Mountain Ash

We found the following examples of good practice.

There was a visitor booking system to manage staggered visits and social distancing. There was a room for visitors to wash their hands, change and dispose of personal protective equipment (PPE) safely.

People were enabled to maintain contact with friends and family through various social media platforms. People needing to self-isolate were supported with increased social contact by staff and activities in their rooms.

There were easy-read and pictorial signs around the home promoting use of face masks, social distancing and limited staff numbers in rooms. Staff had helped people to adjust to the increased use of PPE by promoting fun interactions and providing additional reassurance about their safety.

People had individual risk assessments in relation to infection control and management, this included support to maintain social distancing when going out.

Staff maintained a good practice log with new processes and improvements for managing infection prevention and control.

Further information is in the detailed findings below.

Mountain Ash is a residential care home providing personal care for up to ten people. It is housed in an adapted building providing residential care on one floor for people who have complex learning disabilities and care needs, including diabetes and epilepsy. All areas of the home have wheelchair access. Mountain Ash is located in a residential area.

The service has been adapted 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 to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was larger than most domestic style properties. It was registered for the support of up to ten people and ten people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the converted building fitted well into the residential area and was surrounded by other residential single story buildings.

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

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. 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 them having as many opportunities as possible for them to gain new skills and become more independent.

Risks to people’s health and safety had been identified and actions were in place to ensure risk was minimised. Staff were aware of the actions to take if they thought anyone was at risk of harm or discrimination. Concerns identified had been reported to appropriate external professionals. A complaints procedure was in place and although there were no current complaints staff were aware of the process to follow if any issues were raised.

Incidents and accidents were well managed and recorded, with actions in place to prevent issues reoccurring. Learning from events had been used to improve ongoing care provision. Medicine procedures and systems were robust with staff receiving specialised medicines training to enable them to meet people’s needs safely. Suitable systems were in place to prevent and control infection.

Staffing numbers were assessed dependant on people’s needs. Staff told us staffing numbers were appropriate to meet people’s needs. Care and support were delivered in line with current legislation and evidence based guidance. Regular reviews were completed and people were encouraged to make choices and decisions regarding all aspects of their care and daily lives.

Staff had access to appropriate training and support to ensure they could meet people’s complex needs. New staff completed a full induction which including shadowing experienced staff and observing care. All staff had access to regular one to one support by senior staff and development plans for future learning.

People’s needs and choices were well documented and understood by staff. It was evident that there was a close relationship between people and staff. People and their relatives were involved in the planning of care and any changes to the way care and support was delivered. People’s care was tailored to the individual considering their personal preferences. People’s communication needs were identified and recorded in care plans with specific communication aids made available for people.

Care and support was delivered in line with current legislation and evidence-based guidance with regular reviews being completed. A consistent staffing group meant staff knew people well and understood their needs and preferences. People were encouraged to continue hobbies and interests that were important to them and supported to maintain relationships with friends and family. Peoples end of life wishes had been discussed and documented, this included religious, cultural and spiritual preferences.

People were supported to have a varied and nutritious diet. Wesaw people being offered a variety of food and drink choices. People were able to be involved with meal and drink preparation. People’s health was monitored, and referrals made to other agencies if any issues were noted. Specific guidance in place regarding people’s nutritional needs were being followed.

The building had been adapted to ensure people using wheelchairs had access to the home and gardens. People’s rooms were decorated in a style of their choice. There was a sensory room and hydro therapy pool which people used on a regular basis. We were told both had a positive impact on their health and wellbeing.

The registered manager and staff placed emphasis on person centred high quality care. There was an open culture which was inclusive and valued people and their individuality. Staff were aware of their roles and responsibilities. The emphasis at Mountain Ash was that it was people’s home first and foremost. The registered manager worked with staff each day to provide people with a good quality of care. Regular checks and audits were carried out to ensure the quality and safety of care being provided was maintained.

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 15 December 2016)

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.

The home was purpose built, all the rooms were on the ground floor and there was a large secure garden, which was easily accessible for people using wheelchairs.

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.

This comprehensive unannounced inspection took place on 4 and 9 November 2016.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that restrictions were required to keep people safe. This related to the need for locks on the kitchen door and to the entrance of the pool area. It also meant that those who needed bed rails or lap belts on wheelchairs had them. Appropriate referrals had been made to the local authority for authorisation.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended day centres, activities were provided within and outside of the home daily, and people were supported individually to have their needs met. The sensory room had been redecorated and this offered a relaxing and calming area for people to spend time. There is a hydro pool on site. Over the past few months a number of problems had prevented its use. However, when available this presents a regular and enjoyable activity option for people.

There were safe procedures in place for the management of medicines. People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. Where specialist healthcare was required, for example, from a physiotherapist or speech and language therapist, arrangements were made for this to happen and detailed guidelines were provided. This meant that if people had been prescribed particular exercises, records showed why they were needed, what would happen if they were not carried out. Along with detailed instructions, there were photographs of the equipment to be used and how it was to be used. This meant that staff had the knowledge to support people effectively.

People were asked for their permission before staff assisted them with care or support. Staff were skilled in identifying people’s various ways of communicating. They knew the various sounds and indicators people used to make their needs known and we saw that people reacted positively when staff responded to them.

Staff had the skills and knowledge necessary to provide people with safe and effective care. Training was provided which was specific to meeting people’s complex needs. Staff received regular supervision and support from management which made them feel valued. Staff spoke positively about the way the service was managed and the open style of management. Staff told us, “The manager has the service users and home’s best interests at heart. They keep everyone up to date and check that service users receive good quality care.”

The provider had strong systems to monitor the management and quality of the home and through regular internal monitoring the registered manager ensured that a range of audits were carried out to monitor the care and support provided. Where shortfalls were identified action plans were draw up and matters were addressed in a timely manner. There was a continual system of review and evaluation to drive improvement.