Archived: East View Housing Management Limited - 368 The Ridge

We found the following examples of good practice.

The home was clean and hygienic. Staff cleaned frequently touched surfaces regularly and cleaning schedules were completed to reflect this. Communal areas of the home had been rearranged to allow space for people to socially distance and were often only used by one person at a time. Hand sanitiser was not able to be left in communal areas due to risks to people, hand sanitiser was placed carefully around the home to ensure people’s safety and staff carried small bottles on their person.

People were not able to understand social distancing and enjoyed walking around the home together. Staff supported people on an individual basis and encouraged people to maintain their distance from each other. Staff ensured that surfaces were cleaned as people walked around the home. Staff also supported people to wash their hands frequently.

The home had experienced an outbreak of COVID-19 in the last year. Each person had an individual care plan to support their isolation during this period. People were supported by staff to remain in their rooms during the 14 day isolation period, and staff came up with creative ways to keep people entertained during this time such as dancing outside their bedroom doors. During the outbreak, PPE stations were able to be placed outside people’s doors and staff wore full PPE when supporting people. The registered manager told us staff had pulled together and worked as a team during this difficult time.

One person had been unwell with the after effects of COVID-19. The registered manager had been pro-active in sourcing all the support necessary for this person in a short space of time. This involved working in collaboration with the physiotherapist, GP, speech and language therapist (SALT) team and dietician to ensure the person had all the support they needed.

People received visits from their loved ones. Visitors had lateral flow tests and their temperatures taken before entering the building and wore personal protective equipment (PPE). A room had been designated for visitors which was cleaned between each visit. Staff also supported people to keep in touch with their loved ones through phone and video calls.

Staff had noticed an increase in people’s behaviours that challenge during the pandemic, and staff had worked hard to support people. The registered manager had balanced people’s mental wellbeing with the need to support infection control. People were supported to go for walks outside the home and this had been discussed with Public Health England as to how this could be managed safely.

Staff were wearing PPE in line with current government guidance. The home had adequate amounts of PPE throughout the pandemic. One person did not like clutter and therefore PPE was kept in people’s bedrooms to ensure it wasn’t removed. People had foot operated pedal bins in their bedrooms where they were happy to have these.

The registered manager had produced interim training questions for staff while external trainers hadn’t been able to come into the building, this allowed for management to identify any possible gaps in staff knowledge during this time. The registered manager had also produced an interim supervision form for staff to complete and send into the management team. This form encouraged staff to say how they were feeling, how the pandemic is affecting them and any support they may need. Staff were given the option to discuss their responses on a one to one basis. All staff then received a collective response from the registered manager collating issues raised as well as celebrating achievements.

368 The Ridge is a residential care home providing personal care for up to six people. At the time of inspection, six people were living at the service. People were living with learning disabilities and autism.

The building was situated over two floors. Bedrooms were spacious with ensuite facilities and there were various communal areas for people to relax in. There was also a large accessible garden that we saw people using throughout the inspection.

The service has been developed and designed 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.

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

The outcomes for people reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.

Although regular quality audits were completed to manage oversight of the service, we found improvements were needed to the recording of mental capacity documentation. We also discussed alternative ways of gathering feedback from people to ensure it was effective. For both these concerns, we considered impact on people to be low. The interim manager acknowledged these were areas for improvement and began planning for how to rectify this.

Although people could not all tell us they felt safe, we observed them to be relaxed and happy around staff that knew them and risks to their wellbeing. Relatives were confident that staff kept people safe, one telling us, “I think they’re as safe as they can be, whilst still having complete freedom.”

There were enough staff to meet all of people’s needs and they were recruited safely. We observed medicines being given safely to people by trained and knowledgeable staff.

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 had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One relative said, “Staff are warm and friendly - they know my relative very well, know exactly what's going on and how to manage their support needs.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One relative described the service as, “Like a big family.” We observed people to be happy to see staff and engaging in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as sign language and objects of reference, to gain their views.

Although we found some areas of improvement, feedback about the manager and interim manager was positive from staff, professionals and relatives. A team working culture was promoted and staff were encouraged to be open, honest and supportive of one another. The interim manager said, "When things go wrong, we use it as a learning tool. We take issues to manager's meetings, ask for ideas and talk about where we can improve."

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 September 2016)

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.

This service provides care and accommodation for up to six people with learning disabilities and autism. Six people lived at the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

At the last inspection undertaken on the 31 March and 01 April 2015, we asked the provider to make improvements in relation to a number of areas. Some aspects of staff recruitment processes required improvements to ensure all valid checks had been completed on staff. Records of incidents of behaviours that challenged required more detailed information to support risk assessments and to reduce the risk of future occurrences. Some areas of the home required refurbishing. Further training was required to help staff provide support to meet people’s individual needs and how to apply the Mental Health Act and Deprivation of Liberty Safeguarding in their work roles. Food and drink supplies required further monitoring to ensure they were suitably replenished and to provide people with required choices. Communication by staff required improvements to ensure that people’s individual needs were met. Individual activity planners needed to be updated and presented in the ways identified in people’s care plans. Improvements were needed to ensure people’s goals and wishes were effectively progressed and to explore new activities which met people’s preferences. A quality monitoring system was in place but required improvement to enable the service to identify shortfalls we found at the last inspection.

The provider sent us an action plan stating they would have addressed all of these concerns by 01 October 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references and personal identification.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. Staff training in the Mental Capacity Act 2005 (MCA) and DoLS was effective. People’s mental capacity was appropriately assessed about particular decisions. When necessary, appropriate meetings were held to make decisions in people’s best interests, as per the requirements of the MCA.

Staff received regular one to one supervision sessions and all essential training for their role. The staff supported people to have meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Information was provided using accessible language and contained pictures about menus, activities and how to complain, to help people understand this information.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

People were promptly referred to health care professionals when needed.

Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. People’s individual assessments and care plans were reviewed monthly or when their needs changed. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of activities and a varied and individualised activities programme was in place which met people’s preferences. People’s feedback was actively sought at house meetings and monthly review meetings.

Staff told us they felt supported by the registered manager and they had confidence in their leadership. The registered manager was open and transparent in their approach. They placed emphasis and priority on the person centred needs of people at the service.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care provided.

People living in the house had complex needs and communication difficulties. As a consequence they were unable to fully participate in the inspection process or tell us about their experiences, but we observed what they did and interactions with staff.

We looked at some care records and risk information, this was comprehensive and kept updated. Staff said they felt well informed about people's needs.

Records indicated that the service was mindful of people's specific dietary needs and where nutritional risks were identified.

We looked at how medication was managed. We found that staff had been appropriately trained and that systems to minimise risk to people were kept under review.

We noted the environment and furnishings were of good quality but experienced high levels of wear and tear. There were sometimes delays in works being carried out but these did not impact on the well being of people living there.

We looked at notifications of incidents. We found that staff had a good understanding and showed confidence in regard to their role and responsibilities around these.

From our observations and discussions with four of the six staff on duty, we were satisfied that staff felt that staffing levels were sufficient for the dependency of the people living in the house.