Archived: South Street

South Street is a care home for people who may have a learning disability or autism. The service was registered for up to 9 people; 8 people lived there at the time of our inspection.

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.

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

Right Support:

Care records were mostly detailed and informative. However, some records did not always contain all the information required to keep people safe. Despite this, staff knew people’s care needs well and people and their relatives told us they felt safe and supported.

Records did not always show that appropriate action was taken in response to incidents at the service. Safety incidents did not always trigger a review of people’s risk assessments and management plans.

The systems in place to monitor safety and quality at the service were not always fully effective. The registered manager and provider did not always report notifiable incidents to us and the local authority as required.

Right Care:

Improvements were needed to ensure people’s weight was monitored effectively to identify any significant changes in weight.

There were sufficient numbers of suitable staff at the service. However, improvements were required to ensure the risks associated with delays in pre-employment checks were formally risk assessed.

Staff supported people in line with their individual preferences and agreed care plans. People were supported to receive their medicines when they needed them and were protected from the risk of infection as staff followed safe infection prevention and control practices.

Right Culture:

The auditing systems in place to assess and monitor safety and quality were not always effective.

People told us they were supported to have maximum choice and control of their lives. However, records did not always evidence that the requirements of the Mental Capacity Act 2005 were consistently applied.

People were able to receive visitors without restrictions in line with best practice guidance.

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 24 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We planned to complete a focused inspection to review safe and well-led only. However, due to concerns identified during the inspection with regards to the application of the Mental Capacity Act 2005, we also reviewed the effective key question.

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 to requires improvement. This is based on the findings at this inspection

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for South Street on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified regulatory breaches in relation to; the application of safeguarding processes, the processes in place for assessing and obtaining consent to care and the systems in place to assess, monitor and improve the quality of care at the service.

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

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.

South Street is a Residential 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.

South Street accommodates up to nine people in one adapted building. At the time of the inspection there were seven people using the service. Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was meeting the principles of this policy.

There was a registered manager in post at the time of our inspection. 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 were safeguarded from abuse and risks to people were assessed and planned for to keep people safe. People were supported by sufficient safely recruited staff. Peoples medicines were administered as prescribed. People were protected from the risk of cross infection. The provider learned when things went wrong.

People had their needs assessed and plans were in place to meet them. Staff were supported in their role and had access to an induction and training. People were supported to live in an environment which was suitable to meet their needs.

People received consistent support. People could choose their meals and were supported to eat and drink. People were supported to maintain their health and well-being.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People were supported by staff that were caring. People were supported to make choices and staff promoted people’s independence. People were supported with their communication needs. People had their privacy and dignity protected.

Peoples preferences were understood by staff. People were supported to engage in activities of their choice. People and their relatives understood how to make a complaint. Nobody was receiving end of life care so this was not considered.

Notifications were submitted as required and the registered manager understood their responsibilities. People and their relatives were engaged in the service. Staff felt supported in their role and were involved in the service. Quality audits were in place and were used to drive improvement.

South Street is registered to provide accommodation for personal care for a maximum of nine people with learning disabilities. There were nine people living at the home on the day of our visit. At the time of our inspection 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.

People told us they felt safe in their home and were supported by staff in maintaining their own safety. The staff told us how they kept people safe and the action they would take if they felt a person was a risk of harm of abuse. Staff reported any concerns to the assistant or registered manager to ensure people were supported in any allegation of abuse or harm. Staff were available to assist people when they were at home or out in the community. Staff ensured they were available to help people when needed. Staff checked people’s medicines before they received them to reduce the risk of errors and recorded when the person had taken them.

People were confident in the staffs' knowledge and told us the staff knew how to look after them. Staff told us their training reflected the needs of the people and helped them in understanding people’s needs. The registered manager provided regular support and staff told us they were supported in their role by management. People got to decide about their care and treatment and this had been recorded. Staff showed they listened and responded to people’s choices about their care and support needs. The provider had followed the correct procedure when a person was deprived of their liberty and staff understood the reason for the restrictions.

People planned their meals and were supported with meal preparation where needed. Alternative diets had been considered and people knew the reasons for these. People accessed health and social care professionals with regular appointments when needed. Staff knew when people had appointments or meetings and supported people to attend these.

People knew the staff that supported them and they chatted and relaxed when together in the home. Staff knew people well and were aware of each individuals care needs. People were treated respectfully and staff helped support and maintain their dignity. People’s relationships with their partners, family and friends were encouraged and had been supported.

People told us about their hobbies, interests and the things they did whilst in their home or out and about. People comfortably discussed their concerns or comments with staff and these were addressed. There were processes in place for handling and resolving complaints and guidance was available in alternative formats. Staff knew and would raise concerns on behalf of people at the home when required.

People told us they felt involved in their home and enjoyed living there. People knew the registered manager and knew they could talk with them if needed. The registered manager was available, approachable and worked various shifts to ensure they were able to monitor and support people and staff. Staff felt involved and were able to make suggestions in relation to people’s care needs. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

During the inspection, we spoke with the registered manager, three support workers and four people who used the service.

We found that the provider obtained consent from people who used the service in relation to their care and treatment.

We found that people's care and treatment needs were met.

Everybody we spoke with told us they liked the staff and were happy living at the home. One person told us: 'I like it here. I've been here a long time. I like the staff'.

We found that there were effective recruitment and selection procedures in place.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

As part of our inspection we completed a tour of the premises. We saw that some people had recently had their rooms redecorated. We found that the d'cor in the communal areas was tired. Walls and doors were scratched and wallpaper torn in places. We found that communal areas could benefit from a scheme of redecoration.

The registered manager told us that this had been identified as requiring action. We saw an audit document which demonstrated that this had been referred to the provider for consideration. The registered manager told us they hoped that redecoration would take place in the new financial year. We will check this at our next inspection.

Procedures and staff training were in place to ensure staff knew how to identify and report concerns and incidents within the home, this included suspected abuse.

There was a training matrix available at the home which told us training was available and had been delivered to staff. The staff we spoke with confirmed this.

We looked at the process the service had in place to monitor the quality of the service provided at the home. We found that there were systems in place to audit the service and seek feedback from the people who used the service.