We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
This is a summary of what we found-
Is the service safe?
Staff we spoke with were clear about what was meant by abuse and what actions they would take should abuse be suspected. Families of people who used the service expressed confidence that could raise any issues with the registered manager and the staff team. A senior member of staff was on call at all times in case of emergencies. The provider had a policy for safeguarding adults from abuse. This was communicated to staff during their induction, was available in a policy file and on display in the office. This meant that people could feel confident that they would be protected from abuse.
Staff employed by the home had been recruited effectively. The manager demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role. Staff completed one week of theory based training, and one week working with experienced staff to familiarise with the complex needs of people living in the home. The team leader monitored and checked staff to ensure they understood their roles and responsibilities before they began work unsupervised. Staff we spoke with also confirmed that they had worked with experienced staff until they had felt confident to carry out their role. Monthly supervisions were completed by team leaders, and annual appraisals were completed by the registered manager.
We saw that people were treated with dignity and respect by staff. Staff told us they called people by their preferred name, and ensured people had privacy when they were being supported with personal care. One relative we spoke with told us that: "They (staff) are respectful....just outstanding".
Systems were in place to ensure that the provider learnt from events such as accidents, incidents. This meant that risks to people were reduced and helped the service to improve.
Is the service effective?
An advocacy service was available and had been used by people living in the home. This meant that people had access to additional support if they needed it.
People's health and care needs were assessed with them, and they were involved in planning their care. The care plans had been reviewed regularly and there was evidence that the provider had worked closely with other health professionals such as the community learning disability team, social workers, psychiatrists and occupational therapists.
Families were able to visit at any time and one relative told us: "I always visit unannounced".
Is the service caring?
People were supported by kind and attentive staff. We saw interactions that were thoughtful and which supported and encouraged people to make their own decisions. We saw that people were supported with a range of activities to help them achieve their full potential.
A health professional we spoke with was complimentary about the service and told us: "They really understand person centred care, and have embraced and implemented what we have taught them, they offer fantastic support".
People who used the service, families, external professionals and staff were all invited to participate in an annual satisfaction survey. Actions were taken in response to any concerns or shortfalls identified.
Is the service responsive?
People completed a range of activities in and outside of the service on a daily basis. A person centred approach meant that each person living in the home had services and opportunities available based on their current and perceived needs.
People or their families knew how to complain, and there were copies of the complaint procedure in people's care files.
The manager worked well with other health professionals who provided support with training and recommendations which would be incorporated into the care plans. A health professional from the community learning disability team expressed their view that the staff provided an excellent service and were committed to quality improvement.
Is the service well led?
The provider had an auditing and quality monitoring programme in place. The programme included completion of internal and external audits. Action plans from these audits were completed and progress was monitored the following month.
Unannounced nights checks were completed periodically which meant that people could be confident that the quality of the service was monitored over a twenty four hour period.
The views of people who used the service were taken into account. For example, people participated in staff recruitment, had representation on the health and safety committee, and provided feedback for the monthly visit by the director. There were also 'service user' meetings which were recorded, and any actions documented. This demonstrated that the people using the service were enabled to contribute to the running of the home.
Care documentation was reviewed formally on a six monthly basis by the management team or more frequently if there were any changes.
Accident and incident reports were completed by staff, and the registered manager had a process in place for analysing all information on a regular basis. This ensured that any required actions or identified trends could be addressed.
Complaints and compliments were monitored and recorded and all people living in the home had a copy of the procedure in their file.
Positive comments had been received about the staff from families and health professionals about the quality of the service provided, and the commitment of the management team to provide the best possible care for the people who used the service.