St Anne's Community Services - Cardigan Road

St Anne's Community Services - Cardigan Road is a residential care home providing accommodation and personal care to up to 8 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 8 people using the service.

People’s experience of the service and what we found:

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:

Systems were not robust enough to demonstrate safety was always effectively managed. Staff were inconsistent when recording and reporting incidents. Medicines were not always managed safely. These shortfalls had not been picked up through the provider’s governance arrangements although prompt action was taken once we brought this to the attention of the management team.

There was enough staff available to support people when they were at home and in the community.

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:

People told us they were happy living at Cardigan Road and we saw people were relaxed in the company of staff and others they lived with.

Care plans had some detailed person-centred information but other information was not up to date. Gaps in care records meant it was sometimes difficult to monitor people's health and well-being.

The service worked effectively with external stakeholders.

Right Culture:

People were encouraged to live as full a life as possible in relation to social activities and accessing the community. However, opportunities within the service were less so and routines were sometimes not person centred.

The provider had a range of systems and processes to monitor the quality of the service although they did not always drive the required outcome.

Everyone had opportunities to share their views. Staff felt well supported by the management team who worked at the service.

The management team was responsive to the inspection findings and keen to deliver a high-quality service.

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 26 October 2018).

At our last inspection we recommended that the provider improve standards of cleanliness at the service. At this inspection we found the provider had acted on the recommendation and had made improvements.

At our last inspection we recommended that the provider continued in their efforts to ensure staff received regular supervision in line with their policy and improve communication and decision-making processes for the service. At this inspection we found the provider had acted on the recommendation and had made improvements.

Why we inspected

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

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question 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 St Anne's Community Services - Cardigan Road on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation in relation to medicines and person-centred care.

Follow Up

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

St Anne's Community Services - Cardigan Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cardigan Road provides accommodation for up to eight men and women who have a learning disability. The home is situated close to the cricket and rugby grounds in Headingley, Leeds. There are shops, pubs, GP surgery, and other amenities within walking distance of the home. The home is well served by public transport and there is parking alongside the garden area at the rear of the building.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home has 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff told us they found the decision-making processes at the service did not allow for their input. They said the management team and provider often did not always consider their views. This resulted in some staff feeling disengaged at times. The provider was aware of staff's views and was looking at ways to address their concerns. We have made a recommendation about this.

Areas of the service were not clean. Cleaning schedules were not in place although task sheets did include jobs for staff to support people to undertake. The standards of cleanliness at the service were not routinely monitored. We have made a recommendation about this.

People told us they felt safe at the service and were well supported by staff who were caring and friendly. Staff attended safeguarding training and knew how to report any concerns. Staff understood their responsibilities in relation to reporting accidents and incidents.

Risks to people were assessed and managed to keep people safe. Risk management plans guided staff on how to manage those identified risks.

We saw medicines were managed effectively. Staff had their competency assessed in medicine management before supporting people with the administration of medicines. There were systems in place for the storage, ordering and disposal of medicines.

Staff were recruited robustly and safely. We saw there were sufficient staff available to meet people's needs. Induction and development programmes were in place to ensure staff gained relevant knowledge and skills. They received training which ensured they were up to date with the skills required for their roles.

People were supported to access community health services to have their healthcare needs met. Their care records showed they had input from different health professionals. For example, the GP, the falls team, psychologist and speech and language therapist.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw people were engaged in community events during our inspection. People were given choices and offered opportunities to spend their time however they wished. The service focused on promoting people's independence. Staff treated people with dignity and respect and were genuinely warm in their interactions with people.

Assessments were completed with the involvement of people and their relatives. Assessments determined whether staff had the skills and knowledge to support people at the service and meet their needs.

Care plans were very personalised and focused on the person. People's communication needs were included in care plans and staff told us they were aware of these.

The provider ensured the building was safe by completing a number of safety checks on a regular basis. Continuity plans were in place to ensure staff knew what actions to take in the event of an emergency.

Systems were in place to assess and monitor the quality and safety of the service. Audits of the service occurred on a regular basis. The service had support from the area manager when required and provided support when areas for improvement were found.

Relationships were developed with health and social care services, which enabled people to receive coordinated care.

We found at the inspection in November 2014 that medication practice was not always safe and improvements were needed. We told the provider they needed to take action and we received a report in March 2015 setting out the action they would take to meet the regulation.

Cardigan Road provides accommodation without nursing care for up to eight men and women who have a learning disability.

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 and associated Regulations about how the service is run.

At this inspection we found improvements had been made with regard to medicines management. People were now protected against the risks associated with medicines because the provider had overall appropriate arrangements in place to manage medicines safely but needed to ensure medicines that required refrigeration were stored safely.

People told us they felt safe at the home. Staff showed they had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. They said they would report all concerns and knew how to do so.

The premises were managed to keep people safe. However, the checklist completed monthly did not identify all hazards in the home to enable action to be taken.

Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. There were enough staff to support people and keep people safe. Staff training and supervision provided staff with the knowledge and skills to meet people’s needs well.

People told us they enjoyed the meals and were involved in menu planning and meal preparation. We saw healthcare needs were met promptly.

There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

People were happy living at the home and felt well cared for. People’s support plans contained sufficient and relevant information to provide consistent, care and support.

People were supported by staff who treated them with compassion and kindness. Staff were respectful of people’s privacy and dignity and encouraged people to maintain their independence.

People led fulfilling lives and participated in a range of activities both in the home and community; this included voluntary work. People said they enjoyed what they did.

Staff were aware of how to support people to raise concerns and complaints. There were overall effective systems in place to assess and monitor the quality of the service and address any improvements that were identified.

People looked well cared for, clean and well presented. We observed that staff had enough time to meet people's needs. People were able to say how they wanted to spend their day and what care and support they needed. People were supported in maintaining their independence and community involvement.

One person told us, 'I go out a lot; I have lots of friends and go out on the bus.' Another person said, 'I'm alright outside, I go out.'

In the case records we looked at, we found unacceptable gaps in the time between entries made. This meant it was not possible to determine from the records what care the person had received in this time period. This could result in changes in people's care needs being overlooked, delayed or missed.

The home had procedures for the safe handling of medicines. People told us they received their medication on time.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks were made before staff began working in the home.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

'I like it here, I have a lovely room.'

'I am very happy here, everything I need.'

'I like to be independent, cleaning, cooking my own meals.'

'I feel happy with everything here.'

People we spoke with said they understood their care and support plans and that staff had explained things well to them.

We saw that people received care and support in an environment that was clean and there were systems in place to minimise the risk of infections. People who used the service said they were happy to be involved in house cleaning with staff support. One person spoke with pride about how they liked to keep the house clean.

People who used the service said there were enough staff to support them. They were also very complimentary about the staff. Their comments included:

'Always staff available when you need them.'

'The staff are lovely.'

People who used the service said they felt staff listened to them when they made any suggestions, for example, colour schemes for d'cor and holiday or menu ideas. They were aware of how to make a complaint if they needed to do so. People said they felt confident to speak to the staff about any concerns they may have.