Archived: St Anne's Community Services - Fieldhead

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Sufficient staffing levels were in place. Workers from the service’s own staff team and agency told us they had a good working relationship, supporting people to promote their wellbeing.

Staff were aware of areas of increased risk, with mechanisms for monitoring them. Handovers included checks by two members of staff which helped maintain people’s safety.

Where people had behaviours that could challenge the staff Positive Behaviour Support plans (PBS) were in place. Staff were involved in the development of these, drawing on their experience to support the person safely.

Some checks were being completed within the service to identify what areas worked well and those requiring improvement. The registered manager was developing additional checks to improve quality assurance. They agreed more robust checks would help the service develop.

Staff constantly communicated to ensure people received timely support. Health action plans were used to record people’s health appointments and the outcome of these. Hospital passports contained information about people’s care and support needs to be shared with health professionals to inform their approach to working with people.

Staff received an induction and training relevant to their role.

People were supported 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 support this practice.

Care plans were focused on people’s strengths and how to help them achieve outcomes. They contained details of people’s routines to help staff understand individual preferences. Care workers knew how to adapt their communication to support people to understand and express their views. An advocate had regular involvement with all the people living at the service to help with this. This showed the service worked to involve people in their care and support.

We saw positive interactions between people and staff. Staff knew people’s preferred interests and activities.

Further information is in the detailed findings below.

Fieldhead provides residential care for up to five people with learning and physical disabilities and autism. The home is a detached, two storey house that is situated in its own grounds in Langthorpe. It is close to the local community amenities and facilities of Boroughbridge, including shops and pubs.

At the time of our inspection there were four people living there. They had lived together at this service for a number of years.

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 2008 and associated Regulations about how the service is run.

People received their medicines safely. The service had robust measures in place to ensure staff received medicines training and were then assessed further to check they were competent. There were clear systems in place for ordering, storage and disposal of medicines. Regular medicine stock checks and audits took place which meant if any errors were detected these could be put right in a timely way.

Risk assessments and risk management plans were detailed and specific to each individual. Staff could tell us about these and we saw they were adhered to throughout our inspection.

People were protected from avoidable harm. Staff had up to date safeguarding training and knew how to report suspected abuse. Staff were confident the management team would act appropriately to keep people safe.

Staff worked in line with the principles of the Mental Capacity Act (2005), we saw records of mental capacity assessments and best interest decisions. The service ensured, when required, people had access to independent advocacy. This demonstrated the service ensured people’s rights were respected.

The service offered staff a good induction and ongoing training and support. This meant people who lived at the service were supported by an effective team of staff and could be assured that staff had the skills and knowledge to support them well.

People had access to a balanced diet. Where people had specific dietary or nutritional needs the service had sought advice from appropriate healthcare professionals and we could see this was adhered to by staff.

Staff knew people well, this meant they were able to provide support which was in line with people’s individual needs and based on their preferences. Staff supported people to make decisions about their day to day lives and respected these.

Care was planned and delivered in a person centred way which was based on individual preferences. Care plans were reviewed on a regular basis and contained up to date information about people.

Although staffing issues did not impact on people’s safety we did see a reduction in activity which people could take part in. We found activity plans focused on information about accessing community services. There was a lack of activity planned within the home.

Staff morale was good. Staff told us they were well supported by the management team.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the staff and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Some people who used the service had difficulty communicating and were not able to verbally tell us their experiences. We used a number of different methods to help us to understand their experiences including talking with staff, looking at records and observing the care being delivered.

Is the service safe?

The service had in place systems to make sure staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the referring to specialist services such as speech and language therapy.

The service had policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

Is the service effective?

Whenever possible people's health and care needs were assessed with them and they were involved in developing their plans of care. From speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. There was a lot of humour between staff and people living at the home and staff. People looked well cared for and appeared happy.

Is the service responsive?

People's needs were assessed and records we looked at showed they received specialist support they needed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

We saw the staff team acted in a professional manner and responded appropriately to people's care needs. We saw them explain to people what they were going to do and asked permission before they carried out any support or care.

The service carried out annual surveys that included seeking out the views of people who used the service. We saw the service used questionnaires in their survey and had been available in an easy to read format.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff had a good understanding of the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and responsive.

Effective management systems were in place to promote and safeguard people's safety and welfare. For example, health and safety records and peoples care records were up to date and had been reviewed regularly.

We talked with staff who explained that people were involved in making decisions about their care wherever possible. We saw that where people did not have capacity or needed support to make decisions, appropriate arrangements had been put in place.

We found that the systems for helping people to manage their medication were safe and well organised.

We looked at the systems in place to support the staff. We confirmed that they were well supported to do their jobs. We saw that good training was in place. This included induction mandatory and specialised training. We also confirmed that regular checks were in place to monitor the quality of the service.

During our visit we observed the way staff interacted and supported people. Staff interacted well with the people who use the service, communicating appropriately, asking what people wanted to do and giving choices about drinks, food and where people spent their time. We also saw that each person was given the opportunity to go out during the day.

Each person living at the service had their own care records, providing information about their needs. However, there wasn't enough information in people's records about mental capacity and the support they needed around decision making. We also found that there hadn't been enough staff training provided on the Mental Capacity Act, but we were told that staff would soon receive this training.

Most medication was being administered and managed safely. However, we found one example where emergency medication wasn't being taken with the person when they went out. This potentially placed the person at risk, but the provider has since reviewed this aspect of the person's care with their doctor.

Staff told us they received the training and support needed to help them do their jobs. Comments made by staff included 'I've done every course available and started doing refresher courses' and 'yes she's (the manager) approachable, very supportive'.