ABLE (Action for a Better Life) - 57 King Street

ABLE (Action for a Better Life), 57 King Street is a care home providing accommodation and personal care to up to 6 people who have long term mental health conditions. It is situated near the town centre of Melksham. At the time of our inspection there were 6 people living in the home.

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

People told us that they liked living at King Street. They said they were able to make choices and felt listened to and respected.

Relatives told us that people were supported well and that the staff were “fantastic”

People had access to support from staff who knew them well and who worked in a person centred way.

Care plans for people were clear and reflected people’s needs. We were told that people were involved in developing and reviewing their plans.

The registered manager told us they worked closely with other professionals to ensure people’s needs were appropriately supported. This was reflected by the professionals we spoke to.

Staff received regular, appropriate training and used this in their practice.

Professionals told us that they felt the service worked in peoples best interests and the staff were creative when supporting people.

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. We observed people speaking to staff and discussing things they would like to do.

At the time of the inspection food and drink was being kept in the office, people could come in and get what they needed at any time. The registered manager and staff recognised this was restrictive and they were working with other professionals to restart the usual routine of keeping food and drink in the kitchen.

Risks were managed well, however there was a window designated as a fire escape at the front of the house that did not have a window restrictor on it, we made a recommendation to speak to the fire brigade about this because of the risks it presented.

Rating at last inspection

The last rating for this service was good, (published 13 February 2018)

Why we inspected

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

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.

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

At the last inspection in November 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Staff knew how to keep people safe. Care plans contained risk assessments and clear guidance for staff on how to support people to stay safe. Staff had been trained to undertake their roles and staffing levels were safe. Medicines were managed safely.

People’s needs and choices were assessed. People were supported to have maximum choice and control of their lives. Staff understood people’s needs and were aware of people’s preferences and choices.

People said staff were caring. Staff spoke passionately about the people they supported. Staff knew how to maintain people’s dignity and privacy.

Care plans were personalised and detailed. People said staff knew them well. Complaints and concerns were investigated and dealt with.

People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

There were systems in place to monitor the quality of the service. People spoke highly of the registered manager. Feedback we received from health and social care professionals about the service was also positive.

The registered manager is to hold the post until the new manager in day to day management of the home has been successful with the registration process. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People said they felt safe living in the home. Members of staff knew the signs of abuse and the actions they needed to take for suspected abuse. They attended annual refresher safeguarding adults training to ensure they were able to identify the signs of abuse and to act appropriately where it was suspected.

Risks were managed to protect people’s safety and for people to take risk safely. Potential risks were assessed and action taken to lower the levels of risk. Where risks were identified, action was taken to minimise the risk of harm. For, example risk assessments were in place for people at risk of falls.

People received care and treatment from staff that were trained and supported to undertake their role. Staff had opportunities to discuss concerns, performance and training at one to one meetings with their line manager. They attended training to develop their skills and knowledge to meet people’s needs. Staffing levels were adequate to meet people’s needs. People said they liked the staff and they had the attention..

Safe medicine systems were in place. Where people were able, they self-administered their medicines with staff support. A record of medicines administered was maintained and protocols were in place for medicines to be taken “when required”. However, protocols did not show clear instruction on when to administer medicines to ensure people’s safety. For example, protocols for “when required” medicines for anxiety did not give details on how to identify anxiety.

Members of staff had a good understanding of the principles of the Mental Capacity Act (MCA) 2005. Staff gained people’s consent before they delivered care and treatment. People had capacity to make decisions about their care and welfare. Restrictions were not imposed on their liberty and they were able to leave the home without staff support.

People were supported with their ongoing healthcare and had input from social and healthcare professionals. For example, a community psychiatric nurse (CPN) was involved in the care of some people. Some people were able to manage their healthcare.

Care plans were person centred and were developed on all aspects of people’s care and welfare. People said they were consulted about their preferences and routines and signed them when they were satisfied with the action plans. For example, care plans to help people maintain their mental health wellbeing were in place. The goal and the actions needed from the staff or other social and healthcare professionals were included. For example, one to one time with staff to reduce anxiety.

A system to gain people’s views was in place. House meetings and questionnaires were used to gain feedback. Positive feedback was received from the questionnaires on the standards of care at the home. Staff said they worked well together and the manager was approachable. They said their suggestions were sought.

Quality assurance arrangements in place ensured people's safety and well-being. Systems and processes were used to assess, monitor and improve the quality, safety and welfare of people. There were systems of auditing which ensured people received appropriate care and treatment. The system of audits included care plans and medicine management.

During our visit we looked around the premises and we found the communal areas were clean, tidy and well furnished. The kitchen and bathrooms were in good condition and provided a pleasant and safe environment for people to use.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

We saw the last four weekly staff rota's which confirmed the numbers of staff on duty. Any shortfalls in the staffing numbers would be covered either through overtime or two bank staff. This ensured people using the service had consistent and regular staff who they knew.

The manager told us they had taken steps to encourage the people living in the home to raise issues with them directly if they were not happy with any aspects of their care and support. Each month the person's key worker would meet with them and ask if there were any concerns they wished to raise. We saw written notes from these meetings in the records we reviewed.

Staff were patient and understanding with people. A person living in the home said 'Staff understand, they don't judge, they give human responses and I feel better as a result.'

People's care records included personal recovery plans. Care plans showed identified risk factors and goals. They were reviewed regularly. People signed their agreement to their plans and their key workers were directly involved with them in care plan reviews.

Care plans included explanations of how people could behave and guidance for staff on how to manage behaviours. A support worker told us 'The care plans are there to safeguard everyone.' A person living in the home said 'It's a safe place. You are able to say if someone or something is bothering you.' Staff showed a good understanding of the risks of abuse and their responsibilities for reporting abuse.

We found the home overall was clean but some parts of a bathroom were very dirty. This showed checking of standards needed to be more thorough.