Powys House Residential Home

Powys House Residential Home is a care home. Powys house is registered to provide accommodation and personal care for up to 18 people and supports people living with a learning disability and/or mental health needs. At the time of the inspection there were 17 people living at the service. The service was a large single house, which had been adapted to suit the needs of the people living there.

The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 18 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the home being in a residential area close to local amenities and public transport. People were supported to be active members of their local community and used all local facilities either independently or with staff support. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Where we identified areas for improvement the management team took immediate action to address these. These included the absence of some risk assessments, systems to ensure the safety of prescribed topical creams had not been followed, bath and shower chairs were rusty and could therefore not be adequality cleaned. These could have adversely impacted on people’s safety and had not been identified by the provider’s and registered manager’s quality monitoring of the service.

The registered manager was not fully aware of their responsibilities under the duty of candour which requires the service to apologise, including in writing when adverse incidents have occurred.

CQC had not been notified of all significant events as required. Registered persons are required to notify CQC of a range of events which occur within services. Whilst we had been notified of some events we had not been notified of abuse or allegations of abuse which had occurred. The service had appropriately informed the local authority safeguarding team and taken reasonable action to reduce the risk of recurrence. Following the inspection, the registered manager informed us their systems had been amended to ensure that all necessary notifications would now be submitted, and the duty of candour would be followed correctly in the future.

People told us they were happy living at Powys House and felt supported to live their lives in the way they wished to do so. Staff were observed to treat people with kindness and compassion.

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 supported people and showed an understanding of equality and diversity and people were treated with dignity, and their privacy was respected. People and their relatives were involved in the planning and review of their care and people were supported to be as independent as possible.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. Staff knew how to keep people safe from harm.

Staff were recruited safely, and sufficient numbers were employed to ensure people's care and social needs were met. Staff had received appropriate training and support to enable them to carry out their role safely.

Risk assessments and management plans were generally completed for people and the home environment to ensure safety. There was a system to manage accidents and incidents and to reduce them happening again.

People received their medicines safely and as prescribed.

People's needs were assessed to ensure these could be met by the service. The registered manager and staff worked with other external professionals to ensure people received effective care.

There was a clearly defined management structure and regular oversight and input from the provider’s representative. Staff were positive about the management of the service and told us the registered manager was very supportive and approachable. Any concerns or worries were listened to, addressed and used as opportunities to make continuous improvements to the service.

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 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection was unannounced and was carried out on 26 April 2017 and 4 May 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection, in February 2016, we identified breaches of two regulations; legislation designed to protect people’s rights was not always followed; people did not always receive personalised care; and care plans were not always up to date and reflective of people’s current needs. At this inspection we found action had been taken and there were no longer any breaches of regulation.

People told us and indicated they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider's safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring. Staff sought people’s consent before providing care and understood the need to follow legislation designed to protect people’s rights.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to meet people’s needs and to enable them to engage with people in a relaxed and unhurried manner.

Staff developed caring and positive relationships with people and were sensitive to their individual communication styles and choices. They treated them with dignity and respect. People were encouraged to remain as independent as possible and maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for people and their families to become involved in developing the service. They were encouraged to provide feedback on the service provided both informally and through ‘house meetings’ and an annual survey. They were also supported to raise complaints should they wish to.

People told us and indicated that they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The directors of the company were fully engaged in running the home and provided regular support to the registered manager. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

Staff did not always respond promptly and consistently to people’s needs. Care plans were not always up to date or did not support the delivery of personalised care. A new care planning system was being introduced but had not been completed.

People were satisfied with the care and support they received from staff, who were knowledgeable about their physical and personal care needs. However, staff did not always demonstrate a good understanding of how to support people’s mental health needs. They had not been trained to communicate with people who had limited verbal communication and they did not have access to non-verbal prompts, such as pictures or symbols.

Staff did not always follow legislation designed to protect people’s rights, so were unable to demonstrate that they always acted in the best interests of people.

Whilst most people received a nutritious diet, people were not always able to make choices about the food they received and alternatives were not always offered. The manager described the way meals were served as “institutional” and was taking steps to make it more centred on people’s individual needs.

The provider did not have a clear vision or a set of values for staff to follow. A comprehensive auditing system was in place, although the manager recognised that this was not fully embedded in practice and was taking steps to improve it.

We observed positive interactions between people and staff and staff clearly knew people well. People were supported to build and maintain caring relationships. Their privacy and dignity were protected at all times and they were involved in planning their care.

People felt the home was run well. Management supported staff in their work and were described as “approachable” and “supportive”. Staff who understood their roles, were motivated, and worked well as a team. There was an open culture where visitors were welcomed and links with the community had been developed.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse, and the provider responded appropriately to allegations of abuse. Where necessary, risk assessments and behavioural support plans were put in place to help protect people from harm.

Staff minimised risks to people without compromising their independence. Where people were not able to recognise or manage risks themselves, staff supported them appropriately.

Staffing levels had recently increased during the day and people told us there were enough staff to meet their needs. The process used to recruit staff helped make sure that only suitable staff were employed. Clear systems were in place for managing medicines and people received their medicines when they needed them.

Environmental risks were managed safely and a suitable system was in place to assess and analyse accidents and incidents across the home. There were arrangements in place to keep people safe in an emergency and fire safety equipment was checked regularly.

People had access to a range of activities, although their ability to take part varied greatly and the activities they had completed were not always recorded. They were supported to access healthcare services when needed and staff had good working relationships with other professionals.

The provider sought and acted on feedback from people. A complaints procedure was in place, although this was not provided in an accessible format for people.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We looked at six care plans and saw they were individualised and included the necessary details to inform staff as to the specific care people required. We saw these were reviewed on a monthly basis. We observed care in the communal areas of the home and saw staff were not rushed and interacted with people in a positive way.

We saw the home had effective systems in place to protect people from abuse. One of the people we spoke with said staff 'look after me and make sure I am safe'. There was a duty roster system, which detailed the planned cover for the home. We looked at the duty roster and saw there were arrangements in place to manage short term absences. One member of staff said 'it is nice. The level of staff we have means you do get time to sit down with people and they get quality time to talk to you'.

We found the provider had an effective quality assurance system in place and sought the views of people who use the service and their families through regular surveys.

People told us that they felt "safe and happy" at the home. Most people we spoke with had lived at the home for many years and clearly viewed it as their home. People also told us they had chosen the colours for when their bedrooms had been redecorated and that they each had their own room. We spoke with two visiting health professionals who were complimentary about the home and stated "the manager and staff clearly knew the people they looked after". Health professionals were complimentary about how a person with increasing needs was being cared for.

We viewed care plans and related records for two people. These were individual, and showed that people were receiving the care and support they required. Nutritional needs were appropriately met and there were safe systems in place for the management of medicines. The environment was homely and well maintained. All necessary records were available and stored securely.