Archived: Littlemoor House

There is not a requirement for Littlemoor House to have a registered manager in place. This is because the manager is also the provider and already a ‘registered person’. 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.

The service is registered to provide residential care for up to five people with learning disability or mental health conditions. At the time of our inspection five people were using the service.

People received responsive and personalised care from staff who understood them. People were involved in planning their care and support. The support people received from the service promoted their independence. People received personalised support to engage in interests and activities of their choice. People were asked for their views and people knew how to raise concerns or make suggestions.

The manager had taken steps to make sure people were cared for safely. Sufficient numbers of staff were deployed to meet people’s needs. Any risks to people were identified and assessed in a way that did not restrict people’s choices. Medicines were well managed and safely stored and administered.

Staff checked with people that they consented to their care and support. Policies and procedures were in place should the provider require them, to ensure the principles of the Mental Capacity Act (MCA) 2005 were followed. People did not experience restrictions on their freedom and therefore no applications for Deprivation of Liberty Safeguards (DoLS) had been made.

People were supported to enjoy mealtimes and received sufficient food and drink that met their nutritional needs. Staff were supported through supervision and training and demonstrated knowledge of people’s needs. Staff received training in areas that were relevant to the needs of people using the service. People were supported to access other health care services as required.

The provider was viewed as being supportive and involved in the day to day management of the service. The manager was supported in their leadership by motivated and supportive staff. Records were well maintained and other audits were used to check on the quality and safety of services provided to people using the service.

People were supported by staff who were kind and caring. People enjoyed the companionship of staff. People’s choices and decisions were respected and used to inform their care plans. Staff were mindful of respecting people’s independence, dignity and supporting their privacy.

Was it safe?

Staff followed the Mental Capacity Act 2005 to make sure that people were asked for their consent before they received care. People's care records accounted for their capacity to consent to their care and how their consent was gained for this. They also showed where some decisions were made in people's best interests. For example where others were legally appointed to make decisions about their finances. People said they were regularly consulted about their care and their care plans reflected this.

We saw the provider had made improvements since our last inspection on 5 November 2014. This included their arrangements for people's medicines, staff training and support and record keeping. This meant that people were protected against the risks associated with unsafe or inappropriate care and treatment.

People's care plans accounted for any known risks to their safety and welfare and detailed their medical conditions and how they affected each person. They described the required care interventions for staff to follow and were regularly reviewed to reflect any changes in their care needs. They included monitoring of people's mental health conditions and the arrangements for enabling them to access relevant health care professionals concerned with their care when required.

The provider's arrangements protected people against the risks associated with unsafe medicines practices. This included obtaining people's medicines and their safe storage, recording, handling and administration and for their disposal where required. Where appropriate, people were supported to manage their own medicines safely. Staff responsible for people's medicines received training and policy guidance to follow and regular updates for this.

Staff knew their responsibilities and those of others, for decision making about people's care. The provider's written procedures supported staff to respond to and report any concerns about people's safety and welfare, where required. For example, in the event of any emergency, such as a fire or changes in people's medical conditions.

The provider, who is also the registered manager, was usually on site most days and regularly checked people's care and accommodation. We found their arrangements for the regular servicing and maintenance of equipment in the home were up to date and since our last inspection the provider had consulted with the local fire authority to review their fire risk assessment and safety arrangements to make sure these met with requirements.

Was it effective?

People experienced care and support that met their needs. They told us that staff listened to them and that they knew their rights and were able to exercise their choices. People said they could look at their care plans and we found that they contained clear information about their rights, in a document entitled 'Residents Charter of Rights.' One person told us, 'We can choose what we want to do; I go out a lot with staff.' Another person said, 'They have helped me to stop smoking cigarettes, I feel much better.'

People's care plans were recorded in a way that met with recognised guidance for records and record keeping and they informed staff about people's known daily living choices and lifestyle preferences They detailed what aspects of people's care had been reviewed and who was involved in their care review. Where required, this included outside health and social care professionals concerned with people's care.

People told us they were satisfied with their environment and their care, which included the arrangements for their medicines. Procedures were displayed in the home advising people what to do if they were wanted to make a complaint or in the event of a fire. People were spoke with knew about these.

Was it Caring?

People told us that staff listened to them and that they were happy with their care and liked living at Littlemoor House. We found that staff, were respectful and interacted with people in a way that promoted their belonging, independence and achievements. For example, asking people for their views about maintaining their independent living skills and personal care routines,

One person told us that the manager regularly asked them how they were getting on with their 'stop smoking plan and helped them with their coping strategy for this. Another told us that staff listened to their worries and helped to reassure them.

People were supported to participate in a range of activities of their choice, both in and outside the home. The manager told us they were committed to ensuring activities met people's individual needs and choices.

People told us they liked their own rooms, which they saw as their personal spaces and were encouraged to personalise with their own things.

Was it responsive?

The provider consulted with and agreed people's care with them where possible and acted according to their wishes and best interests. Records of care plan reviews and community meetings held with people showed where changes were either made or were being implemented in response to people's expressed views. This included privacy individual privacy arrangements, meals and social and recreational activities.

Records showed that staff responded to changes in people's health needs and referred them to relevant outside health care professionals where required.

We saw the provider had made changes to improve people's care in response to our last inspection visit report of 5 November 2014. This included their arrangements for people's medicines, staff training and support and record keeping.

Policies and procedures had all been reviewed since our last inspection and a number had been developed further to ensure they met with recognised advice and practice. For example, medicines, care planning and staff recruitment. The provider also told us about work in progress to ensure that personal emergency evacuation plans were provided for each person living at the home.

Was it well led?

Staff said they received the training, supervision and support they needed to enable them to deliver care to people at Littlemoor House. Records we looked at reflected this. .

Staff, were kept informed about people's care and said they received feedback about any changes or any learning from incidents or from the provider's checks of care and safety. They also told us they were felt comfortable to raise concerns they may have with the manager, who they said listened to them and acted on what they said.

The provider/registered manager regularly checked the quality of care people received. This included people's care plans, medicines, staffing arrangements and accidents, incidents and complaints. There had been no complaints received since our last inspection. They spoke with people daily to gain their views about their care. They also held regular community meetings with people about their daily living arrangements, lifestyle preferences and wishes.

People we spoke with told us they went out regularly and liked to go shopping for clothing. Some people went out independently to attend day centres or health appointments. People told us they liked living at the home and liked their rooms. One person told us 'I like living here, I have a nice soft bed' Another person told us 'Everything is good ' I can recommend it.'

People's privacy, dignity and independence were respected. Information was available on people's preferred routines and preferences.

Some care needs were identified and assessed. However we found that the planning and delivery of care did not always meet the person's individual needs and or ensure the welfare of the person. We found inconsistencies, gaps and lack of detail in people's care plans. People had suitable access to healthcare professionals.

There were suitable systems in place to order medicines. There were not suitable risk assessments and storage arrangements in place where people managed their own medicines. Staff did not always have clear administration instructions available to enable them to give medicines to people safely. Not all staff who were administering medicines had received training.

Some staff training had been delivered and more training dates were planned. However people who use the service may not always be safe and receive appropriate care as staff did not always receive appropriate training as there were gaps where no training was scheduled to take place.

Records were not stored securely and were not always accurate or up to date. Some recent care records were not available at the time of our visit. The care records we saw were not kept up to date so did not include details about people's care needs. In two records we saw conflicting information recorded about the person's abilities or wishes

During our inspection we visited peoples rooms and found that they had each brought in their own personal belongings and had been encouraged to personalise the room.