Anderson Close

Anderson close is a residential care home providing support and personal care for 3 people. The bungalow is in a residential area. Each person living in the home had their own bedroom and shared a communal lounge and kitchen area. There is a staff office which also provided a room for staff to sleep in when carrying out sleep in shifts.

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

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.

Right Support: People were supported in a respectful way by their staff team who knew them well. People participated in activities tailored to their individual needs. Independence was promoted to prevent social isolation, and to ensure people being supported were integrated into the local community.

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. The service had a consistent staff team with appropriately skilled staff to meet people's needs and keep them safe. Care was person-centred and positive professional relationships were observed. People felt safe with the support from staff.

Right Culture: All staff including the management team were aware of people’s needs and ensured people were central to support provided. Staff were happy within their role and spoke highly of the people they supported. Management supported staff development.

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

Rating at last inspection and update

The last rating for this service was Good (published 01 March 2018).

At our last inspection we recommended the provider kept all risk reviews together within the care file and to ensure all documentation in relation to people who are unable to make decisions for themselves was reviewed and improvement made. At this inspection we found the provider had actioned these recommendations. The service utilised an electronic system which enabled all care plans to be on the one system. Mental capacity assessments and best interest decisions were documented within the same systems and were appropriately completed.

Recommendations

We recommend the provider reviews the risk assessments to ensure information is consistent.

Why we inspected

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

Follow up

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

We found the following examples of good practice.

The provider was assisting relatives by supplying lateral flow tests to facilitate testing at home prior to each visit and to avoid waiting outside in the cold for confirmation of a negative result. Where a resident had tested positive for Covid-19 we observed good practice to mitigate risks for the other residents.

Anderson Close is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Anderson Close accommodates three people in one adapted bungalow.

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.

At our last unannounced inspection in June and July 2016 we identified four breaches of relevant legislation. These related to fire safety, consent, lack of staff supervision and appraisal and governance. During this inspection we found the provider had made improvements to the service although further improvement was required with regard to governance.

During this inspection we saw that the service was working within the principles of the MCA. We saw evidence that where people lacked capacity to make decisions, the provider had considered the least restrictive option and consulted appropriately with people to make best interest decisions, however this was not robustly recorded.

The service had a registered manager in post. 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.

People told us that they felt their relatives were safe living at the home and that they were well cared for. The provider had measures in place to protect people from avoidable harm and abuse. Staff received training in this regard and demonstrated clear understanding of responsibilities and procedures.

We found that safe administration of medicines was taking place, however we saw that on the day of inspection the keys were not securely stored. We discussed this with the registered manager and they confirmed they would remind staff of the correct procedures.

Risks associated with people’s care had been assessed and were kept under review. There was a process to record accident and incidents. Although none had occurred since 2013 staff were aware of the actions they should take if an accident occurred.

The provider followed safe recruitment procedures including checks with the Disclosure and Barring Service (DBS). The DBS helps employers make safer recruitment decisions and prevent unsuitable staff from working with vulnerable people.

Staff had good understanding of the needs of people living at Anderson Close. Relatives were happy with the care their family member received.

At the last inspection we saw that staff had not received regular supervision and appraisal. During this inspection we found that staff felt supported in their roles and had received appropriate supervision and appraisal.

Staff said they received the training they needed to carry out their roles and were able to attend courses presented by the local authority. The provision of staff hours meant that people always had access to support when they needed it.

We saw that staff knew the needs, preferences, likes and dislikes of people living at Anderson Close well. Staff were observed to be friendly, caring and attentive at all times during the inspection and showed regard to dignity and respect. Care planning was person centred and care plans contained essential information and risk assessments.

The provider had a complaints policy in place and relatives told us that they knew how to raise a concern and who to contact should the need arise. There had been no complaints since the last inspection.

All family members and staff spoken with were complimentary about the registered manager. The registered manager was present during the inspection, engaged well with the inspection process, responding well to any suggestions regarding possible improvement. They were aware of their role and responsibilities both within the service and with regards to their registration.

The home was last inspected on 02 & 07 May 2014 and did not meet the required standard for assessing and monitoring the quality of service provision, as the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We made a further visit on 13 August 2014 and found that the required improvements had been made.

Anderson Close is a small three bedded care home providing support for young people with learning disabilities. On the day of our visit three people lived in the home. This service is owned by Community Care Matters.

The service is registered for accommodation for persons who require nursing or personal care. It is a domestic style bungalow/property located within the local community in Padgate, Warrington. The service is fully equipped for people needing assistance with hoists and wheelchair access. A large drive way offers accessible access and parking facilities.

The home had a Registered Manager. 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 this inspection we identified four breaches of the relevant regulations in respect of safe fire evacuation drills, staff training supervision and appraisal, consent and quality monitoring . You can see what action we told the provider to take at the back of the full version of the report.

We found that whilst the administration, storage and disposal of other medications were safe, the staff administering medicines had not attended recent training.

Some staff had not received current training to protect vulnerable people from abuse.

Fire fighting equipment and alarm testing was in place to support people safely in the home, however staff had not undertaken practice drills for some years to evacuate the premises in the event of a fire.

The experiences of people who lived at the home were positive and they led active lives.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications to the supervisory body. However the provider was not always working in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice.

People’s needs were assessed and plans were developed to identify what care and support people required to maintain their health and wellbeing and foster their independence where possible. Staff had in depth knowledge of individual’s needs as they had supported them over a number of years.

Staff had good relationships with people who lived at the home and were attentive to their needs. Staff respected people’s dignity at all times and interacted with people in a caring, respectful and professional manner.

Staff and families supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Staffing levels in the home enabled people to be flexible in their choices, activities and lifestyle.

We carried out this inspection to follow up on action taken by the provider to ensure the quality of services were assessed and monitored and that people who lived in the home were able to contribute their views about the running of the home.

We spoke with the officer in charge and two staff members who told us that all policies, procedures and monitoring systems had been updated to ensure the home was run in the best interests of the health, safety ad wellbeing of people who lived there. Records viewed confirmed this.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff told us they had one to one staff to help them to safely meet the individual needs and choices of each person living at Anderson Close.

Staff had received updated training in safeguarding and felt confident in being able to maintain people's safety. Staff were confident they would be listened to by the provider and supported with reporting procedures to safeguard people living at the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted, the staff did have a good knowledge base regarding these safeguards. However they did not have access to appropriate policies and procedures in place including guidance on the 'Mental Capacity Act.' These policies and legislation are necessary to ensure the protection of vulnerable people who lack ability to consent on various issues

Is the service effective?

One relative told us they were very happy with the care that had been provided to their relative and they felt their needs were being met. We observed the support being provided and it was clear the staff were knowledgeable of people's needs, in particular specialist forms of communication.

Staff discussed the individual needs of each person they supported. Staff described the support they provided on a day to day basis including daily choices with meals and social activities and in regard to the facilities and environment to ensure people were comfortable and doing what they chose to do.

Is the service caring?

We observed staff speaking respectfully to people as they approached them so they were aware who was supporting them. Staff were friendly and helpful to the people they were supporting. We observed that people being supported were relaxed and happy in the company of their support staff.

We spoke with two relatives of people living at the service. They made various positive comments such as:

"We feel the staff go above and beyond to provide care for our relative" and "It's a home from home, we have piece of mind when we walk away."

Is the service responsive?

Each person living at the service had a person-centred support plan in place to help to show how their needs would be met at the service. These records were detailed and showed that people's choices, interests and diverse needs were being met and were regularly reviewed and updated to meet their needs.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and that they felt well supported by the provider.

Relatives told us they were always kept informed and updated regarding their relatives support and needs.

A range of policies were in place and accessible by all staff. However some policies were out of date and in need of review. These policies created risks to the staff team who needed updated information to ensure the safe management of the service. The organisation and provider oversight of quality checks at the service required development to help improve the monitoring of the service specifically with the management arrangements of fire safety, safeguarding and general incidents.

We saw that all areas identified in our last report had been repaired and decorated. The home looked clean and tidy.

The service is homely but has a good range of equipment and adaptations to aid the staff to support people living there and to aid staff in moving people safely such as manual hoists and ceiling hoists. The garden area has been improved so that people could sit more comfortably in the fresh air.

We looked at staff files for the three most recently appointed staff members. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

The staff members we spoke with were very positive about the home and the quality of care it was providing to people. Staff spoken with said "it is a great place to work" "we ask people what they want and support them to do it."

We saw that the provider had a range of checks completed by the manager and staff on a regular basis.