We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found:
Is the service safe?
People who lived in the home told us the staff looked after them and treated them well. One person said 'No one in the home treats me badly'. Another person said 'All the staff are nice'. People told us they could speak with the manager or their social worker if they had any concerns.
Staff spoken with knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns.
On the day of our inspection the three people who lived in the home looked calm and relaxed. We saw people together in the communal areas and they looked at ease with each other and did not appear concerned. However, staff told us one of the individuals challenging behaviours had escalated significantly the previous day resulting in a serious incident that required police intervention. Staff said the person's behaviours had frightened the other two people. Staff had sought to reassure them and to make them feel safe. Staff said when the person displayed challenging behaviours the other two people preferred to go to their own rooms or to go out with staff.
Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans included a range of individual risk assessments and actions for managing these risks. This included risk assessments for challenging behaviours identifying triggers and actions staff could take to minimise these risks. The manager said they were currently in the process of reviewing the previous day's incident with social services to ascertain whether any lessons could be learned. We were told the person's social worker was arranging a 'best interests' meeting to review the individual's care needs.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the home had not needed to submit a Deprivation of Liberty Safeguards application so far. However, the provider was aware of the circumstances when an application should be made and the procedures to follow. This helped ensure that people's human rights were protected.
Arrangements were in place to deal with foreseeable emergencies. We saw records of monthly fire drills. The provider had an emergency evacuation plan and a medical emergency policy in place. Staff told us they received first aid training and would call out the GP or ambulance service if needed.
Is the service effective?
The service tried to support people to live their lives in a way that suited their personal needs and improved their quality of life. People told us they were generally happy with the care and support provided. One person said 'I'm happy here, no problems'.
Staff told us the provider arranged relevant training and support to help them meet the needs of the people in the home. Training records confirmed what staff had said. Staff said people who lived in the home were relatively independent in terms of their personal care needs. They mainly required prompting from staff and support in accessing outside activities and appointments.
All three individuals in the home could display challenging behaviours from time to time. We saw care plans contained risk assessments and de-escalation plans identifying triggers and actions staff could take to minimise these risks. Staff said they had received training in non-abusive behavioural management techniques. They said the behavioural management plans for people who lived in the home had been mostly effective in managing people's challenging behaviours. However, one of the individual's behavioural management plans now required review in the light of a recent serious incident.
We saw people were supported in promoting their independence and community involvement. People told us they regularly went out into the community either on their own or with staff members. Care records showed people were supported to go on trips and holidays, participate in community leisure activities and carry out various hobbies and pastimes.
Is the service caring?
We observed staff treated each person as an individual with dignity and respect. They spoke to people in a calm, re-assuring and friendly manner. People were allowed their own space but staff were on hand when they were needed.
Each person had their own individual bedroom on different floors of the building. We observed people's rooms contained individualised furnishings and personal belongings. One person said their room had recently been redecorated and they had chosen their own colour scheme. This approach helped people feel more at home and promoted a sense of personalisation and empowerment.
We observed staff supported people to make their own daily living choices and to be as independent as they were able to be. This helped promote people's self-esteem and gave them a sense of achievement.
Is the service responsive?
We saw people's needs were assessed and their care was planned and delivered in line with their individual preferences. Each person's keyworker had regular one to one discussions with them about their activities and choices. Notes of these discussions were recorded in people's care plans and were used as part of their monthly care plan review. This helped ensure care and support remained appropriate to each person's individual needs.
People told us they were able to make choices regarding meals and activities. We also observed people decided where and how they spent their time. They were free to move around the home or to go out when they wished. We saw people spent some of their time on their own in their rooms and at other times they were together in the communal areas watching TV or having meals.
The staff we spoke with demonstrated a good understanding of each person's support needs and preferences and how they should be met.
Is the service well led?
The provider appointed a new manager for the home in January 2014. The manager had previously managed one of the provider's other services. The manager has applied to be registered with CQC. Their application to become a registered manager was still in progress at the time of our inspection.
There was a clear staffing structure in place with clear lines of reporting and accountability. Staff said they were well supported by colleagues and the provider's management. They said they could report any issues or concerns to the manager in the first instance. The manager said they were able to contact the director of the company and external health and social care professionals for advice or support whenever needed.
As a small care home the quality of the service was mainly monitored through personal contact with people and their representatives. We were told feedback from visiting professionals was an important part of the provider's quality monitoring system.
We saw the provider had a comprehensive range of policies and procedures for staff to follow. The provider used an external company to draw up their policies to ensure compliance with current legislation and best practice.
We reviewed a number of recent significant event reports and saw examples of learning from incidents and investigations.