Archived: Streatfeild House

We inspected Streatfeild House on 7 and 11 September 2017.This was an unannounced inspection. The service provides care and support for up to 22 people living with a range of learning disabilities and a variety of longer term complex healthcare needs such as epilepsy and diabetes. The age range of people at this time was from 50 years upwards. Several people have been living at the service for over 20 years. There were 20 people living at the service on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Streatfeild House was last inspected in June 2016. At this comprehensive the overall rating for this service was Requires Improvement. Two breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. This was because the provider had not taken adequate steps to ensure people’s safety in relation to fire risks, medicines and checks on staff suitability to work within the service. We also found kitchen staff had not consistently followed basic food hygiene principles. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by May 2017.

This inspection on 7 and 11 September 2017 was to see if improvements had been made and embedded into practice. We found that significant improvements had been made and the breaches of Regulation met.

This inspection found that the management and storage of medicines were safe. As discussed with us on inspection, there were areas to further develop in respect of the management of ‘as required’ (PRN) medicines and these were immediately actioned. Risks related to fire exit safety had been reviewed and advice sought as required. Fire exit safety was now effectively managed and all exits could be accessed immediately in the event of an evacuation. The provider had systems to monitor and drive improvements in the quality of the service.

People who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People had a range of individualised risk assessments to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of the MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety. Staff received a wide range training to ensure they could support people safely and received support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for. People's nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people's independence and right to privacy.

People received care that was personalised to meet their needs. People were supported to maintain their health and were referred for specialist advice as required. There were good systems that ensured safe transitioning between services. Staff knew the people they cared for and what was important to them. Staff appreciated people's life histories and understood how these could influence the way people wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities of their choice in house and in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider's complaints policy. Leadership within the service was open, transparent and promoted strong staff values. This had resulted in a caring culture that put the people they supported at its centre.

People, their relatives and staff were complimentary about the management team and how the service was run. The registered manager informed us of all notifiable incidents. Staff spoke positively about the management support and leadership they received from the management team.

We last inspected Streatfeild House on 28 January 2014 where we found it to be meeting all the legal requirements within the areas we inspected.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Although people told us they felt safe living at the service we found the provider had not taken adequate steps to ensure people’s safety in relation to fire risks, medicines and checks on staff suitability to work within the service. We found kitchen staff had not consistently followed basic food hygiene principles.

Peoples’ access to a communal activities room was impacted due to its dual use as a meeting room. The registered manager was aware of this issue and was working to resolve it.

The provider had systems in place to monitor and drive improvements in the quality of the service; however we found shortfalls with areas of quality assurance which meant the provider did not have consistent oversight of the service. Some records in relation to staff documentation were not complete.

Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s needs.

It was clear staff had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

Staff received training and had an understanding of the Mental Capacity Act 2005 and were seen to act in accordance with its principles.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and epilepsy areas. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

People told us staff were kind and we observed positive interactions between people and staff.

Staff had a clear understanding of their roles and spoke enthusiastically about working at the service and positively about senior staff.

People were provided with opportunities to take part in activities ‘in-house’ and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

The provider had a complaints policy; this was displayed in a communal area. People and their relatives told us they knew how to complain.

We found breaches in Regulation. You can see what action we told the provider to take at the back of the full version of this report.

Records we examined showed us that people had their individual needs and wishes assessed and recorded before receiving a service.

Each person living in the home had a detailed plan of care in place that included their individual needs and aspirations and also recorded their physical and emotional healthcare needs.

The staff team received training relevant to their roles. They told us they were well supported by the manager.

There were processes in place to record, investigate and respond to complaints in a timely manner.

A person using the service told us. 'It's really brilliant here and I have a nice life. The staff are really good to me, I have lots to do and they help me a lot.'

People told us they were very happy living in the home. One person said the staff looked after them very well and they were comfortable. We found evidence that people were encouraged to make choices and observed people being treated with respect and dignity. A relative said the home was excellent and people were very happy there.

We examined three care plans. We found that people living in the home and their relatives were involved in making decisions about the care provided. We spoke with three of the care workers. They demonstrated an understanding of people's needs and discussed how they enabled people to make choices and be independent.

We looked at staff training and supervision records. Staff told us the training and supervision they received helped them to provide the care and support people needed and wanted.

There were a number of systems in place to review the quality of service being provided at Streatfeild House. Questionnaires were used to capture the opinions of people living in the home and their relatives, and we saw there were day to day discussions with people regarding the care they wanted.