Archived: Bailiffgate

Plans were in place for the care service to adapt and to be developed and designed in line with the values that underpin the Registering the Right Support guidance. The model of care proposed from 2015 and 2016 guidance that people with learning disabilities and/or autism spectrum disorder which proposed smaller community based housing. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

At our last inspection in September 2016 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.

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At this inspection we found the service remained good.

The atmosphere was welcoming and the building was well-maintained with a good standard of hygiene. A professional commented, "The manager and team are welcoming and professional and enable effective assessment and support planning with people."

Staff were kind and caring and had developed good relationships with people using the service. People were comfortable in the presence of staff. Relatives confirmed the staff were caring and looked after people very well.

People told us they were safe and were well cared for. Several people commented, "I love living here." Staff knew about safeguarding vulnerable adults procedures. There were enough staff available to provide individual care and support to each person. Staff upheld people's human rights and treated everyone with great respect and dignity.

Staff were well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

Staff were skilled and knowledgeable and they were committed to making a positive difference to each person. There was clear evidence of collaborative working and excellent communication with other professionals in order to help people progress and become more independent.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care and records reflected the care provided. Arrangements for managing people’s medicines were safe.

Staff were well supported by the registered manager and senior management team. The registered manager had a clear vision for the service and its development. They were enthusiastic and believed strongly in the ethos.

People had food and drink to meet their needs. They were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were all supported to contribute and to be part of the local community.

People were supported to have 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. Information was accessible and made available in a format that helped people to understand.

There was regular consultation with people. All people were kept involved and encouraged to make decisions, whatever the level of need. They were involved in regular meetings about their care and the running of the home. Menus were planned with input from people, based on their personal preferences and choices.

Robust auditing and governance systems were in place to check the quality of care and to keep people safe. People were encouraged and supported to give their views about the service.

People said they knew how to complain. They told us they would feel confident to speak to staff about any concerns if they needed to. People had access to an advocate if required.

Further information is in the detailed findings below.

The inspection took place on the 12 and 19 July 2016 and was unannounced. The service was last inspected on 14 and 15 December 2014. There was one breach of regulations at that inspection related to the numbers of suitably skilled staff deployed in the service. It was also found that documentation related to decisions taken in the best interests of people needed to be improved. We found that there had been an improvement in relation to both of these issues during this inspection.

A new manager had been appointed and was in the process of being registered with the care Quality Commission (CQC). There were plans to recruit a deputy 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. We received feedback about a number of positive changes made by the new manager.

Suitable numbers of staff were deployed and there had been an increase in staffing since the last inspection. This included the appointment of an activities coordinator. Safe recruitment procedures were followed which helped to protect people from abuse.

Safeguarding policies and procedures were in place and staff had received training in the safeguarding of vulnerable adults. A session had been held with people to raise their awareness of safeguarding issues and how to tell someone if they had concerns.

We checked the management of medicines and found there were suitable procedures in place for the ordering, receipt, storage and administration of medicines. Routine stock checks and audits of medicines were carried out and the competency of staff to administer medicines safely was checked on a regular basis.

Checks on the safety of the premises were carried out including gas and electrical safety and window restrictors and water temperatures. Debris which could have posed a hazard was found in the rear garden and was awaiting disposal. This had been removed by the second day of the inspection.

Individual risks to people were assessed such as risks associated with road safety, behavioural disturbance and falls. Where risks had been identified, care plans were in place. These were up to date and regularly reviewed. A record of accidents and incidents was maintained and monitored for any patterns or trends.

Suitable infection control procedures were in place. The home was clean and well maintained and bedrooms were nicely personalised and homely.

Staff received regular training which was relevant to their role. Staff received regular supervision, and annual appraisals were carried out. This meant that the development and support needs of staff were met.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Capacity assessments had been carried out and applications to deprive people of their liberty had been made to the local authority in line with legal requirements.

People were supported with eating and drinking. Special diets were catered for and people were offered choices of meals and were supported to prepare their own food where appropriate. Advice had been sought from professionals where necessary including the speech and language therapist to provide advice about swallowing difficulties.

The health needs of people were met. They were supported to attend health appointments in the community. Communication aids were in use to support people to express when they were in pain or feeling unwell.

We observed caring and respectful interactions with people throughout the inspection. People were included and involved, and treated as equals by staff. Communication was adapted to ensure that people were supported to share their views and express their feelings. Regular meetings were held with people as a group and individually. These were recorded in pictorial easy read format.

Person centred care plans were in place to meet the physical, psychological and social needs of people. These were up to date and were reviewed regularly. Effective systems were in place to ensure that staff remained up to date with any changes to care and treatment. Relatives told us they were kept informed about the care of their family member.

The amount of activities available to people had increased since the last inspection and there were comments from staff and relatives about the positive impact of this on people who used the service.

A complaints procedure was in place and was available in easy read format. Complaints were also logged including the response to these.

Staff and relatives spoke positively about the new manager and the improvements they had made.

A number of checks and audits were carried out to ensure the quality and safety of the service. Surveys were provided to people to elicit their views about the quality of the service which were available in an easy read format.

We concluded that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. They were provided with a choice of suitable and nutritious food and drink.

We concluded that there was enough equipment to promote the independence and comfort of people who used the service

There were effective recruitment and selection processes in place.

People’s personal records and those relating to staff and the management of the home were accurate and fit for purpose.

Relatives told us and records confirmed, that consent was gained before care and treatment was carried out. One relative said, “X had to go for a dental procedure and I got a written form to sign.”

Relatives were extremely complimentary about the service and the care and support provided. Comments included, “It’s absolutely brilliant” and “I’m really really happy with the care.” We considered that people experienced care, treatment and support that met their needs and protected their rights.

Relatives we spoke with were complimentary about the cleanliness of the service. Our own observations confirmed this. We considered that people were cared for in a clean, hygienic environment.

Relatives told us and our own observations confirmed that there were enough staff at the home to meet people’s needs.

Relatives said they felt able to raise any concerns or comments about the service and that they had no complaints to make. Records confirmed that people were made aware of the complaints system.