House Martins Care Limited Number Two

People who used the service also benefited from being near another residential home owned by the same provider, House Martins Number One. The two services had a joined-up approach to delivering care and support across both of their locations. This enabled the service to provide a wide range of activities from both locations. Deployment of staff was also flexible between both locations which meant the service was well equipped to respond to people’s individual needs. Throughout this inspection report there will be similarities in the content to that of the inspection report for House Martins Number One, which we also inspected alongside House Martins Number Two.

The service has been developed and designed in line with the values that underpin the 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 can live as ordinary a life as any citizen.

We were assisted throughout the inspection by a registered 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.

This inspection took place on 18 and 19 October 2018. The service was last inspected on 25 and 26 January 2016 and received an overall rating of 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.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

Staff were aware of their responsibilities to safeguard people from abuse. Risks to people's safety were assessed and medicines were administered safely.

Infection control policies continued to protect people from the risk of infection.

There was an open learning culture and staff felt supported in their roles. This was reflected in a low turnover of staff and this benefited the quality of care that was provided.

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.

The service continued to work within the principles of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of involving people as much as possible in their care and acted in their best interests if decisions needed to be made on their behalf.

Staff spoke about people with genuine empathy and compassion and demonstrated a commitment to providing good care. Staff were observed to interact with people and each other in kind and caring ways. The service had clear values in relation to supporting people to maintain their privacy, dignity and respect.

Key workers were knowledgeable about people’s needs and people told us that they were happy with the care they received.

Care and support plans were regularly reviewed. People were supported to maintain good health and receive ongoing healthcare support. Care and support plans were regularly reviewed. Care and support plans included hospital passports and health action plans, which ensured they were supported effectively should they need to access health services.

People continued to receive support with their nutrition and hydration. Advice and guidance from health professionals had been included in the support plans. People liked the food and could choose what they wanted to eat and told us that they liked the food.

Staff were proactive at promoting activities and access to the wider community. People participated in regular activities that they chose and enjoyed including holidays and access to paid employment.

End of life care was person-centred and focused on providing the best care possible. This included considering the persons wishes and preferences and involving both professionals and family.

The registered manager was committed to providing a high-quality service and spoke in a caring and compassionate way about the people who used the service. The service had internal quality assurance systems in place to monitor performance and to drive improvement.

The service continued to work closely with their partners and stakeholders to share skills and knowledge and maintain the quality of the service.

Further information is in the detailed findings below.

House Martins Care Limited provides specialist residential care and support to people who are deaf and living with a learning disability. Accommodation and support at House Martins Number Two is provided from a residential house which is well integrated within the local community. At the time of our inspection visit, five people who used the service were living at House Martins Number Two. People who used the service also benefited from being in close proximity to the services other residential home, House Martins Number One. This enabled the service to provide a wide range of activities from both locations. Deployment of staff was also flexible between both locations which meant the service was well equipped to respond to people’s individual needs.

At the time of our inspection there was a registered manager in post. 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.

The service had systems and procedures in place which sought to protect people who used the service from abuse. This included an appropriate safeguarding policy and associated procedures. Staff we spoke with demonstrated a good understanding of local safeguarding procedures and how to raise a concern. However, we found safeguarding information was not available in a format which would help people who used the service to understand how to raise a safeguarding concern. We spoke with the registered manager about this and immediate positive action was taken by obtaining information from the local authority website and then clearly displaying this information within the service.

We looked at recruitment and selection procedures and found safe recruitment practices were in place. This was evidenced through our examination of employment application forms, job descriptions, people’s proof of identity, written references, and Disclosure and Barring Service (DBS) checks. These helped to ensure potential employees were suitable to work with vulnerable people.

Accidents and incidents were appropriately recorded and included details of preventive strategies used by the service to reduce the likelihood of such events occurring in the future.

Information was readily available which detailed how people’s individual support needs should be managed in the event of an emergency evacuation from the premises.

Medicines were stored, administered, recorded and disposed of safely. This included a sample signature list of staff responsible for administering medicines being available. A photograph of each person who used the service receiving medication was displayed on their file to reduce the risk of medication errors. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Health and safety records relating to buildings and premises were complete and up to date. Fire equipment was maintained and checked. Emergency lighting was checked and a first aid kit was readily available. Gas and electrical safety certificates were up to date. Emergency contact information was also readily available in case of a domestic emergency such as; flood, fire or loss of power.

People’s care plans included a wide range of up to date and relevant personal and health information. Risk assessments were completed and up to date. We found holistic assessments in place for each person who used the service which included comprehensive information detailing: ‘about me’, ‘my circle of support’, and ‘my daily routine’. Health action plans were also included in each file, which contained health and other relevant information to help provide consistency of care.

We found the staff induction programme for new starters was robust. The service followed nationally recognised ‘Common Induction Standards’ through the Skills for Care Framework.

Staff supervision was conducted consistently with a wide variety of issues being discussed, which included identifying training needs, personal development and person-centred care planning.

Opportunities for staff to access training and development were on-going throughout the year. Staff we spoke with told us they were able to access training courses relating to specific subjects as well as more generalised training.

We looked at the how service supported people with their nutritional and hydration needs and found that staff demonstrated a good understanding of people’s likes and dislikes, dietary preferences and personal requirements.

People who used the service told us staff were kind and caring. A number of people had lived at House Martins for many years and knew their support workers well. Three people who used the service were very happy to show us their rooms and told us they had been involved with choosing the decorations and furnishings.

People told us they enjoyed a variety of activities and were well supported in accessing the local community. We saw a ‘daily plan’ for each day of the week which detailed a wide range of activities that people who used the service were supported to participate in. This included football, dance, swimming, drama and crafts. Additionally, two people who used the service were supported to access part-time employment.

The service had effective systems in place for quality assurance and audit. Quarterly quality assurance checks were completed covering a variety of areas; including the environment and first impressions; policies and procedures; medicines management; finances; person-centred support; and, general risk assessments.

People who used the service, their relatives, staff and other professionals we spoke with, all agreed the service was well-led and the management team was knowledgeable, friendly and approachable.

The service had an appropriate complaints policy which clearly described how to make a complaint. We also looked at the comments and compliments book which included a variety of thank you cards and notes, in addition to a number of complimentary emails sent from an appreciative relative.

We looked at a sample of people's support plans. The support plans were detailed but information was difficult to find. The manager told us they already had a draft copy of a 'person centred plan' they intended to use.

We saw that support staff encouraged people to have a healthy lifestyle. On the day of our inspection people had been swimming and cycling. During the afternoon three people were playing a game of 'Wii ten pin bowling'. Comments included: 'it is nice the staff are nice.' 'I can chose what to do.'

We saw interactions between people who lived at the home and support staff were positive. People had lived at the home for a long time and were encouraged to maintain their hobbies and interests.

There was an 'open door policy' at the home and people were encouraged to express their opinions. The manager made time to speak with people who lived at the home, their relatives and support staff.

We spoke with support staff who told us that they received formal and informal supervision and they had opportunities to develop skills and knowledge via an on line training system. This meant that staff were able to develop skills and keep up to date with new methodology.

Comments from people who used the service included;

'I really like living at Number Two. I enjoy swimming and dancing when I can'.

'I have a paid job at the moment. The staff always go with me each time I'm working'.

'The staff help me with my medication. I get my tablets every morning'.

'I like going on holiday. A member of staff always comes with me'.

We found that people living at the home were supported by the staff to live as independent a lifestyle as possible which was centred around their hobbies, interests and personal preferences.

None of the people we spoke with had any concerns about the service provided but everyone said they would feel quite comfortable in raising any concerns with the manager of the home if anything ever did arise.