Cranley Gardens

Cranley Gardens is a residential care home providing personal care to up to 6 people. The service provides support to people who have a learning disability and/or autism. The service also specialises in supporting people with epilepsy. At the time of our inspection there were 6 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were not supported in a safe, well-maintained environment. Elements of the service were worn and not inviting. Environmental risk assessments were not comprehensive enough, including in relation to fire safety and security.

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. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to take part in activities and pursue their interests in their local area. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. However, we saw that some incidents and safeguarding concerns were not reported appropriately and consistently through the provider’s internal processes in order to identify trends and themes in a timely manner.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

There had been a change in the management at the service and whilst leadership was improving, there had been a period of instability. The management team had identified a number of areas requiring improvement at the service, however, systems to review the quality of the service were not comprehensive enough to identify all the concerns we found during our inspection. Relatives did not always feel able to speak openly to staff and ensure any concerns raised were listened and responded to.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. The interim manager had undertaken a closed culture audit in response to recent concerns raised at the service, to ensure staff knew how to raise concerns.

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 27 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to safety and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Independence Homes Limited - 14 Cranley Gardens accommodates six people with a learning disability in one adapted building. The care 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. At the time of this inspection there were 6 people using the service.

This inspection took place on 21 March 2018. At our last inspection of the service we rated the service ‘good’. At this inspection we found the evidence not only continued to support the rating of good, we also found for the key question ‘is the service caring?’ the service had improved to ‘outstanding’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Staff had formed open and honest relationships with people and their relatives to gain their trust and build confidence that the care and support provided would be caring, considerate and reflective of people’s specific needs and preferences. Staff dealt with any tensions and conflicts that arose with empathy and compassion and went the extra mile to enable people to express their views so that their preferences and choices would be understood by everyone supporting them. They encouraged people to explore different options with regard their care.

People and relatives praised staff for their care and kindness. Staff were considerate and attentive to people’s needs, spoke about people with great respect and affection and clearly knew people well and what was important to them in terms of their day to day support. Staff respected people’s right to privacy and to be treated with dignity. They were warm and welcoming towards people’s relatives when they visited the service.

People were safe living at Independence Homes Limited - 14 Cranley Gardens. Staff understood how to safeguard people from the risk of abuse. Staff followed current guidance on how to minimise identified risks to people to keep them safe from injury or harm.

Risks posed to people by the premises were appropriately managed. The provider maintained a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. The premises was kept clean and clear of slip and trip hazards. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely and people received them as prescribed.

There were sufficient numbers of staff to keep people safe. The provider maintained recruitment checks to assure themselves of staff's suitability and fitness to support people. Staff had regular and relevant training to keep their knowledge and skills up to date with best practice.

Staff adhered to current best practice, legislation and standards in the delivery of people's care and support needs to help them achieve positive outcomes in relation to their physical, emotional and mental health and wellbeing. People were actively involved in planning and making decisions about their care and support needs so that they would continue to receive highly personalised care and support, tailored to meet their individual needs. People’s care and support needs were discussed and reviewed with them regularly to ensure the support provided continued to meet these.

People were encouraged to keep healthy and well, to eat and drink enough to meet their needs and helped to access healthcare services when needed. The provider’s bespoke epilepsy alarm system ensured people received timely support from staff when required.

The design and layout of the premises provided people with flexibility in terms of how they wished to spend their time when at home. People were supported to participate in a wide range of personalised and group activities and events to meet their social and physical needs and to build and maintain friendships and relationships with others. They also had access to education opportunities to develop skills and promote their independence.

People were asked for their consent before care was provided and prompted to make choices. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People, relatives and staff were asked for their views about how the quality of care and support could be improved. Senior staff demonstrated good leadership and were approachable and supportive. Senior staff monitored the quality of care and support provided. They undertook surveys and regular audits of the service and took appropriate action if any shortfalls or issues were identified through these. If people were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately.

The provider supported the service to continuously improve and worked in partnership with others to develop and improve the delivery of care to people. The provider was assisting in trials of new technology to improve outcomes for people living with epilepsy. The service was also participating in the Sutton Homes of Care Vanguard Initiative to provide ambulance and hospital staff with the information they needed to help them determine the treatment a person may need in an emergency.

The service had a registered manager in post who was aware of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.

Further information is in the detailed findings below.

14 Cranley Gardens provides accommodation, care and support to up to six people with epilepsy and learning disabilities. At the time of our inspection six women were using the service.

The service had 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.

A safe environment was provided which was suitable to people’s needs. People were able to express their opinion about the environment and were involved in decorating decisions.

Staff had the knowledge and skills to keep people safe. They were aware of the reporting procedures if they had concerns a person was being harmed and ensured they shared their concerns with a member of the management team so appropriate action could be taken to support the person.

Staff were aware of the risks to people’s safety, including any risks associated with their epilepsy. Staff maintained a balance between giving people their independence whilst maintaining their safety. We saw that staff worked with people to identify risks to their safety and how people could self-manage those risks.

Staff supported people to self-medicate and progress towards self-management of their medicines. Safe medicines management processes were followed and people received their medicines as prescribed.

People were supported in line with the Mental Capacity Act 2005 and were involved in all decisions about their care. If staff had concerns about a person’s capacity to make a decision they arranged for a mental capacity assessment to be undertaken to identify what support would be in the person’s best interests.

People were supported to be as independent as possible, this included participating in paid employment, using public transport, and undertaking household tasks. People were offered choice about how they received the support they required and staff respected people’s opinions. Staff were respectful of people’s privacy and maintained their dignity.

Detailed care plans were developed in discussion with people and their families to identify what support people required and how staff could help them to lead fulfilled lives. People were supported to access local amenities and participated in activities they enjoyed.

There was a stable staff team who worked well together. People knew the staff and the staff knew people’s preferences and their interests. Staff had the knowledge and skills to support people. They undertook regular training and completed relevant qualifications to ensure they were aware of good practice guidance.

People, their relatives and staff were invited and encouraged to share their views and opinions about the service. We saw that feedback received was used to improve service delivery.

The staff team and the senior management team reviewed the quality of the service, and implemented the required actions to improve service delivery. Incidents, accidents and complaints were learnt from to further improve the support provided.

We found that people were involved in their care and treatment and were encouraged to be as independent as possible. Care and treatment was provided in line with person centred care plans by qualified and appropriately trained staff.

We found that medicines were correctly stored and administered. We also found that there was a system in place to record and deal with complaints even though none had been received in the preceding 12 months.

People living at Cranley Gardens are well cared for; the house is well maintained and feels like a real home. The staff were well informed and very capable. They spoke well about Independence Homes as a company and praised the training and support provided. The systems of management and quality control were exemplary as were the systems in place for obtaining service users feedback as well as that of other stakeholders.