Flexible Support Options Limited (Thorntree Way)

We found the following examples of good practice.

Staff used PPE safely and effectively. The service was clean and well maintained. One person who lived at the home was very knowledgeable about the additional cleaning procedures which were carried out to keep everyone safe.

Relatives spoke very positively about the communication with staff, infection control, visiting arrangements and activities provision during the pandemic. Comments included, “They always keep me informed, they phoned every day to keep me up to date. The staff are fabulous it’s like a family,” “She has a better social life than me, she’s been at shows, panto and goes out for meals. I can’t sing their praises enough they are wonderful” and “The place is nippin’ [very] clean.”

Flexible Support Options Limited (Thorntree Way) consists of two purpose built bungalows situated in a residential area of Blyth, Northumberland. It is registered to provide accommodation and personal care for up to ten people with autism and/or a learning disability, some of whom may also have physical disabilities. At the time of the inspection, there were five people living in each self-contained bungalow.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People living in the home receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

People and staff said they enjoyed living and working in the home. People spoke highly of the care, support and attention they received. This was reflected in the positive attitude and approach of staff and the management team. The management and staff team took considerable time to understand people’s needs and were exceptionally skilled at responding to their needs and preferences. This included a thorough understanding of people’s communication needs, to enable people to express their wishes and views in a meaningful way. By working in imaginative and person-centred ways, the staff worked to develop people’s lives for the better. There were numerous examples of how people had been supported to build their confidence and self-esteem in a supportive and open atmosphere.

People told us they felt safe and staff were kind and caring. Our observations during inspection, were of positive and warm interactions between staff and people. Staff were motivated and demonstrated a clear commitment to providing dignified and compassionate support. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. The provider operated an effective recruitment procedure to ensure staff were suitable to work with vulnerable people. Risk assessments were created to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from the risks associated with the spread of infection. People received their medicines safely.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on providing opportunities to gain new skills and become more independent. 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. Staff received training relevant to their role and new staff completed an induction training programme. Staff felt well supported by the management team. People were involved in the development and review of their support plan documentation and had regular meetings with their keyworker. People had access to a broad range of meaningful activities which improved their quality of life and feelings of well-being.

The service was well-led by a committed management team. Together with the staff team they provided high-quality, person-centred care. The registered manager provided clear leadership and took into account the views of people, their relatives, staff and visiting professional staff about the quality of care provided. The registered manager and staff used the feedback to continuously improve people's experience of care.

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 25/05/2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Flexible Support Options Limited (Thorntree Way) consists of two purpose built bungalows situated in a residential area of Blyth, Northumberland. It is registered to provide accommodation for up to ten people with autism or a learning disability, some of whom may also have physical disabilities. At the time of the inspection there were ten people using the service.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since July 2016. A previously employed registered manager was still listed for the service and had not formally deregistered with the CQC. Consequently their name appears on this report. A registered manager is a person who has registered with the 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 2008 and associated regulations about how the service is run. We were supported by the registered manager throughout the inspection.

Staff were aware of safeguarding issues, had undertaken training in the area and told us they would report any concerns around potential abuse. The provider was following appropriate safeguarding processes and reported concerns to the local safeguarding adults team and notified the CQC. Appropriate safety checks had been carried out on the environment and equipment used at the service. Risk assessments were in place regarding the environment of the service and the delivery of care. Accidents and incidents were recorded and monitored.

The service was clean and tidy. We found some bathrooms and laundry areas were in need of updating and refreshing. We have made a recommendation about this.

There were sufficient staff to support people appropriately and accompany them to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were stored and handled correctly and safely.

Staff had access to regular training and updating of skills. Records indicated most staff had completed a range of training and systems were in place to monitor it remained up to date. Staff told us, and records confirmed there were regular supervision sessions for all staff members and annual appraisals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. A number of people had been subject to formal restrictions through the granting of DoLS. Best interests decisions had been made where people did not have capacity to make their own decisions.

People had access to health care services to help maintain their wellbeing. There were regular visits to general practitioners and other health and social care professionals.

People were supported to access adequate levels of food and drink. Specialist dietary advice had been sought, were necessary, and guidance followed.

Some areas of the home, especially the kitchen facilities were in need of refurbishment. We have made a recommendation about this.

We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Relatives told us they were happy with the care provided. Staff understood about treating people with dignity and respected people’s personal space and choices. A number of people were being supported by an independent advocate.

People had individualised care plans and risk assessments that addressed all their identified needs. Care plans had detailed information for care staff to follow. Changes to care delivery were reviewed, although this was not always recorded in detail. People were supported to attend various events and activities in the local community. The registered manager told us there had been no formal complaints in the last year and relatives told us they had not raised any concerns.

Regular checks and audits were carried out on the service by the registered manager and these actions were overseen by the operational manager. Staff were positive about the leadership of the service and the support they received from the registered manager. They said there was a good staff team and felt well supported by colleagues. Feedback from questionnaires sent by the provider and completed by relatives where not shared with the service. We have made a recommendation about this. Daily records at the home were up to date and contained good detail.

Flexible Support Options (Thorntree Way) provides care for up to nine people who have learning disabilities. There were nine people living at the service at the time of the inspection. The service comprises of two bungalows. Four people [all female] lived at 13 Thorntree Way. Five people [all male] lived at 15 Thorntree Way.

We noted that the provider had not registered their full address of 13 and 15 Thorntree Way with the Care Quality Commission [CQC]. We have written out to the provider to request that this issue is addressed.

We last inspected the service in August 2014 and found that they were meeting all the regulations we inspected.

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.

Staff and relatives told us that another manager was in ‘day to day’ charge. This was confirmed by the acting manager although she did say that the registered manager was always available by phone should any advice be required. She had commenced work at the service in September 2014 and started managing in January 2015. She said that she was going to apply to become registered manager. We have written to the provider using our regulatory powers to ascertain the registered manager situation.

There were safeguarding policies and procedures in place. Staff told us that they had not witnessed anything which had concerned them. We found, however, there had been some low level safeguarding incidents which involved altercations between people and an allegation of abuse. The acting manager informed us that the local authority had not been informed of the allegation of abuse. We passed this information onto the local authority safeguarding adult’s team. We had not been notified of any safeguarding incidents at the service.

We saw that the premises were clean. We noted that the electrical installations test was overdue. The acting manager organised for this test to be carried out before we visited the service again on 19 November 2015. The electrician had deemed the installations to be satisfactory. Medicines were generally managed safely. One relative told us that the layout and equipment available at the home, did not fully meet their family member’s needs with relation to bathing.

People, staff and relatives told us there were enough staff to meet people’s needs. This was confirmed by our own observations. There was a training programme in place. Staff were trained and supported in safe working practices and to meet the specific needs of people who lived at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Although we found that staff were following the principles of the MCA, the acting manager was aware that further work was required to ensure that mental capacity assessments and best interests were completed for specific decisions.

People told us that they were happy with the meals provided at the home. We saw that the kitchen was well stocked with fresh fruit, meat and vegetables. A weekly menu planner was in place and people were involved in choosing what they wanted to eat. Healthy snacks, such as fruit, were available.

People and their relatives told us that staff were caring. Most of the interactions we saw between staff and people were positive. One relative informed us they felt that staff communication could be improved. We saw that a member of staff use a person’s clothes protector to wipe their mouth during the meal time instead of using a napkin. We considered that this action did not fully promote the person’s dignity.

People were supported to maintain their hobbies and interests and to remain actively involved in the local community. Relatives were disappointed that there was only one mini bus now at the service. They said that this affected the flexibility and spontaneity of activities provision at the service.

There was a complaints procedure in place. Minor concerns about care and support were documented in people’s care files.

The acting manager and staff at the service carried out a number of audits and checks to monitor all aspects of the service. We found however, that they did not always identify the concerns we had highlighted during our inspection.

The provider had not notified us of six DoLS authorisations, five low level safeguarding issues and a police incident which they were legally obliged to inform the CQC of. Staff at the service were unaware of all the events and incidents which were legally required to be notified to the CQC. The submission of notifications is important to meet the requirements of the law and enable us to monitor any trends or concerns.

We found one breach of regulation 18 of the Care Quality Commission Registration Regulations 2009. This is being followed up and we will report on any action once it is complete.

We also found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. You can find out what action we took at the back of this report.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

The provider had effective systems in place to identify, assess and manage risks to help protect the health, safety and welfare of people using the service and others.

There were risk assessments in place to help protect people's health and safety. For example, associated risks when going out in the community, eating and drinking and the use of bedrails.

Routine safety checks and repairs were carried out by staff and external contractors carried out regular inspections and servicing. For example, fire safety equipment, hoists, electrical installations and gas appliances.

Appropriate checks were undertaken before staff began work and effective recruitment and selection processes were in place to help ensure staff were suitable to work with vulnerable people.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS. We saw documentation that relevant people had been involved in decisions made in the best interests of people who lacked capacity.

Is the service effective?

People's health and care needs were assessed which included communication, expressing sexuality, medications, personal care, mobility, controlling body temperature and bed time routines. Support plans were in place which gave staff information about people's needs, equipment that may be required and how their care and support should be delivered.

We spoke with staff and they were able to describe people's individual care needs and what support they needed.

Is the service caring?

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people, and supported them to eat their lunch, access community facilities and pursue their hobbies.

We spoke with two relatives whose comments included, "I can't fault the quality of care provided. The staff are pleasant and the manager does a fabulous job" and "I think Y is well cared for but I would like to see more activities provided."

We spoke with a health care professional who visited the home and they told us they felt the staff were very caring and people were well cared for.

Is the service responsive?

A complaints procedure was in place and two relatives confirmed they were aware of how to make a complaint. We saw there was information available on the notice board in the home about making a complaint.

A health care professional told us that the staff were very good at involving other care specialists if they had any concerns or issues and required advice.

Is the service well led?

The registered manager had recently left the organisation and we were told that the position had been advertised and interviews were due to take place. A senior care worker was acting as the manager until a replacement manager was found.

The service had a quality assurance system in place that included the use of surveys issued to relatives of people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Relatives told us that three monthly family forum meetings had been set up and they had been invited to attend to discuss day to day issues in the home.

Regular staff meetings were held which meant they were able to feedback their views and concerns to the management of the home. Staff told us they felt supported in their role and felt their views were listened to and taken into account.

We saw records to show audits were carried out by the manager to help ensure standards were maintained and any improvements could be introduced. These included audits related to care records, medications, infection control, accidents, safeguarding, health and safety, training and supervision.