Brighton & Hove City Council - 15 Preston Drove

15 Preston Drove is a '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. 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. Permanent and respite care and support is provided for up to five for people with a learning disability or autistic spectrum disorder. At the time of the inspection four people were living in the service and one person was receiving regular periods of respite care. The service is situated in a residential area with easy access to local amenities and transport links.

At our last inspection 14 March 2016 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 the last inspection we found some systems had been subject to slippage in the agreed timescales, for example, not all staff had received regular one-to-one supervision at a frequency determined by the provider. The frequency of team meetings had not been maintained. Although staff spoke of a comprehensive induction process for new staff, the supporting paperwork had not been fully completed and was not available to view during the inspection. Records we looked at had not always been fully completed. For example, the recording of people’s weights and where food and fluid charts were required, these had not been consistently filled in. There was no record of the training completed by the bank staff who regularly worked in the service. Although staff told us regular monthly medicines audits were completed there were no records of these, and annual competency checks for people administering medicine had not all been completed. At this inspection we found improvements had been made and the issues highlighted addressed.

There was a new 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. They had drawn up a robust action plan which staff had followed to ensure the continuous improvement in the service.

Systems had been maintained to keep people safe. The building and equipment had been subject to regular maintenance checks from external providers. Infection control procedures were in place. People remained protected from the risk of abuse because staff understood how to identify and report it. People’s care and support plans and risk assessments continued to be developed and reviewed regularly.

Relatives told us they had continued to feel involved and listened to. The culture of the service remained open and inclusive and encouraged staff to see beyond each person's support needs. The registered manager worked with care staff to develop the service with people at the heart of the service.

All the feedback from staff was of a supportive, consistent team with dedicated bank staff. Staff continued to have the knowledge and skills to provide the care and support that people needed. Staff told us they had received supervision and appraisal’s. They had been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively.

People continued to live in a service with a relaxed and homely feel. They were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health and access healthcare professionals when needed.

Staff and relatives told us the service was well led. A member of staff told us when asked what the service did well, “It feels like a home away from home. They (People living in the service) are safe, I feel really safe and well supported. We have really good managers.” Staff told us the registered manager and senior staff were always approachable and had an open-door policy if they required some advice or needed to discuss something.

15 Preston Drove has up to five people with a learning disability living in the service. At the time of the inspection there were four men living in the service whose behaviour could be complex. People have single bedroom accommodation and a range of communal facilities they can use. The service is situated in a residential area with easy access to local amenities, transport links and the city centre.

The service had a registered manager, who was present throughout the inspection, who has been in their current post for a number of years and knew the service well. 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.

The service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Relatives, staff and visiting healthcare professional told us the service was well led. One member of staff told us the registered manager was, “Easy to talk with. He is on the ball.” However, staff spoke of a particularly difficult time due to staffing and the high use of agency and bank staff. Senior staff spoke of having to cover staff shifts in the service, which had impacted on the completion of quality assurance in the service. They told us that some systems had been subject to slippage in the agreed timescales, for example, staff feedback as to the frequency of supervision was variable. Not all had received regular one-to-one supervision at a frequency determined by the provider. The frequency of team meetings had not been maintained. Although staff spoke of a comprehensive induction process new staff followed, the supporting paperwork had not been fully completed and was not available to view during the inspection. Records we looked at had not always been fully completed, for example the recording of people’s weights and where food and fluid charts were required these had not been consistently filled in. We spoke with one member of the bank staff who told us their essential training was up-to-date. There was no record of the training completed by the bank staff who regularly worked in the service. Although staff told us regular monthly medicines audits were completed there were no records of these, or annual competency checks for people administering medicine had not all been completed. We found this had not impacted on the care provided to people, however this is an area in need of improvement.

Relatives told us people were safe in the service. People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were up-to-date, were detailed and reviewed regularly. One relative told us, “I am so happy with the care provided.”

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans. There were procedures in place to ensure the safe administration of medicines.

Care staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People were supported by kind caring staff. One relative told us of the staff, “They are very good. They are spot on.”

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the registered manager. One member of staff told us, “I like working here. It’s a friendly place to work.”

People and their representatives were asked to complete a satisfaction questionnaire to help identify any improvements to the care provided. There was a detailed complaints procedures should people wish to raise any concerns. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

There were four people who used the service at the time of our visit. We used a number of different methods to help us understand the views of these people. They had complex needs which meant they were not able to tell us about their experiences. We observed the care provided, looked at supporting care documentation, medication records, staff records and records relating to the management of the service. We spoke with the manager, three care workers (one of whom was from the organisation's bank staff) and three relatives of two of the people who used the service.

This told us people who used the service or their representatives had been involved in making decisions about their care and treatment and where they were able to, gave consent to the care. People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

People's care had been provided by care workers who understood their care needs. There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service. One relative commented 'They are all absolutely wonderful. They are so good to him. He is a different person as he knows that he is loved.' Another commented 'He is always really happy.'

Staff records and other records relevant to the management of the services were accurate and fit for purpose.