Individual Care Services - 60 Ward Grove

About the service

Individual Care Services – 60 Ward Grove is a residential care home based in a small cul-de-sac within a small community. It provides accommodation and personal care to a maximum of 3 people with a learning disability and/or autistic people. At the time of our inspection, 3 people lived at the home.

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

People did not always receive person centred care in line with Right Care, Right Support, Right Culture.

Right Support: People were not always involved in making decisions about their care. There was limited consideration given to the varying ways people could be empowered to make their own decisions and choices using different communication methods. People were not always supported to have maximum choice and control of their lives and records did not always show decisions had been made in people’s best interests.

Right Care: Risks to people’s health and well-being had been identified and assessed, but not always managed safely. Healthcare professional advice was not always followed or implemented effectively. The provider used a high number of temporary staff supplied through an agency who had not always received the same level of training as the permanent staff which impacted on people’s care.

Right Culture: The provider did not always promote a person-centred culture which empowered people to make their own decisions. Systems were not always operated effectively to identify if people were receiving care and support in line with Right Care, Right Support, Right Culture. Feedback from a variety of sources indicated people did not always feel able to raise concerns because they were not confident their views would be responded to positively.

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 17 October 2018).

Why we inspected

We received concerns in relation to the application of the Mental Capacity Act 2005. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Individual Care Services – 60 Ward Grove on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to consent, safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is a ‘care home’ operated by Individual Care Services. 60 Ward Grove provides accommodation with personal care for up to three adults. People cared for at the home are living with learning disabilities, and complex health and physical disabilities. People in care homes receive accommodation and 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. At the time of our inspection visit, there were two people living at the home.

There was 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.

At the last inspection in June 2016 all five key areas were rated as Good. At this inspection we found the quality of care had been maintained and people continued to receive a service that was safe, caring, effective and responsive to their needs. The rating continues to be Good.

There were enough staff on shift with the appropriate level of skills, experience and support to meet people’s needs and provide effective care. Risk management plans were in place. Staff knew what action to take in the event of an emergency and had been trained in first aid.

Staff understood their responsibilities to protect people from the risks of abuse. Staff had been trained in what constituted abuse and would raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process. Staff received training and used their skills, knowledge and experience to provide safe care to people.

People were encouraged and supported to maintain good health. Staff frequently liaised with other healthcare professionals. People received their prescribed medicines in a safe way.

Staff worked within the principles of the Mental Capacity Act 2005. The registered manager understood their responsibilities under the Act. They had applied to the supervisory authority for the right to deprive two people of their liberty when their care and support included restrictions in the person's best interests.

Staff supported people in a kind and compassionate way. Relatives felt staff were caring. People had varying levels of communication which were largely through gestures and non-verbal communication. These had been assessed so staff knew the appropriate communication methods to enable people to express themselves non-verbally, and make choices about day to day things such as what to wear.

People had detailed individual care and support plans which provided staff with the information they needed to respond to people’s needs. Staff recognised people as individuals and care was given in a person-centred way. This included people being supported with various activities both inside and outside the home.

The registered manager and deputy manager regularly checked the quality of the service to make sure people's needs were met safely and effectively. Feedback about the service was encouraged. The provider and registered manager understood their regulatory responsibilities and worked with other organisations and healthcare professionals to ensure positive outcomes for the people who lived at the home.

Further information is in the detailed findings below.

The service was last inspected in December 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Ward Grove provides accommodation for people in a residential setting and is registered to provide care for up to 3 people with learning disabilities. There were 3 people living at the home when we inspected the service.

A requirement of the provider’s registration is that they have 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 and associated Regulations about how the service is run. There was an experienced registered manager in post at the time of our inspection visit who had been at the service for several years. We refer to the registered manager as the manager in the body of this report.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care. Care staff understood how to protect people from abuse and keep people safe. The character and suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough care staff to deliver the care and support people required. Staff were caring and respected people’s choices about how they wanted to receive their care.

Care staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care staff had the right skills to provide the care and support they required. Support plans and risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

People received medicines safely by trained and competent staff. Where people’s needs changed they were cared for effectively, and people had access to health care professionals when required.

Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff. The managers understood the principles of the Mental Capacity Act (MCA), and care staff respected people’s decisions and gained people’s consent before they provided personal care.

Staff, people and their relatives felt the manager was approachable. Communication was encouraged and identified concerns were acted upon by the manager and provider. People knew how to complain and information about making a complaint was available for people. Care staff said they could raise any concerns or issues with the managers, knowing they would be listened to and acted on.

There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys and a programme of other checks and audits. Where issues had been identified, the provider acted to make improvements.

We found people and family members were involved with giving their consent regarding the planning of care of people using the service.

Relatives we spoke with told us that the care that was discussed with them matched the care that was being provided to people using the service. They also told us they were regularly kept up to date about the changes made to people's care.

We saw that the care plans were person centred and reflected people's individual needs. We observed that staff were compassionate and caring when supporting people. We found there were risk assessments available to inform staff on how to manage any identified risks for people.

We noted the home was clean and there was a cleaning schedule which staff followed. We saw checks were made to review the cleanliness of the home.

We saw the provider ensured that the appropriate checks were undertaken before a new member of staff was employed. The manager showed us the induction plan which new staff had to complete during their employment at 60 Ward Grove.

We found the service was well led and had systems in place to monitor the quality of service being provided.

We saw people's needs had been assessed, risks identified and personalised plans of care developed. There was evidence of support by healthcare professionals to ensure people's ongoing healthcare needs were met. We observed that although reviews of people's care plans had taken place these changes had not been incorporated into the person's associated care plan. This could put the person at risk as the updated care had not been reflected within the person's live care plan.

During the inspection we spoke with the senior care worker and one other care worker.

Both said there had been sufficient staff available to accommodate people's needs and that the staff worked well as a team. We saw staff were supported through attendance at staff supervision, yearly staff appraisal and at staff meetings.