This inspection took place on 25 November 2016 and was unannounced which meant the registered provider and staff did not know we would be visiting. Arran House is a mid-terraced property situated in the centre of Guisborough. The service provides residential care and accommodation for up to four people who have learning disabilities and mental health needs. It is situated close of local bus route and within walking distance to local amenities and the centre of Guisborough. At the time of inspection there were three people using the service.
The service had a registered manager who had been registered with us in respect of the registered provider's new registration since 8 January 2015. Before this they were registered as manager for the registered provider's previous registration. 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.
During our last inspection, we found that people who used the service and others were not protected against the risks of inappropriate or unsafe care and treatment, as effective quality assurance processes were not in place to enable the registered manager to identify and minimise these risks. We asked the registered provider to take action to ensure they were meeting the regulations.
At this inspection people told us they felt safe. Risk assessments were in place for people who needed these. Some risk assessments lacked detail around specific medical conditions. However, staff were knowledgeable about the associated risks and action they should take.
Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks. The registered manager reviewed all accidents and incidents on a monthly basis. Falls were also monitored to identify any trends occurring.
Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the registered provider had a policy in place to minimise the risk of abuse occurring. Safeguarding alerts had been submitted to the local authority when needed and appropriate action had been taken.
Emergency procedures were in place for staff to follow. A robust procedure for recording fire drills had been implemented, which recorded how each person had managed during the evacuation process.
Medicines were managed appropriately. The registered provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when medicines had been administered and disposed of. People we spoke with confirmed they received their medicines when they needed them and we observed this happening safely.
Certificates were in place to ensure the safety of the service and the equipment. Maintenance and fire checks had been carried out regularly.
A safe recruitment process was followed to reduce the risk of unsuitable staff being employed. Only one new staff member had joined the service in the past 12 months. An induction process had been completed with the registered provider.
Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely and training was up to date. People who used the service suffered from a variety of medical conditions including diabetes, epilepsy and learning disabilities. However, we did not see evidence of any specialist training in these areas.
People were supported to maintain their health and make independent decisions regarding food and fluid, including participating in creating a weekly shopping list. People spoke positively about the nutrition and hydration provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration and records showed appropriate action had been taken to make these referrals when needed.
Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take if they suspected a person lacked capacity. However, appropriate documentation was not always in place to support best interest decisions. We have made a recommendation about this in the body of our report.
Each person was involved with a range of health professionals and this had been documented within each person's care records. From speaking with staff we could see that they had a good relationship with health professionals involved in people’s care. People’s care records contained evidence of appropriate referrals to professionals such as dieticians and dentists.
The service was clean and pleasantly decorated throughout. People were able to bring their own furniture and personalise their bedrooms as they wished. People had been involved in decisions about the décor and furniture in the service.
People spoke highly of the service and the staff. People said they were treated with dignity and respect and observations throughout the inspection evidenced this.
People were actively involved in care planning and decision making. This was evident in signed care plans, consent forms and from observations during the inspection. Information on advocacy was available and displayed throughout the service.
Care plans detailed people’s needs, wishes and preferences. However some care plans lacked person-centred and relevant information. Care plans were reviewed every 12 months, but staff told us this would be done sooner if there were any changes that needed to be recorded.
We saw people participating in a range of activities and people were able to independently choose which activities they wanted to do. Some people could independently access the community and we saw this person coming and going throughout the day of inspection. People were able to tell us about the activities they did on a weekly basis and told us they enjoyed the activities provided.
The service had a clear process for handling complaints. There had been no complaint received in the past twelve months, but the registered manager told us they regularly ensured people knew how to make a complaint. A copy of the complaint policy was displayed in the home and on peoples bedroom doors in easy read format . People we spoke with confirmed they knew how to make a complaint.
Staff told us they enjoyed working at the service and felt supported by the management. Staff told us they were confident any concerns would be dealt with appropriately. We could see from our observations and speaking with people that the registered manager had a visible presence at the service and people were familiar with them.
Quality assurance processes were in place and regular audits were carried out by the registered manager and care manager, to monitor the quality of the service. However, these audits did not always identify areas of concern with regards to care plans not containing sufficient person-centred information.
Feedback was sought from people who used the service. Feedback questionnaires had been sent to people in February 2016. The registered manager told us this information was evaluated and action plans produced if needed. All the feedback from the questionnaires had been positive. People were given the opportunity to provide feedback during regular ‘resident’ meetings and a feedback box was also located at the service.
The service worked with various healthcare and social care agencies and sough professional advice to ensure that the individual needs of people were being met.
The registered manager understood their role and responsibilities and was able to describe when they would be required to submit notifications to CQC.