This inspection took place on 23 & 26 August 2016 and was unannounced. St Anne’s Residential Care Home provides accommodation and personal care for up to nine people with a learning disability. We carried out an unannounced comprehensive inspection of this service on 1 and 5 June 2015. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check they had followed their plan and to confirm that they now met legal requirements.
The home 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.
At this inspection we found that considerable improvements had been made. However, we found the provider had breached a different regulation. Not all of the appropriate recruitment checks had been completed before staff began work, including disclosure and barring service and employment history. If a member of staff had a criminal conviction, the provider had not completed the relevant risk assessments to make sure staff were suitable to work with vulnerable people.
At the inspection in June 2015 we found essential maintenance had not been completed around the home. This included gas, electrical and fire systems safety. At this inspection we found the provider had taken appropriate action and all of the relevant maintenance was up to date. There was also a robust schedule in place to make sure maintenance was kept up to date in the future.
At the inspection in June 2015 we found the provider did not have a robust quality monitoring system in place. At this inspection we found the provider had made good improvements to the quality monitoring processes in place. However, these processes needed time to be developed and improved further.
At the inspection in June 2015 we found that while care workers demonstrated they had the skills to meet people’s needs effectively, they were not well supported with training, supervision and appraisal. Most training needed refreshing and supervision and appraisals had not been completed regularly. The provider did not have a schedule in place for when this should happen. At this inspection we found the provider had supported and encouraged staff to complete a variety of training. This included safeguarding, health and safety, moving and handling, and food hygiene. Staff were also given specific training so they could effectively meet the individual needs of each person. This included supporting people with autism and/or behaviour that may challenge people and others. Staff gave us positive feedback about the training and support they received.
People experienced excellent care and support. They were supported to live safe, and meaningful lives in the way they wanted to. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Risks to individuals were well managed and people were able to stay safe without having their freedoms restricted. Managers and staff promoted peoples independence and encouraged people to develop a skills to help them live a more independent life. If an incident or accident did occur, they were well reported and investigated. Staff understood the importance of learning from incidents, so they could reduce the risk of them happening again.
Staff were very caring and always ensured they treated people with dignity and respect. They had an excellent understanding of the care and support needs of every person living in the home. People had developed positive relationships with staff and there was a friendly and relaxed atmosphere in the home. People were well supported to do the things that were important to them, such as going to college, church or out for lunch. Staff were well supported with training, supervision and appraisal which helped them to ensure they provided effective care for people. There was always enough staff on duty to safely support people.
Person centred care was important to the service and staff made sure people were the main focus of their practice. Care plans focused on the whole person, and assessments and plans were regularly updated. People’s individual preferences, needs and choices were always taken into account by the caring and compassionate staff and managers.
The registered manager and staff had a good understanding of the Mental Capacity Act (2015) (MCA) and gained consent from people in line with legislation. Deprivation of Liberty Safeguards (DoLs) referrals had been made to the appropriate authorities. The registered manager knew who to involve if a best interest decisions needed to be made on behalf of a person who could not make the decisions themselves.
People’s medicines well managed. Staff were properly trained and people received their medicines safely and on time. Staff understood when they needed to give people medicines on an ‘as and when basis’, and how people communicated this was what they needed.
The registered manager and staff ensured everyone was supported to maintain good health. They took a positive approach to making sure people’s health needs were met, and ensured that when people needed specialist input from health care professionals they got it.
People were well supported to eat and drink enough. Food was homemade and nutritious and people were involved in making decisions about what they wanted to eat. People were supported to eat healthy food and maintain a healthy weight, with specialist diets when required.
People and those important to them, such as their relatives, were asked for feedback about the quality of the service. Any feedback received was acted on, and any concerns were dealt with quickly before the formal complaints procedure was needed. The registered manager and staff knew what they should do if anyone made a complaint.
There was an open culture in the home, and staff said they felt well motivated and valued by all of the managers. Staff said they would be happy to discuss any concerns they might with any of the managers and said they would act on them. Senior staff all knew people who use the service very well, and were clear about each individual’s care needs. All of the registration requirements were met.
We have made a recommendation to the provider about quality assurance processes. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Not all of the appropriate recruitment checks were completed before staff began work. You can see what action we told the provider to take at the back of the full version of this report.