meetings took place regularly to provide support to the staff team.
CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken in line with procedures set out in the MCA. Applications to the Court of Protection were currently being considered by people's care managers in the local authority, and the registered manager was working with the local authority to progress these as soon as possible. People's consent to care and treatment was obtained before staff delivered care.
People were treated with dignity and respect and they enjoyed good relationships with staff. The ethos of the service was to promote people's independence and there was evidence that people had progressed in their abilities to look after themselves as a result of receiving care and support from the service. Some people were able to advocate for themselves and others had relatives acting on their behalf. People were supported to maintain their general healthcare needs and their food and fluid intakes were monitored to ensure they ate and drank enough to remain healthy. Specialist input into people's care was arranged as and when needed. Care plans about how to support people, written by healthcare professionals such as psychiatrists were retained within people's care records for staff to refer to.
Complaints received within the service were handled appropriately and feedback was actively sought from people who used the service, their relatives, staff and healthcare professionals with a view to making improvements to the service where necessary.
We received positive feedback about the registered manager and overall leadership of the service. A structured management team was in place which provided support to the service and registered manager. Meetings were held within the service internally and also within the provider's organisation at national and regional level. Quality monitoring systems were robust including a range of audits and checks being carried out in relation to health and safety matters, medicines management, finances, infection control, accidents and incidents and safeguarding issues. The provider had oversight of auditing within the service as regular monthly reports and results of audits and analysis were sent to them. Regular external provider level audits of the service were also carried out by the health and safety team and quality team that were part of the overall provider organisation.
The provider recognised the achievements of both people and staff and issued a range of awards. Social isolation was encouraged and events were held for people who used the service to partake in, if they so wished.