This inspection took place on 3 August 2016 and was unannounced.Sense- 163 Newington Road is a care home for adults who have sensory impairment and learning disabilities. The service is run by the national charity Sense, and can provide care and support for up to four people. The service is situated in a residential area of Ramsgate. There were four people living at the service at the time of the inspection. Most people had lived at the service for a long time and some people had very complex physical needs. The accommodation was on one level. There was a communal lounge, conservatory, dining room/kitchen area and a small garden. Hallways were wide and accessible so people in wheel chairs could move around the service. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to access facilities in the local area and to access a variety of activities.
There was a registered manager working at the service and they were supported by a deputy 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. The registered manager, deputy manager and staff supported us throughout the inspection.
The registered manager had been in charge at the service since it had opened 11 years ago. They knew people and staff well. The registered manager was passionate about giving people the care and support they needed in the way that suited them best. They were committed to improving people’s lives. The registered manager was supported by a dedicated, stable staff team who had also worked at the service for many years.
People's medicines were not always handled and managed as safely as they could be. Temperatures where medicines were stored were not checked. When people needed medicines on an ‘as and when’ basis the guidance was not in place to make sure these were given consistently. Some medicines were decanted from their original packaging into containers. This increased the risk of mistakes being made. This was a breach of the regulations.
Risks to people’s safety were assessed but the guidance on how to keep some risks to a minimum had not been recorded. Some assessments identified people’s specific needs, and showed how risks could be minimised but other risk assessments did not contain all the information to make sure staff had all the guidance and checks needed to mitigate risks. Staff knew people well and had given the appropriate care and support. This is an area for improvement.
The registered manager and staff team carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Audits and monitoring systems ensured that any shortfalls or areas for improvement were identified and addressed promptly. There were systems in place to review accidents and incidents and make any relevant improvements as a result. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Fire safety checks were carried out regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.
Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People received care that was personal to them. People indicated and said they were satisfied and happy with the care and support they received. Staff understood people’s specific needs well and mutual good relationships had developed. People were settled, happy and contented. Staff were caring and respected people's privacy and dignity. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. Throughout the inspection people were treated kindness and respect. People were able to make choices about their day to day lives. Everyone had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. Care and support was planned around people’s individual preferences and needs.
People were involved in activities which they enjoyed and were able to tell us about what they did. Planned activities took place regularly and there was guidance for staff on how best to encourage and support people to develop their interests, skills and hobbies. Staff supported people to achieve their personal goals.
Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.
The registered manager and staff were effective in monitoring people’s health needs and seeking professional advice when it was required. Staff followed the advice that they were given.
The provider had taken steps to make sure that people were safeguarded from abuse and protected from the risk of harm. Staff had been trained in safeguarding adults and were confident that the registered manager would take action in the event of any suspicion of abuse. Some staff where unsure of the agencies they could report abuse to outside the organisation. Relatives told us that people were cared for in a way that ensured their safety and promoted their independence.
Relatives felt their views were listened to and acted on. People and their relatives felt comfortable about complaining. If they raised a concern they would be taken seriously and felt confident that their concerns would be looked into and action taken to resolve them. There was a close relationship and good communication with people's relatives.
People were supported to have a nutritious diet. Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.
The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance.
The management team made sure the staff were supported and guided to provide care and support to people enabling them to live fulfilled and meaningful lives. New staff received a comprehensive induction, which included shadowing more senior staff. Staff had regular training and additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively. Some people used British Sign Language (BSL) to communicate and staff had received training so they could communicate effectively with people.
Staff said they could go to the registered manager at any time and they would be listened to. Staff fully understood their roles and responsibilities as well as the values of the service and the organisation. All staff worked hard and were dedicated to provide the best level of care possible to people.
A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and receive the care and support that they needed. There were enough staff to take people out and to do the things they wanted to.
The registered manager had sought informal feedback from people, relatives and other stakeholders about the service. Not all the feedback had been analysed to drive improvements to the quality and safety of the service. This is an area for improvement. Relatives had recently been asked to complete a questionnaire so feedback could be analysed to improve the service. Staff surveys had been undertaken across the company and improvements had been made as a result of these.
Staff told us that the service was well led and that the management team were supportive. The registered manager was aware of and had been submitting notifications to CQC in an appropriate and timely manner in line with CQC guidelines.