No 11&12 Third Row

11& 12 Third Row is a residential care home providing accommodation for persons who require nursing or personal care, up to a maximum of 4 people. The service provides support to people with a learning disability or autism. The service consists of two terraced properties that have been converted into a single building. People living at the home have their own rooms and share a range of facilities, such as bathing and toilet facilities and kitchen and lounge areas, in a ‘family style’ setting. At the time of our inspection there were 3 people using the service.

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

This was a focussed inspection where we only looked at the safe and well-led domains. Based on our inspection of these areas we found people were well supported in their daily lives.

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 to have choice about their daily lives. Not everyone being cared for was able to express their needs verbally. The staff and the registered manager had a good understanding of people's responses and non-verbal communication. Staff had worked with the individuals for a considerable time and knew them extremely well, including their likes and dislikes and personal preferences. People were able to access the community, if they wished and were supported to maintain good contact with their families.

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: Care was person centred and staff supported people to achieve their ambitions and live their best life possible. Staff spoke affectionately and with understanding about the people they cared for. Relatives compared the home to a family environment. People were treated with dignity and respect and staff had an in depth understanding of the person and the support they needed.

Right Culture: The manager spoke passionately about caring for the people at the home and the desire to ensure they were safe and well cared for. Staff spoke about working at each person’s own pace and ensuring the service worked for them. One staff member told us, “The lads (people) are a pleasure to work with. Half the time it doesn’t feel like work but like you are visiting them in their own home.”

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 23 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous 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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report. 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 11 & 12 Third Row on our website at www.cqc.org.uk.

Enforcement and recommendations

Since the last inspection we recognised that the provider had failed to notify CQC of events they are legally required to do so. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

We have made a recommendation for the provider to review staffing levels at weekends to support people accessing the community.

Follow up

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

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

This inspection took place on 22 June 2018 and was announced. This meant the provider knew we would be visiting as it is a small service and we wanted to be sure people were in.

We last inspected the service in January 2017 where we found concerns related to the safeguarding of people from abuse and improper treatment because applications to deprive people of their liberty had not been sent to the supervisory body at the local authority in line with legal requirements. We also found gaps in audits and checks on the quality and safety of the service. We asked the provider to complete an action plan outlining improvements they planned to make.

At this inspection, we found the provider had made improvements in both these areas and was no longer in breach of regulations.

DoLS applications had been made in line with legal requirements and policies and procedures had been updated relating to capacity and consent.

Medicines were managed safely and regular medicine audits and checks on the competency of staff to administer medicines were carried out.

Regular checks were carried out to ensure the safety of the premises and equipment and infection control procedures were followed. Improvements were made to the premises following fire safety advice due to adaptations to the premises. Individual risks to people were assessed and plans were in place to mitigate these. A record of accidents or incidents was maintained.

Safeguarding policies and procedures were in place and staff knew what to do in the event of concerns of a safeguarding nature. There were suitable numbers of staff on duty to care for people safely.

Staff received regular training, supervision and appraisals. There were no gaps in supervision records at this inspection and staff felt well supported.

People were supported with eating and drinking. Specialist dietary advice was sought when necessary and people’s nutritional needs were closely monitored. The health needs of people were met. They were supported to attend routine appointments and checks-ups and timely advice was sought in the event of health concerns being identified.

A number of improvements had been made to the environment. All rooms in the house were personalised and homely.

Staff were caring and polite and knew people well. We have not provided very detailed examples of care to protect the privacy of people as it was a small service. We observed numerous examples of kind and caring interactions with people.

People were supported to make choices where possible using adapted accessible communication. Things people could do for themselves and the level of support they needed to maintain their independence was clearly documented in care plans.

Care plans were person centred which meant people’s individual needs and preferences were taken into account when planning care.

A complaints procedure was in place, including in easy read format for people using the service. No complaints had been made. Relatives we spoke with said they had not needed to make a complaint but said they felt confident any concerns they may have, would be acted upon by staff and the registered manager.

Improvements had been made in the management of the service since the last inspection. A new registered manager was in post and systems and processes were more robust to enable more reliable monitoring of the safety and quality of the service.

Questionnaires and surveys were used to gather the views of people and relatives and the ones we read were positive about the running of the service.

11&12 Third Row is one of two locations owned and run by Mr J & Mrs D Cole and is situated in the village of Linton, near Ashington. It provides accommodation for up to three people with a learning disability, who require assistance with personal care and support. At the time of the inspection there were three people living at the home. There was no registered manager in post at the time of the inspection but plans were in place to appoint a registered manager to the service. A general manager was in day to day charge of the service.

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.

We checked the management of medicines and found that appropriate procedures were in place for the ordering, receipt and administration of medicines. Medicine audits were carried out daily to ensure medicines had been given as prescribed. A competency checklist used to assess staff competency was basic, and records of when to give as required medicines could have been more detailed. We have made a recommendation about this.

Risk assessments and safety checks on the premises and equipment were carried out including electrical, legionella, and the oil tank storage. Fire procedures were in place. Staff received fire safety training and alarms and equipment were tested regularly.

Individual risks to the safety of people had been assessed and mitigated. Records of accidents and incidents were maintained and appropriate action taken where possible to prevent reoccurrence.

There were suitable numbers of staff on duty. People's needs were responded to in a timely manner and staffing took into account people's needs such as the requirement of two staff to go out. A manager was on call 24 hours a day to support staff.

Recruitment practices were appropriate and the suitability of applicants to work with vulnerable adults were carried out prior to employment. This helped to ensure that people were protected from abuse. Staff had received training in the safeguarding of vulnerable adults and knew what to do in the event of concerns. There were no concerns of a safeguarding nature at the time of the inspection.

Staff received regular training including related to the specific needs of people who used the service. Appraisals were carried out, and a system of staff supervision was in place. There were some gaps in supervision records and the general manager told us they had a plan in place to address these. Staff told us they felt well supported. Due to the small size of the service and number of staff employed the general manager had contact with staff on a regular basis.

People had access to a range of health professionals, including their GP, nurses and chiropodist. The health needs of people were responded to in a timely manner.

People were supported with eating and drinking. A menu was in place which had been reviewed and amended. People were offered a range of choices and healthy options were promoted. Some people had limited preferences of food choices and these were catered for by staff. Daily records of food and fluid intake were maintained and people's weights were monitored.

The premises were homely and generally well maintained. There was a rolling programme of redecoration and refurbishment. New carpets, a new handrail and improvements to the garden had been made since the last inspection. A lounge area had also been redecorated.

We observed kind and caring interactions between staff and people throughout the inspection. Staff knew people well and often responded to their needs through their interpretation of non-verbal cues from people who had difficulty communicating verbally. There had been a reduction in behavioural disturbance of one person which was partly attributed to the skilled approach and consistency of the staff team. The privacy and dignity of people was maintained.

The individual needs of people were responded to promptly, including a decline in physical health. People were supported to transition to the home from another service and relatives and care managers told us that people had settled well into their new surroundings.

Person centred care plans were in place which were up to date and regularly reviewed. Plans were in place to support people exhibiting behavioural disturbance or distress.

People took part in a variety of activities in line with their personal wishes and preferences. Staff were prepared to be flexible with activity plans based on people's wishes at the time. Routines met the needs of people who used the service.

A general manager was in day to day charge of the service. They carried out regular checks on the quality and safety of the service including on a daily basis and spot checks out of hours. A daily handover sheet had been introduced which recorded care and other safety checks. This was signed by staff and gave staff additional responsibility and accountability. Monthly audits had been introduced following the last comprehensive inspection, and we found some gaps in these at this inspection. We have made a recommendation about this.

Staff told us they felt well supported by the general manager and relatives also told us they were approachable and helpful. The general manager told us they were looking forward to the new registered manager providing greater oversight and support to strengthen the current management systems in place.

At this inspection we found one breach of Regulation 13 Safeguarding service users from abuse and improper treatment. This was because applications to deprive people of their liberty had not been submitted to the local authority of authorisation in line with legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 18 December 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘11&12 Third Row’ on our website at www.cqc.org.uk’

11&12 Third Row is one of four locations owned and run by Mr J & Mrs D Cole and is situated in the village of Linton, near Ashington. It provides accommodation for up to three people with a learning disability, who require assistance with personal care and support. At the time of the inspection there were three people living at the home.

The provider had fitted window restrictors to the upper floor windows to prevent them opening fully and limiting the chances of a fall occurring from a first floor window. The general manager had also undertaken visual checks on small electrical appliances used in the home, to ensure there were no defects or damage to the items which may make them dangerous to use.

The general manager had also commenced weekly audits of the home to ensure that any issues that required addressing or updating were noted and addressed.

At our focused inspection on 18 December 2015, we found that the provider had followed their action plan and legal requirements had been met.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

We found the house was designed to provide a safe environment. We saw arrangements were in place to ensure the house and gardens were maintained to protect people from the risks of unsafe or unsuitable premises.

We found the house was clean and people were protected by the systems in place to reduce the risk and spread of infection. We saw staff were provided with appropriate training to equip them with the skills to meet people's needs.

The provider had systems in place that identified, assessed and managed risks to the health, safety and welfare of people using the service and others.

We saw people's individual records had been reviewed and they included risk assessments which were updated as people's needs changed.

We noted that people's records were accurate and had been updated to reflect any changes in their care.

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff said they would immediately report any concerns they had about poor practice and were confident these would be addressed.

There was no one who was subject to a Deprivation of Liberty Safeguard authorisation, however the provider may wish to review the living arrangements of individual people in view of the recent Supreme Court judgement, to identify where their circumstances may amount to a deprivation of liberty, according to the revised definition.

Is the service effective?

There were systems in place to ensure people's health and care needs were assessed with them. We found they were involved in this process. We saw that specific care plans were in place for people with particular needs such as, lack of mobility or nutrition.

Staff training was provided that took account of the needs of the people in the house. For example, we saw training in catheter care and administration of medicines had been provided.

People were supported to be able to eat and drink sufficient amounts to meet their needs and records were kept as necessary. There was a varied selection of food and people were consulted about what they wanted to eat.

Is the service caring?

We saw staff responded kindly and respectfully to requests from people. There was a relaxed atmosphere and we saw there was a good rapport between people and staff. One person said, 'The staff are fine. They were good after I came back from hospital and helped me with things I couldn't manage.'

People's preferences, interests, and diverse needs were recorded and we saw staff were aware of these during the inspection.

Is the service responsive?

We saw evidence that the care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, when someone returned from hospital changes in their care needs were identified and as they recovered staff had identified they needed less support.

People told us they were aware of the complaints procedure and staff could describe how they would assist a person to make a complaint. We saw there were systems in place for dealing with and recording complaints.

Is the service well led?

The service had a quality assurance system in place that included the use of surveys from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Staff had regular supervision and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. Appraisals were scheduled to take place. Staff we spoke with confirmed their views were listened and account was taken of them. They said they felt well supported by the management of the home.

People living at the home were offered a range of food and drinks. We found that there was a range of food and goods in store, which included fresh vegetables. People were also able to visit local cafes and pubs for meals.

Accommodation was provided across two stories and key facilities such as the kitchen area and wet room were easily accessible. The accommodation was well maintained and had a homely feel. Adaptation had been made to meet individual's needs.

We found evidence that proper staff recruitment and selection processes being followed. Appropriate checks were undertaken before people started working at for the service.

We noted that regular supervision and appraisal meetings were not taking place to ensure staff had an opportunity to discuss any concerns or training needs.

We found records were not always kept in good order and reviews of care plans and risks were limited. There were no formal records of people's personal preferences. Daily records were up to date and included details of activities, meals and any issues of note.

We observed people were asked for their opinion and about what they wanted to do and the provider acted in accordance with their wishes. Staff checked with people they were happy for us to examine their personal files and for us to view their bedrooms.

We established people in the home had comprehensive assessments of their needs, detailed care plans and that risk assessments had been undertaken. These highlighted important aspects of their care needs.

We saw medicines were stored securely in a locked cupboard and signatures were in place to indicate that a medicine had been given. We saw that there were regular audits of the medication and the recording systems.

We saw that there was an up to date training record for all staff. This indicated the range of courses that had been undertaken and the dates training needed to be renewed. Staff told us that they had regular supervision meetings and yearly appraisals with senior staff to discuss their work.

We saw the home had a written complaints procedure detailing the process to be followed in the event of a complaint. This indicated complaints should be documented, investigated and responded to within a set timescale. We saw there were pictorial questionnaires that people using the service had completed to show what they thought of the service.