Archived: United Response - 2 William Street

United Response – 2 William Street is a residential care home providing personal care to three people with a learning disability. 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 using the service 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 for them to gain new skills and become more independent.

People were happy with the support they received and felt safe living at William Street. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously.

Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively. People received support to take their medicines safely.

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.

People were supported to maintain a good diet and access the health services they needed.

The manager provided good support for staff to be able to do their job effectively.

The provider’s quality assurance processes were effective and resulted in improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service in February 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which were rated requires improvement.

We looked at infection prevention and control measures under the Safe Key Question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response – 2 William Street on our website at www.cqc.org.uk.

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.

2 William Street is one of a number of small care homes provided by the organisation in and around the Chippenham area for four people with learning disabilities. At the time of the inspection there were three people accommodated.

People’s experience of using this service:

• There were a range of quality audits undertaken by the area manager and registered managers from other locations. However, internal audits were not consistent with all the findings from the inspection.

• People told us senior managers were approachable. Staff told us the team worked well together. The team was stable and long standing. They said the registered manager was approachable but there was a lack of management presence.

• People were not able to recall that support plans were in place to meet their need. Where people had attended the review meeting their names were included in the minutes. The recently introduced support plan format ensured staff identified future learning and goals. However, how to achieve outcomes identified were not made clear in the care plans. Some care plans were conflicting and lacked detail about how staff were to meet people’s identified needs.

• Risks were not clearly identified and detailed in care plans. Information gained about people that had identified risk was not used appropriately in the care planning. For example, risk assessments needed clarity on how they were to be reviewed.

• People told us the day to day decisions they made and who helped them with more difficult decisions. Staff were knowledgeable about the principles of Mental Capacity Act 2005 in relation to daily living decisions.

• Mental capacity assessments were not in place for all specific decisions. Where mental capacity assessments were in place, there was no evidence to show how the person was supported to make specific decisions. Best interest decisions were made before assessments of capacity were undertaken. Where relatives had power to make decisions, documentation about this was not checked.

• There were areas of the home that would benefit from better cleaning routines. Cleaning schedules were not in place.

• There were systems to support staff with developing their skills and discuss performance. Staff said one to one supervision with their line manager was “sporadic ” but the training matrix provided showed one to one supervision had occurred at the set intervals. Staff told us more specific training was needed to create an insight into how best to care for people with particular conditions.

• Medicine systems were managed safely. Medicine administration records (MAR) charts were signed to show medicines administered. Where medicines were not administered codes were used to detail the reasons. A record of medicines no longer required was maintained and signed by the pharmacist to evidence receipt of the medicines for disposal. However, the protocol for one person needed to be reviewed to reduce confusion on when to administer remedies and pain relief. We recommend that you seek guidance on how to develop PRN protocols for people that have over the counter medicines.

• The views of people, friends and families as well as professionals were gathered. People gave positive feedback about the service.

• People told us they felt safe with the staff. The staff we spoke with knew the types of abuse and to report their concerns.

• People told us the staff responded to their request for support and assistance. We saw adequate numbers of staff available to support people.

• People participated in menu planning and food preparation. People’s dietary requirements were catered for.

• People had access to healthcare services as required. The hospital passports were up to date.

• People we spoke told us they were able to maintain relationships with relatives and friends. We saw some good interactions between people and staff. .

• Activities were taking place. People arranged their daily activities using a white board with staff support.

• People knew who they would approach with complaints.

• The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy. The home was located close to shops and people were recognised as part of the local community.

Rating at last inspection:

This service was rated good at the inspection dated October 2015.

The Action we told the provider to take:

We found breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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

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

Is the service safe?

Care plans instructed staff how to meet people's needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Safeguarding procedures were robust and staff had a clear understanding of their responsibilities with regard to protecting the people in their care. There had been no safeguarding referrals made in 2013 or 2014. People told us they felt safe and told us: 'we wouldn't put up with being pushed around.'

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). The home had not made any Deprivation of Liberty Safeguards referrals in 2013 or 2014. We saw that people had best interests meetings and advocates were involved in particular decision-making processes, as appropriate.

People were helped to take their medication, safely.

The home made sure it had a recruitment process which minimised the risk of employing staff who were not suitable or safe to work with vulnerable people.

Systems were in place to make sure that managers and staff continually monitored the quality of care offered to people. Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

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Is the service effective?

People were involved in their care planning and knew what actions would be taken to support them to meet their aims and objectives for the year ahead. One person described how they had been supported to participate more in community activities.

Three of the four people who lived in the home told us: 'we are very happy living here.' 'It's a lovely home.'

People's health and care needs were assessed with them, and/or their relatives, as appropriate. They were involved in developing their plans of care if they chose to be. Care plans were detailed, they clearly identified people's health and well-being needs and how they should be met.

Is the service caring?

People were supported by knowledgeable kind and patient staff. We saw that care staff interacted positively with people who used the service. We saw that they were sensitive to people's moods and needs and approached them in a respectful and appropriate manner.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Peoples' individual interests were identified and used to enhance peoples' lifestyle.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Each person had an individual weekly activities plan, which met their current needs.

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. Two people told us they knew who to complain to and were sure that the manager would: 'quickly put things right.' The home had not recorded any complaints during the last 12 months.

Is the service well-led?

The service had a robust quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was being maintained or improved.

Staff told us that they had the support of a manager and could get assistance from 'head office', as necessary. We saw that the home had a stable staff group who had worked in the home for a number of years.

People had choices and were supported in making decisions. Arrangements were in place should they not have the capacity to make a choice. The home provided people with a safe and comfortable environment where they shared responsibilities for cooking and cleaning with support from staff. Staffing levels met people's needs and enabled them to have one to one support. Records were kept that recorded the support people were given and provided guidance to staff on how to respond to people's needs. People were given information about how to complain and the support they would receive in this area. People were happy living in the home and did not express any concerns. The home had not received any complaints.

One of the people we spoke with said that they liked living at 2 William Street and enjoyed their life. They said they got to do the things they enjoyed. People told us how they discussed and chose what to have at mealtimes. One of the people we spoke with told us they would speak with staff if there was anything troubling them.

One person was assessed as needing a specialist bed with rails at the sides. This was risk assessed to ensure it was in the person's best interests.

One member of staff we spoke with told us they 'love working here'. They had worked at the home for 22 years and spoke about the 'longevity of relationships'. They told us they 'couldn't have better support'. Another staff member referred to the organisation as 'approachable and person centred for staff'. They said they felt supported by the team and the registered manager.

We were told that the annual quality assurance survey was about to be sent to all people who used the service and their relatives and others such as people's social workers and health professionals. We saw that this had been produced in two formats including an easy read version with pictures.