ExtraCare Charitable Trust Lovat Fields Village

ExtraCare Charitable Trust Lovat Fields Village is an Extra Care housing service. The village has 259 apartments and bungalows, and more than 300 people live in the village. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 37 people receiving personal care.

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

There was a very comprehensive assessment of people’s needs that looked at all areas of their life such as physical and medical health, people’s mental health needs, social care needs, loneliness, social networks and their family history. As part of the assessment process, the service worked closely with other healthcare professionals such as occupational therapists and district nurses to make sure that care was always based on up to date legislation, and best practice.

Training was tailored to meet people's individual needs and the provider recognised that the on-going development of staff skills, competence and knowledge was central to ensuring high-quality care and support. Staff received regular, useful and engaging supervision from senior staff members. The staff appraisal system ensured that all staff were working to the same vision and values as the provider.

People experienced extremely positive outcomes regarding their health and wellbeing. A well-being advisor was available to support people with anything that could affect people’s health and wellbeing and action was taken quickly to address this. People were empowered to make choices about their health and how it should be monitored and managed.

The provider and the management team were highly committed to ensuring people lived fulfilling lives and were protected from social isolation. People were supported to attend a range of support groups and there was an extensive range of activities on offer to ensure people led meaningful and satisfying lives. New initiatives to combat social isolation and loneliness had been introduced to ensure people’s mental well-being was always maintained.

There was a positive commitment to ensuring innovative steps were taken to meet people’s information and communication needs. We saw that people’s communication needs were assessed and then information was provided to people in the way that suited them best.

The provider was very committed to sharing best practice and taking action on dementia. There was a ‘Dementia and Mental Wellbeing Enabler’ who supported people living with dementia-and other related conditions. They supported people with individual strategies, self- help groups and advice, so they could remain independent in their own homes.

People received compassionate end of life care that was planned with them and their families, in advance and centred around their individual wishes, spiritual beliefs and cultural needs.

A culture of being open and transparent was embedded in the service. There was exceptional communication throughout the service and we saw that regular meetings and focus groups gave people a forum to share their views. Everyone we spoke with confirmed that they felt involved and part of village life. We found the service had a positive culture that was person centred, inclusive and empowering.

The leadership, management and governance of the organisation assured the delivery of high quality, person-centred care. The staff understood the vision and values of the provider and these made sure people were at the heart of the service.

Staff understood their responsibilities to report any unsafe care. New initiatives to recognise and raise awareness of domestic abuse had been introduced, to keep people safe. People had risk assessments in place to enable them to be as independent as they could be in a safe manner.

Robust and safe recruitment checks were carried out to ensure suitable staff were employed to work at the service. The staffing arrangements ensured people were provided with the support they needed.

Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

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 provided care and support in a very caring and meaningful way. They knew the people who used the service very well and had built up kind and compassionate relationships with them. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

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 Outstanding (published 16 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.

This was the second comprehensive inspection carried out at Lovat Fields retirement village.

ExtraCare Charitable Trust Lovat Fields Village has 258 homes and over 300 people using the service. Dependent on individual circumstances they can support people from housekeeping to personal care, including supporting people with dementia. At the time of our inspection there were 59 people receiving support with personal care.

The service had 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.

People's experiences of care were overwhelmingly positive. They told us that they had a voice, felt listened to and that they mattered. Staff supported people and their relatives to fully engage in discussions about their care and support. They worked proactively to help people to make choices and decisions about their care and lifestyle choices and to experience new activities or take up past ones. The registered manager and the staff knew each person as an individual and knew what mattered to them.

People's needs were comprehensively assessed and care and support plans gave clear guidance on how people were to be supported. Care was personalised so that each person's support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. People were supported to attend a range of support groups and there was an extensive range of activities on offer to ensure people led meaningful and fulfilling lives. The service was flexible and adapted to people's changing needs and desires, enabling positive outcomes for all concerned. Each person was treated as an individual and as a result their care was tailored to meet their exact needs.

People, relatives and staff were very positive about the leadership of the service and about the support they were able to provide for people. Staff demonstrated a passion and commitment to providing excellent care that supported people to lead gratifying and independent lives. People told us the service engaged consistently and meaningfully with families. There were excellent communication systems ain pace and people reported feeling involved and being part of village life. We found the service had a positive culture that was person centred, inclusive and empowering.

The service was exceptionally well led by a dedicated registered manager, who was very well supported by a forward thinking and self-motivated management team. The culture and ethos within the service was transparent and empowering; staff told us that they were proud to work for the service and wanted it to be the very best it could be. Best practice guidelines were followed and the service used innovative approaches in its efforts to support people.

Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. This provided people with a sense of purpose and wellbeing.

The registered manager and the staff team strived for excellence and it was clear from our discussions with people that staff worked tirelessly to ensure people were cared for in a holistic manner. Numerous initiatives implemented had resulted in reduced physical ailments and improved health and mental well-being for people.

There was strong oversight of the service and the registered manager demonstrated that they were highly committed to improving the service they provided. Their passion and determination to deliver exceptional care for people was clear in the way they spoke about what they did for people and how they tried to meet people's individual needs.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix on duty to support people with their needs. Effective recruitment processes were in place and consistently followed by the service. Staff were not offered employment until satisfactory checks had been completed. Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received an induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current best practice when supporting people. Staff were supported with regular supervisions.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were enabled to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. People were supported to access a variety of health professional and there was a well-being advisor that supported people with their healthcare needs if required.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

People knew how to make a complaint. There was a complaints procedure in place which was accessible to all. Complaints had been responded to swiftly and in line with the organisations complaints procedure.

During our inspection of Lovat Fields Village we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found.

Is the service safe?

We saw evidence that where staff were not performing in line with the organisation's procedures and best practice guidelines; these were being addressed with individuals in a formal manner. This meant that action was being taken to address staff poor performance and unsafe practice.

We found discrepancies with people's medicine administration. This meant that people's medicines were not being managed safely.

Is the service effective?

We found evidence in two of the care plans we looked at which indicated staff were not always staying for the allocated timescale as stipulated in their care plan. This demonstrated that some people's care and support needs were not always consistently undertaken within the agreed timescale.

We saw that people had individualised care plans and risk assessments in place. We found however, that two people's risk assessments had not been appropriately maintained and kept under regular review to promote their safety and welfare.

Is the service caring?

As part of this inspection we visited a person in their home. We found that the support workers were aware of the person's care needs. The support workers were observed treating the person with kindness and compassion. This ensured that their dignity was respected and promoted.

Is the service responsive?

We found that there was not enough detailed information in some people's care records in relation to their identified needs and how care should be provided. This meant that people's support needs may not always be appropriately met.

Is the service well-led?

We were made aware that there had been changes to the management of the service. A new manager was appointed but has not yet been registered with the Care Quality Commission.

Staff spoken with said that the new manager had brought in lots of changes to improve on the care provided. A staff member said, 'We all have to support the manager during this transition, she really wants to improve the service for the good of the clients.' It was evident that staff were happy to work under the new manager's leadership.

During our inspection of Lovat Fields Village we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with domiciliary care and support. We saw documentary evidence of this in the five care files we looked at. This meant that staff had the information they needed about people's care needs and were able to provide safe care. We found that some people's records had not been reviewed at the time set down by the provider which meant that care and support may not be meeting people's needs safely. We also found that records which contained information on the amount of food and fluid that people had taken did not contain sufficient detail to ensure people were prevented from the risk of dehydration and malnutrition.

We found that records evidenced that regular checks on equipment, water temperature, fire fighting equipment was in place. We also found that the general maintenance logs showed that the service was managed safely and that urgent repairs were prioritised and managed promptly.

Is the service effective?

We saw that individualised care plans and risk assessments were in place. We saw that one person's risk assessments had not been reviewed following two falls. However another person's risk assessment had been reviewed and a referral made to a physiotherapist following falls.

It was clear from our observations and from speaking with staff that they had a good understanding of the individual care and support needs that people required. We spoke with people and their family members and they all told us that they had seen recent improvements in the service at Lovat Fields Village. They told us that 'Communication is much better now' and 'things are now being sorted out'. They also told us 'the new manager has made a difference'.

Is the service caring?

We observed staff responding to people with patience and gave them time to be as independent as possible. We saw that people were supported by knowledgeable and approachable staff. We heard staff speak to people in an encouraging and sensitive way which evidenced their knowledge of people's individual needs. We heard staff and people laughing and joking together, and it was clear from our observations that staff knew the people very well. We found that whenever possible people had been involved in the planning of their care and support requirements so that their wishes were respected.

Is the service responsive?

Assessments included identifying any risks to people and detailing how staff should care for people to support their safety and well-being. This meant that care and support had been provided in accordance with peoples wishes. We read that when people had become unwell the GP or district nurse had been contacted promptly so that assessment or treatment could be given. We observed staff respond effectively to emergency calls from people. We also saw that regular reviews of one person's care needs had led to a prompt referral to a dietitian.

Is the service well led?

The staff we spoke with had a good understanding of the ethos of Lovat Fields Village and their individual part they played to ensure that people were well supported in all of their day to day needs. We found that there was a system in place to monitor some aspects of the quality and safety of the care and support for example, by via monthly medication audits.

We saw that complaints had been responded to promptly and that there was a system in place to record any issues and the outcome of the concerns raised. We were made aware that there had been some recent changes to the management of the service. People and their relatives told us that 'things are now moving in the right direction, we have confidence in the manager'. Staff told us that they were able to discuss any concerns and that they could see that management were responding to these and making improvements.

The people using the service provided positive feedback about living at Lovat Fields village. Some of the comments included: 'The food is very good at the restaurant and I love it here'. 'I have no complaints but I do know how to make a complaint and I have done it in the past and it was resolved'. 'The place is lovely and clean and so is my flat'.

One person told us that they completed a quality assurance questionnaire about the services provided at Lovat Fields village. They told us that the 'carers are nice and they talk to me'. They also told us that they received their medication on time and 'the activities here are very good'.

The people we spoke with told us they had been provided with information about the services provided by the agency. They told us the staff treated them with respect and preserved their dignity when carrying out personal care tasks.