523-525 Marfleet Lane consists of two bungalows which are registered to provide care and accommodation for up to seven adults with a learning disability. Number 523 has room for three people and number 525 for four people. Number 523 was currently unoccupied as two people had recently been moved to number 525. This meant the people who lived in number 525 were of a similar age and needs to each other. It left number 523 vacant and ready to accept three people of similar age and needs.The service has 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.
We undertook this inspection on the 22 March 2016 and saw there were four people using the service. We decided to give a short notice period of 48 hours regarding the inspection, as some people who used the service accessed the community on a daily basis and we wanted to be sure people were in. At the last inspection on 6 October 2013, the registered provider was compliant in the areas we assessed.
The people who used the service had complex needs and were not able to tell us about their experiences. We relied on our observations of care and our discussions with staff and other professionals involved.
We found there was a quality monitoring system in place but this needed some improvements to make sure it was effective in identifying areas to improve and ensuring these were completed. A new system was currently being developed and when fully implemented should address the shortfalls.
We found new staff had been recruited safely and all checks had been completed prior to them starting work. However, we saw that when positive information was recorded on disclosure and barring service checks, these had not been communicated to the registered manager of the service so that risk analysis could be completed and management plans put in place. We have made a recommendation about this in safe and well-led sections.
Staff and rotas confirmed there were sufficient staff on duty during the day but since one of the bungalows has closed, there is only one member of staff on duty at night. When the second bungalow re-opens the issue will be resolved as a second member of staff will be on duty there. In the meantime, the registered manager told us this would be monitored to make sure there was no impact on the people who used the service and staff. We have made a recommendation about this. There was an on call system for emergencies.
We found medicines were stored securely and administered as prescribed to people. There were some recording issues which required improvements to make sure there was a good audit trail of why medicines were omitted and to ensure staff had clear guidance for some medicines which were to be administered ‘when required’. We have made a recommendation about this.
We found risk assessments were completed to guide staff in how to minimise harm during activities of daily living. There were also policies and procedures, and training, to guide staff in how to safeguard people from the risk of abuse. In discussions with staff it was clear they knew how to recognise abuse and how to report it to the appropriate agencies.
We saw people’s health needs were met. Staff kept a log of when people had contact with health professionals in the community. Staff followed advice about treatment plans the health professionals prescribed.
People’s nutritional needs were assessed and met. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists.
We saw people were supported to make choices about aspects of their lives when they were able to. Staff were clear about how they supported people to do this and in discussions they provided examples. We saw when people were unable to make major decisions, staff acted within the law and held meetings with relevant people present to decide a course of action in their best interest.
We saw staff had developed good relationships with people and it was clear they knew their needs well. Staff approach was kind and patient. Staff supported people to maintain family relationships.
People received care that was tailored to their individual needs and care plans provided staff with information about how best to support people in line with their known wishes and preferences. Reviews were carried out to make sure care plans were updated when required.
We saw people participated in activities within the service and staff supported them to access community facilities and to go on day trips and annual holidays.
Training was completed; records and staff confirmed there was sufficient training to enable them to feel confident when supporting the people who used the service. There was a system to identify when refresher training was due.
Staff told us they received supervision and support and could speak to the registered manager or senior managers when required. Annual appraisals were behind schedule but the registered manager was aware of this and had plans to complete them.
We saw there was a complaints policy and procedure which guided staff in how to manage them. The complaints procedure was also available in easy read for the people who used the service.