We inspected 22 Levick Court on 28 October and 13 November 2015. This was an unannounced inspection on the first day which meant that the staff and registered provider did not know that we would be visiting. We did announce the second day of inspection.
22 Levick Court can accommodate a maximum number of 16 people who have a learning disability. The service is situated in a residential area of Linthorpe in Middlesbrough. The service is divided into two units, one for people requiring residential care the other for people requiring respite care. There are communal lounges, dining areas, bathrooms and toilets on both floors. Bedrooms are for single occupancy and contain ensuite facilities which consist of a toilet, sink and shower or a bath.
The service had a registered manager in place. 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 registered manager was on leave on the first day of inspection however an experienced senior residential social worker was able to assist us. The registered manager met with us on the second day of inspection.
People told us they felt safe. There were policies and procedures in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with told us how they keep people safe and were able to explain the whistleblowing and safeguarding procedures.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.
Risk assessments were in place for people and they had been personalised to each individual and covered areas such as going out in the community, use of public transport, choking, health and behaviour that challenged. This helped staff to have the guidance to manage the risks to people and to keep them safe.
We saw that staff had received supervision and appraisal, however this was not on a regular basis.
People told us there were always sufficient staff on duty to meet their needs. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood and had received training in the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.
We saw safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
There were appropriate systems in place for the storage, administration and management of medicines so that people received their medicines safely.
We saw positive and caring interactions between people and staff. We saw that staff treated people with dignity and respect. People told us they felt cared for and were looked after. We spoke to staff who demonstrated that they knew the individual needs of people well. We saw staff being responsive to people’s needs.
We saw that people were provided with a good choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Alternatives were offered if people did not like what was on the menu. The menu was displayed daily on a chalkboard in the dining room.
People were supported to maintain good health and had access to a variety of healthcare professionals and services. People were supported and encouraged to have regular health checks. People told us that staff or their relatives accompanied them to these appointments if needed. We saw that people had hospital passports. A hospital passport is a document sent with the person on admission to hospital. The hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health.
We looked at people’s care plans and saw they were very person centred and written in a way that we could see the person had been involved in putting them together. They explained the support and care the person needed and also their likes and dislikes and how they liked to spend their day from start to finish. These were regularly reviewed, evaluated, and updated.
People had many and varied hobbies and interests which were individual to them or some were group activities. We saw that there were also outings arranged and that people who used the service went on holidays at home and abroad. We saw and were told that where it was needed staff supported people to access activities within the community.
We saw that the service had a policy and proceedure for responding to people’s concerns and complaints. However, the complaints procedure was not in easy read format but there was a nominated member of staff working on this. People were regularly asked for feedback verbally, in residents meetings and through questionnaires. We saw there was a keyworker system in place which helped to make sure people’s care and welfare needs were looked after by a named individual. People said that they would talk to the registered manager or staff if they were unhappy or had any concerns.
There were systems in place to monitor and improve the quality of the service provided, however this needed to be developed further. We saw there were audits carried out by both the registered manager and senior staff within the service however we did not see a record of provider visits or action plans. We saw that the views of the people using the service were regularly sought and changes made based on their feedback.
People and staff told us that the registered manager had an open door policy and that the culture was open and inclusive. People, staff and relatives spoke very favourably of the registered manager.