Strathallen

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Strathallen is a residential care home providing personal care support to up to 9 people living with a learning disability and/or autistic people. At the time of our inspection, 7 people were living at the service. The service accommodates people in one building across 3 floors. It is located in a residential area within close proximity to local amenities.

People’s experience of using this service and what we found

Right Support: The environment was clean, large, spacious and personalised. Ongoing maintenance kept the service to a good standard. The environment reflected the people who lived there with photographs, artwork, and personalised decorative accessories on display in bedrooms and communal areas. People had choice in all aspects of their lives and were supported to do all they wanted to do. Staff had a flexible approach and accommodated people's wishes. People had an active life which incorporated activities on offer in their local community. Where people had shared interests, they went out or on holiday together. People received their medicines as required and staff worked in-line with recommendations from health professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. There were always enough staff on duty to provide safe care to people. The registered manager had a flexible approach to staffing levels to ensure activities, hobbies, individual interests and outings were catered for. Staff acted quickly when needed to keep people safe, whilst promoting positive risk taking to allow people to build their daily living skills. People were support by a stable staff team who knew them really well.

Right Culture: People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Management led by example and staff empowered people to do all that they wanted to do. People received compassionate and empowering care that was tailored to their individual needs. Staff spoke highly of people and went 'above and beyond' for them to live the best lives possible. The service was committed to a culture of improvement and regularly sought feedback from people, relatives, and professionals. The provider participated in pilots and focus groups to help drive forward improvements in provisions in the local area for people with a learning disability. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people's views.

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

Rating at last inspection

The last rating for this service was good (published 24 December 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the time since the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Strathallen on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Strathallen is an adapted building in the heart of Saltburn-by-the-Sea. It is an established service for up to nine people who live with a learning disability. Each person had their own bedroom on the first or second floor with access to several communal areas on the ground floor. At the time of inspection, there were seven people using the service.

This inspection took place on 13 November 2018. We made telephone calls to relatives and professionals on 21 and 23 November 2018.

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.

The provider was also the registered manager and had been in post since the original registration in 1999. 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 18 and 19 March 2016, we rated the service as good. At this inspection, we found the service remained good, but the responsive domain had significantly improved since the last inspection and we rated this domain as outstanding. The provider and staff had been extremely proactive in delivering responsive care since our last inspection.

Staff were committed to delivering extraordinary care to people to ensure they lived fulfilled lives and were able to remain as independent as they could be. People were supported to maintain relationships with people important to them. Privacy and dignity was maintained throughout. Staff worked alongside health and social care professionals to provide exceptional end of life care.

An effective and consistent staff team were in place who delivered remarkable levels of care to people to ensure positive outcomes for people. The service was positive, proactive and supportive of people who lived with a learning disability. The service had continued to develop since the last inspection. Effective quality assurance systems were in place and the service regularly sought feedback from all those involved in the service.

Staff supported people to live in a safe environment where the risks to them were proactively managed. This had led to people living independent and enriched lives. There were always sufficient staff on duty to ensure this. Medicines were safely managed and infection prevention and control procedures were well managed. Systems were in place to ensure lessons were learned when incidents took place and to make sure people remained safe at the service.

Staff followed recognised guidance to provide people with the support they needed. Staff received regular supervision, appraisal and training to assist them in their role. Records reflected people’s nutritional needs, visits with health professionals and details of any recommendations. People were supported to have maximum control of their lives; their views and choices were recorded and people were involved in any decision making. The environment was suitable for people using the service and the building had been well maintained.

People received exceptional person-centred care from an experienced staff team. Records were regularly reviewed and updated. People had access to regular activities, with some people attending voluntary work and a variety of social clubs. No complaints had been received since the last inspection.

In December 2014 we inspected Strathallen and found improvements needed to be made to the systems for monitoring the performance of the home. The registered provider sent us an action plan detailing how and when these improvements would be made. We re-inspected the service in July 2015 and found improvements had been successfully made.

Strathallen is a nine bedded home providing care and support to adults with a learning disability. It is situated in the centre of Saltburn, close to all local amenities. The home has a communal lounge and dining room and all bedrooms are single occupancy.

The registered manager is also the registered provider. 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 time of the inspection eight people lived at the home and we met five of the people who used the service. They told us that they were very happy with the service and found it met their needs.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed or that their mental health was deteriorating. We found this had a very positive impact on people and led to a marked reduction the number of occasions people were admitted to hospital.

People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities.

Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained people’s privacy and dignity. We found that staff treated people with respect and compassion.

Staff had also received training around the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The staff we spoke with fully understood the requirements of the MCA and were ensuring that where appropriate this legislation was used.

People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints. People felt confident that staff would respond to any concerns they raised and would take action to deal with any issues.

We found that the building was very clean and well-maintained. The registered provider had redecorated several bedrooms and installed a new kitchen and this included an enclosed area for the medication cupboard. Also there was a workbench for staff to use when administering medications which we told had made the safe handling of medication much easier.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, relevant infection control procedures were followed by the staff at the home. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. These included electronic systems for monitoring the performance of the home. We saw that the registered manager had implemented these and used them to critically review the service.

People told us they were able to make their own day to day decisions and lifestyle choices. They also told us they were treated with dignity and respect. We found that people had their needs assessed and that care plans were in place. All the people we spoke with were satisfied with the service they received.

People were provided with a choice of suitable and nutritious food and drink.

There were appropriate arrangements in place for the recruitment of staff.

There was a complaints procedure in place and this was accessible to people.

We found that people's personal care records were accurate and fit for purpose and were stored securely in the home.