Fiveways

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 the service and what we found

We observed that people were calm, happy and relaxed during our inspection. Those who could told us about the things they liked to do when at home in the service and when out in the community. We saw that people with more limited verbal communication were able to make their needs and wishes understood by staff who understood their preferred means of communication. People received information in formats they could understand. They showed themselves to be comfortable around staff, approaching them to make requests for support.

We observed and heard staff speaking respectfully and kindly to people. Staff showed they understood people’s needs. New staff told us how they had spent time reading peoples plans when they first commenced work to help them understand peoples support needs Staff said they were kept informed about any changes to these at shift handovers and staff meetings, so they could continue to provide the care people needed.

Relatives and health and social care professionals spoke positively about how people were treated and cared for by staff. They told us that they were asked to contribute feedback about service quality which was analysed and published.

People ate well and enjoyed their meals. Easy read menus with pictorial prompts were developed to help them make meal choices. Any special dietary requirements were taken account of in meal planning.

Easier to read version of the complaints and safeguarding procedures were provided. People were asked by staff about any concerns they might have at resident meetings and when they spent one to one time with staff. Relatives told us they had not had cause to make a complaint and thought that any minor concerns they had raised had been dealt with immediately and resolved.

People had received support from staff and relatives to make known their preferences in how they would wish their last wishes to be carried out. These had been recorded and added to the support plan to ensure people received the care they wanted when they approached the end of their life.

Staff received an appropriate induction to the service, so they had the basic care skills and knowledge to support people safely. Training updates were provided to all staff at regular intervals. Staff had learned about abuse and how to respond to any suspicions they may have by raising and escalating alerts, they showed commitment to protecting people and keeping them safe.

There were enough staff available to support people’s individual needs safely and provide the appropriate level of support to them when at home and out in the community. Peoples consent was sought daily and where people lacked capacity appropriate authorisations had been applied for and obtained. People were supported to have maximum choice and control of their lives and care 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 showed respect for people’s privacy dignity and confidentiality and were alert to people’s wellbeing. They supported them to access health appointments and receive medical attention when needed. Accidents and incidents were recorded and improvements in their recording ensured these made clear the actions taken. When things went wrong the provider and staff learned from this and implemented changes to practice and procedure to minimise recurrence.

People lived in a safe, clean and well-maintained environment. Staff attended fire training and drills to understand how to respond in the event of a fire. Policies and procedures guiding staff practice were kept updated. People were able to spend time alone but had worked with staff to develop activity programmes tailored to their own interests and preferences. Relatives told us they were consulted and informed about the important things in their family members life and had become involved in best interest decisions as required.

People were supported by staff that enjoyed where they worked, felt well supported and worked well together as a team.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

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

Rating at last inspection

The last rating inspection for this service was requires improvement (published 12 February 2019) when there were two breaches of regulation. 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 enough improvement had been made and the provider was no longer in breach of regulations.

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.

Fiveways is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Fiveways is registered to provide accommodation and personal care for up to five people who have a learning disability and other complex needs. Fiveways is on the outskirts of Whitstable and is close to local transport and amenities. Five people were living at the service at the time of inspection and each had their own personalised bedroom. People had access to a communal lounge, conservatory, kitchen, laundry room, sensory room, two bathrooms, a wet room and toilet.

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.

There was a registered manager in post, and present at the time of our inspection. 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 the last inspection on 8 June 2016 the service was rated 'Good' in all key questions. At this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and have now rated the service ‘Requires Improvement’.

Checks and audits were in place, but has not been successful in identifying the concerns we identified during this inspection. The registered manager had not completed checks on new staff working at the service, and therefore did not identify issues with staff recruitment. Medicine audits failed to identify issues with medicines reconciliations.

We found that medicines management was not consistently safe. Staff failed to react when three people missed three days of medicines. Accidents and incidents were reported, but action was always not taken or clearly documented to minimise the risk of it reoccurring.

Staff knew how to safeguard people from potential harm and abuse. Staff had received a full induction, and had access to on-going training and supervision. The service was clean, well maintained and fit for purpose.

People told us, and we observed there to be sufficient staff numbers to keep people safe, and meet their needs. Risks to people had been identified and minimised where possible.

People were supported to be involved in meal planning and food preparation. People were supported to take part in meaningful activities, and encouraged to live healthier lives.

People’s needs had been assessed, and staff worked with best practice guidance. Staff knew people well, and could identify when their needs changed, and organised for input from healthcare professionals.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us they were treated with kindness, respect and compassion. We observed staff interactions with people, and saw a mutual respect between people and staff. Staff supported people to be as independent as possible, including supporting them to take positive risks.

People received personalised care specific to their needs. People told us they choose how they spent their time.

People were supported to express their views and be involved in decisions about their care and support. People told us they understood how to complain.

People told us they were happy living at the service. People told us the staff and registered manager were the best things about living at the service. Staff told us they were well supported in their roles. There were systems in place to improve the quality of the service, including completing quality assurance questionnaires. However, the overarching results of this had yet to be analysed by the provider.

The registered manager had submitted statutory notifications as required, and was displaying their CQC rating within the service.

You can see what action we told the provider to take at the back of the report.

Fiveways is registered to provide accommodation and personal care for up to five people who have a learning disability and other complex needs. Fiveways is on the outskirts of Whitstable and is close to local transport and amenities. Five people were living at the service at the time of inspection and each had their own personalised bedroom. People had access to a communal lounge, conservatory, kitchen, laundry room, sensory room, two bathrooms, a wet room and toilet.

The service had a registered manager, who was present throughout the inspection. 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.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted.

The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs well.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they were able and wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Staff told us that the service was well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager at any time and they would be listened to. The registered manager had good management oversight and was able to assist us in all aspects of our inspection.

We saw that the provider had systems in place to obtain consent from people in relation to the care and support they received.

People told us and records confirmed that the service responded to people's health needs and that staff talked to people about their care and any changes that may be needed. People said that they were happy with the care they received and that they got on well with the small team of staff.

People told us that they felt safe and that if they were not happy about anything they would speak to the manager.

We found that there were effective recruitment and selection processes in place for the recruitment and management of staff, and the staff working there had had the necessary recruitment checks.

The provider had procedures in place for dealing with complaints, comments and suggestions. There were systems in place to safeguard people from harm and abuse.

People met regularly to talk about the service and things like the menu and activities. Independence and individuality was promoted within the home. People living at the service were supported, enabled and encouraged to express their views and to make or participate in making decisions relating to their care and treatment. People told us or expressed that the staff were kind and helpful and that they felt safe. We saw that staff spoke to people with kindness and patience.

People told us or expressed that the staff were kind and helpful and that they felt safe. We saw that staff spoke to people with kindness and patience.

People's hobbies and interests were supported and people were supported to keep in touch with and visit their family and friends. People who used the service were part of the local and wider community and had support to access and take part in a wide range of leisure and work activities.

The service worked closely with health and social care professionals to ensure that people had the support they needed to remain well and healthy.