Archived: North Yorkshire County Council - 80 High Street

The service offers short breaks to people with learning disabilities and autism. It provides personal care and accommodation for up to seven people. In total 15 people accessed short breaks at the service on a regular basis.

At the time of our inspection there were four people staying at the service. Three people were on a planned short break and one person had come to stay due to a family emergency.

The service had a registered manager in post. 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 service had completed some detailed best interest decisions to ensure people received effective care. However, we did not see evidence of mental capacity assessments to show why people lacked the ability to make their own decisions. This meant the service was assuming people lacked the capacity to make a decision without following the principles of the Mental Capacity Act 2005 (MCA). DoLS were appropriately referred for. We have made a recommendation about following the principles of the MCA.

The registered manager and staff team knew how to protect people from avoidable harm. Staff were aware of the different types of abuse and how to report concerns to ensure these were investigated effectively. Staff were aware of individual risks to people and what they needed to do to keep people safe.

There were sufficient staff to keep people safe when the service was open. However, due to challenges of staff recruitment and retention the availability of the service had reduced and this had caused some concern for families and the staff team.

Medicines were safely managed. The staff team had received regular training to ensure they were competent to administer people’s medicines.

Staff were provided with a detailed induction and had access to a range of training. This training covered standard training topics and more specialised training was provided, based on the needs of people who stayed at the service.

People’s food preferences were taken into account and adapted crockery and cutlery was available to support people to be as independent as possible.

Although the environment was not purpose built it was evident the needs of people who stayed at the service were taken into account. For example specialist equipment and adaptations had been made to support people.

Staff knew people and their families well. This meant they were able to deliver care which ensured people’s preferences were met. Staff respected people’s dignity and privacy. All of the staff we spoke with said they would be happy for their relative to stay at the service.

People were supported to be as independent as possible. The service had a separate living area which could be used to support people to develop daily living skills such as cooking, cleaning and laundry.

Care plans provided staff with detailed information about each individual, what was important to them and how they would like to be supported. The service responded to people’s changing needs and sought advice and support from relevant health and social care professionals.

People were supported to access a range of activities. Staff arranged events at the service and invited a variety of community resources to raise the profile of the service. The provider sought the views of people who used the service and their relatives and took action in relation to suggested improvements

The registered provider had a complaints policy in place and people we spoke with knew how to raise concerns and were confident these would be investigated and resolved. The service had systems in place to evaluate the service and to ensure quality care was provided.

We did not speak to people who used the service about the outcome areas we inspected, as there were no people in at the service during our visit.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

There were two people staying on short term care when we visited the service. We spoke to one person who was staying at the respite unit about their experience. We were not able to speak with the other person due to their complex care needs. We also spoke with relatives and staff by telephone.

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

Is the service safe?

We observed that when people who used the service interacting staff members were knowledgeable about their individual care needs. We saw in care records that people's complex health care needs were being met safely by staff at the service, although some people's care records had not always been reviewed.

Relatives we spoke with told us that they thought 80 High Street was a good service. One relative told 'This service has been really good for us. I never feel worried as I feel my relative is always safe.'

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We contacted the organisation and were provided with evidence regarding their recruitment process. Recruitment procedures were rigorous and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice could be identified and therefore people were protected.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. We did not see any arrangements in place for staff to receive updated training to confirm their understanding of when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with were knowledgeable about the people they supported and knew people very well. People's health and care needs were assessed with involvement from people themselves, their relatives and health and social care professionals. When speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Staff had received training to meet the needs of people they supported. Comments from staff included, 'We receive all the mandatory training we need.'

Is the service caring?

We observed a relaxed and friendly atmosphere at the service throughout our visit. Good professional relationships existed between people who used the service and staff. We saw that care staff tailored how they communicated with individuals and gave lots of encouragement and praise.

Relatives were also asked for their opinion and they too were welcomed and kept well informed. One relative said, 'This is an excellent service.'

When speaking with staff it was clear that they genuinely cared for the people they supported. One member of staff said 'The group of clients that stay here we have known for years and they are all really great. It is a nice place to work.'

Our observations of the care provided, discussions with relatives and records we looked at evidenced that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People's needs were assessed and records we looked at showed they received any specialist equipment or aids that they needed. Suitable aids and equipment were provided to promote and maintain people's skills and independence.

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

Relatives we spoke with told us they knew who to speak to if they had any worries or concerns. They were confident that any issues they raised would be looked into and action taken. However one relative did tell us that there had been 'a lot of staff changes in the last year.' They said 'Staffing has been an issue at weekends for example my son had said they had not gone out because they were short of staff.'

Is the service well-led?

Effective management systems were not always in place to promote and safeguard people's safety and welfare. This included health and safety records and peoples care records were not up to date or had been reviewed regularly.

Relatives we spoke with told us they thought that overall the service ran well. One relative said 'I have no concerns about this service. Overall this is a good service.'

The service had a quality assurance system in place; however this was not effective as most records we saw were either out of date or had not been completed. The service had not identified problems and opportunities to change things for the better in order for the quality of the service to continuously improve.

We found that there were good systems in place to ensure the control of infection and other diseases. We also saw that the building and the equipment were safe and that important areas of the service were regularly audited.

We saw that medication was well managed and audited. We observed that staff administered medication in the right way and kept accurate records.

We found that there were enough staff on duty to support people using the service. We also saw that there were regular meetings taking place to review staff practice and the performance of the service.

We saw that people's preferences and choices were supported by the staff. People said 'I stay here many times through the year. Each time I come staff ask me what I would like to do and how I would like to be helped' and 'They always ask if I want to get up or when I am tired if I would like to go to bed.'

We found that staff were well supported and received regular training to help keep their skills up to date. We also saw that there were regular meetings taking place to review staff practice and the performance of the service.

We found that the service had good systems in place to ensure that the building and the equipment was safe and that important areas of the service were regularly monitored.