Archived: PAKS Trust - 17, 18 & 42 Clarence Street

The service is a ‘care home’ operated by P.A.K.S Trust. The service consists of two separate houses; 18 and 42 Clarence Street. A third house, 17 Clarence Street, was previously part of this service. However, this property had not been used since June 2018. The provider was in the process of removing 17 Clarence Street from their registration with us. The service is one of six services provided by P.A.K.S Trust and provides accommodation with personal care for up to four adults. People cared for at the home are living with learning disabilities, including autism. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection visit, there were four people living at the home.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. 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.

At the last inspection in April 2016 all five key areas were rated as Good. At this inspection we found the quality of care had been maintained and people continued to receive a service that was safe, caring, effective and responsive to their needs. The rating continues to be Good.

There were enough staff on shift with the appropriate level of skills, experience and support to meet people’s needs and provide effective care. Staff knew what action to take in the event of an emergency and had been trained in first aid.

Staff understood their responsibilities to protect people from the risks of abuse. Staff had been trained in what constituted abuse and would raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process. Staff received training and used their skills, knowledge and experience to provide safe care to people.

Risks of harm or injury to people had been assessed and management plans were in place. The home was clean and tidy and staff understood how to prevent the risks of cross infection. At the time of our inspection visit, there had been a large flood from a water pipe in the kitchen of one house. Immediate action was being taken, by the provider, to address this and there was minimal disruption to the service.

People were encouraged and supported to maintain good health. Staff frequently liaised with other healthcare professionals. People received their prescribed medicines in a safe way.

Staff worked within the principles of the Mental Capacity Act 2005. The registered manager understood their responsibilities under the Act. Three people had authorised deprivation of liberty safeguards (DoLS) in place when their care and support included restrictions in the person's best interests.

Staff supported people in a caring and compassionate way. People had varied levels of verbal communication and some used gestures and non-verbal communication which staff understood well. The registered manager told us about their plans to improve the use of pictorial communication to support people in making choices.

People had individual plans of care which provided staff with the information they needed. Care plans were pictorial and accessible to people, however, they did not always reflect people’s involvement in planning their care and support. The registered manager told us care plans were to be updated to a new style which would be more inclusive and accessible so people could be more involved in reviewing their care.

People made individual choices about how they wanted to spend their time. There were opportunities for people to attend a day centre operated by the provider. People were supported with various activities both inside and outside the home.

People had no complaints about the service. They felt staff would address any concern if they needed to raise something.

The registered manager checked the quality of the service to make sure people's needs were met safely and effectively. Feedback about the service was encouraged on a day to day basis from people and staff. Staff felt supported in their role. The provider and registered manager understood their regulatory responsibilities.

Further information is in the detailed findings below.

Numbers 17, 18 and 42 Clarence Street provide accommodation, care and support for up to five people with learning disabilities, or autistic spectrum disorders. There were five people using the service when we visited. Accommodation was provided across three terraced houses in the same street. Each house had a minimum of two bedrooms, a shared lounge, dining room, kitchen, bathroom and small garden area.

A requirement of the service's registration is that they have 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

People and their relatives told us staff were caring. Staff had a good understanding of people’s needs. People were treated as individuals whose preferences and choices were respected. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

Staff had received training to help them safeguard people who used the service. They were able to explain the correct procedure to follow if they had concerns. There were enough staff to meet people's needs safely and effectively. Staff recruitment checks ensured staff were suitable prior to them starting work at the service. Risk assessments around the provision of people’s care and support had been carried out and action was taken to reduce any identified risks.

People, their relatives and staff spoke positively about the registered manager. They were able to talk with the manager if they had any concerns and felt their concerns would be dealt with. The manager ensured staff received on-going training and had regular meetings in which their performance and development was discussed.

The provider understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with DoLS and the MCA, and at the time of our visit was awaiting the outcome of those applications.

People told us they felt safe and liked living at the service. We saw there was a good choice of food available and people could get snacks and drinks when they wanted them. People were supported effectively with their health needs and saw the appropriate healthcare professionals when necessary. There were systems to ensure that medicines were stored and administered safely.

People were supported in a range of activities, both inside and outside their home. People had been asked what was important to them and how they liked to spend their time. Activities enabled people to be part of their local community and to take regular holidays.

People were supported to be involved in decisions about their life and their support needs. People were supported to make decisions about their environment and choose how their room was decorated.

Each person had a care and support plan with detailed information and guidance personal to them. Care plans included information on maintaining the person's health, their daily routines and preferences.

People who lived at 17, 18 and 42 Clarence Street and their relatives were given the opportunity to share their views about how the service was run. Quality assurance procedures identified where the service needed to make improvements and where issues had been identified the manager and provider took action to continuously improve the service.

We saw that care staff knew people well and spoke with them in a friendly, respectful way. We saw that staff were sensitive to people's needs and offered them support when assistance was requested or indicated.

Family members spoken with told us, 'I can't praise the service highly enough. My relative is happy and safe,' and 'I completely trust the staff to care for my relative. Communication is first class.'

People were supported to take part in recreational activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what activities to be involved in. This included shopping, eating out, social clubs, day centres and going on holiday.

Systems were in place to ensure that medicines were managed appropriately on people's behalf.

Staff were positive about working for the organisation. We were told there were regular training sessions to enable staff to develop their skills and knowledge and provide effective care for people who used the service.

We saw that complaints processes were in place for people to use if they were not happy with the service provided.

Other people using the service had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences.

People appeared comfortable and at ease in their surroundings and with the staff. Two people we spoke with told us that they were happy living in their homes. "Yes, I'm happy living in my house' was one comment made.

Relatives we spoke with were happy with the care and support provided. 'Paks Trust are absolutely wonderful, I'm very happy and would recommend Paks definitely" was one comment made.

People had care plans in place that contained information to assist staff with meeting their care needs. Staff we spoke with were knowledgeable about people's care needs and were able to tell us about them.

Medication was managed safely on behalf of the people using the service.

Confidential records belonging to people using the service and the staff were maintained in good order and were stored securely.