Care Services (UK) Limited - 37 Wolseley Road

Care Services (UK) is a residential care home providing personal care to 5 people at the time of the inspection. The service can support up to 5 people, accommodated in one adapted building.

The building is over two floors and is made up of separate bedrooms with en suite facilities.

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 some areas of independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Risks were mostly assessed and managed to reduce the risk of avoidable harm, however the risks relating to fire had not been assessed or managed well. The outcomes for people using the service mostly reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. However, promoting independence was an area that could be significantly improved. People we spoke with and relatives told us they felt safe. Staff knew how to identify and report concerns relating to people's safety. People received support to take their medicines safely. There were enough staff to meet people's care and support needs.

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. Decisions about people's care and treatment were made in line with law and guidance.

Staff encouraged people to maintain a balanced diet and understood people's special dietary needs. People were involved in choosing their own food. The registered manager and staff team worked with external health professionals to ensure people's health and wellbeing were maintained.

Staff were caring in their approach and had good relationships with people. Staff supported people’s independence where possible but did not focus on further promoting peoples independent living skills. Staff had a good understanding of people's individual communication methods and supported people to make their own decisions.

People were supported by a staff team who understood their complex needs and their preferences.

Relatives and external professionals were involved in the assessment and planning of people's care. Relatives knew how to raise a concern if they were unhappy about the service, they or their family member received.

A registered manager was in post. Positive feedback was received in relation to the management of the service. People, relatives and staff had opportunities to feedback about the running of the service. Quality checks were carried out to monitor the service and identified where improvements could be made. We found that in most areas these checks were effective, but had not identified the concerns relating to fire safety.

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 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to premises and equipment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

At our previous inspection, we told the provider to make improvements to ensure that when people were not able to make certain decisions for themselves, they followed the guidance available. At this inspection, we found that the required improvements had been made. People were supported to make decisions, and when they were unable to, the provider had shown why their support was in their best interests.

People continued to be safe living at 37 Wolseley Road. The staff knew how to support people to ensure they were protected from harm. Risks to individuals were assessed and reviewed, and medicines were managed safely. There were enough staff available to meet people’s needs, and recruitment processes were followed to ensure that staff were suitable to work in the service.

Staff had the knowledge and skills required to carry out their roles. They completed an induction programme when they started to work at the home. Staff also had access to ongoing training to develop their skills. People were supported to maintain a balanced diet and access health care services.

People were supported by staff who were caring and patient. They were encouraged to make day to day decisions about their care, and their independence was promoted. Staff knew how to care for people in a dignified way, and understood how to respect people’s privacy.

The care provided continued to be individual to each person, and this was delivered in a responsive manner. People were enabled to participate in activities that they enjoyed, and they were able to maintain relationships that were important to them.

The management team promoted a positive, open culture for the people who used the service and the staff who worked there. People were encouraged to give feedback about the support they received. There were effective systems in place to drive continuous improvement within the service.

The service had a registered manager in place. 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.

Consent to care was sought in line with legislation and guidance, and capacity assessments were completed when needed. However when people did not have the capacity to make certain decisions, it was not clear in their records how decisions had been made and why these were in their best interests.

We found that people were supported by staff to protect them from harm and abuse. The staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Risks to individuals were managed to keep people safe, and this was done in a way that promoted their independence. There were sufficient staff to keep people safe and meet their needs. The provider had safe recruitment processes in place. People received their medicines in a safe manner by staff that were trained to do this.

People were helped to make decisions and choices in their lives. They were supported by a staff team who knew them well and had the skills to meet their needs. Staff received a range of training which improved their practice. We saw that people were supported to maintain a balanced diet and the kitchen was open for people to access as and when they wanted to, with support when they needed it. People were enabled to maintain good health and have access to healthcare services when required.

Positive caring relationships had been developed and we found that people were treated with dignity and respect. Staff promoted people’s independence and their families were encouraged and enabled to be a part of their lives.

People received support that was individual to them and met their needs. They had the opportunity to choose how they spent their time. We saw the service had made some changes to the building to make it better for the people who lived there. People knew how to raise any concerns and were encouraged to express their views about the service.

We found there was a positive, open culture within the service. Staff felt supported by the registered manager and the provider. Staff and relatives told us they were approachable and responsive. People were encouraged to be involved with developing the service and there were systems in place to monitor the quality of the service and drive continuous improvement.

Is the service safe?

A relative told us they 'Feel confident staff provide a good service'. When we visited the people we spoke with told us they were happy with the care provided. Records showed there were care plans in place designed to meet people's individual needs and ensure people's welfare and safety.

We found there were good systems in place for ensuring people were provided with access to specialist health services and advice. Care staff accessed the advice of specialist healthcare professionals and incorporated this advice into the care people received.

The manager told us some people were not always able to fully understand and make decisions relating to their care. We found examples of reference to decisions which might need to be made in the person's best interest recorded in care plans. This meant arrangements were in place to meet the requirements of the Mental Capacity Act 2005 (MCA). This is a law that provides a system of assessment and decision making to protect people who do not have capacity to make decisions for themselves. No one using the service was subject to an authorised deprivation of liberty. People's rights were protected and there were arrangements in place to make decisions a person's best interests.

Is the service effective?

We spoke with someone about the care provided who told us they were much happier with their relative's care since they had moved there. They said the person had previously been quite socially isolated but they had developed a good rapport with the other people who used the service. Another relative told us they had seen a real improvement. They said their relative was now carrying out household tasks they had not been able to before moving to the service. Each person had their own key worker who met them regularly to review their care plan. We saw peoples' care plans had been updated to reflect changes in the person's needs. This included developing new risk assessments if the person was carrying out a new activity or changes to existing ones if the nature of the risk had changed. We spoke with two relatives who told us they were invited to participate in care reviews. They said care staff asked for their views about the quality of care provided

Is the service caring?

On the day of our visit we saw two people being supported to take trips into town, another person was helped to bake cakes. We observed staff providing care and saw they treated people as individuals. One relative told us 'Staff support them to get what they need they see and treat them as a person'.

Is the service responsive?

A relative told us care staff had been very active in understanding if their relative experienced pain related to their disability. As a result the person had been reviewed by a team specialising in neuro- rehabilitation. They said they 'Initiated contact by emailing and ringing the manager about things and they were very receptive about any suggestions'.

Another relative told us they did not have to worry about dentists and doctors' appointments. They said staff had these organised and made sure their relative received appropriate care. They told us care staff were very quick to get in touch if there were any problems and involved relatives in supporting the person's care for example by making sure they were involved in hospital visits.

Is the service well led?

We saw the manager checked people's care plans regularly and approved any changes care staff had made following a discussion with the person they supported. The records of care staff meetings showed the individual needs of people who used the service were discussed. Someone external to the service visited every month to carry out a quality assurance review of the service and we saw records of these visits and the quality checks carried out by the manager.

When we spoke with care staff they told us they felt happy to discuss ways of improving the service when they met with their manager in supervision meetings. They told us they felt supported to provide people with a good quality service.

We spoke with people who used the service. We observed and people told us they were happy living at 37 Wolseley Road. We saw that people were preparing and being supported with their daily activities.

We spoke with staff about the care and support they provided each day. They gave a detailed account of the specific individual needs of people. We saw staff supported people in a caring and compassionate way.

We looked at the care plans of people who used the service and found they were up to date and documented the specific care needs of people.

We looked to see if people's medication was being managed properly. We found the service had systems in place to ensure medication was handled safely and securely.

The service had a complaints procedure which detailed how to deal with any comments and complaints made by people who used the service or their relatives. Staff told us they had not received any complaints recently.

We found that 37 Wolseley Road was compliant in the five outcome areas we looked at.

People that lived at the home were involved in making choices about their lifestyle. Meetings were held to talk about their care and the things they wanted to do. People took part in activities both in and out of the home. People were supported to be as independent as possible.

People's needs were assessed and support plans were in place that showed their needs and how they should be supported. We saw that the care provided corresponded with the plans of care. Health action plans were in place and people were receiving the health care they needed.

The home had procedures in place to keep people safe. Staff were trained in safeguarding issues. They knew the signs of abuse and the actions to take if they had any concerns.

Staff were trained, supervised and supported to provide people with appropriate care. Staff completed regular training to maintain their knowledge and met with the manager to discuss their work and training needs.

The home had systems in place to monitor and improve the care provided to people. Checks and audits about care were completed regularly and people's views were sought about their care. The home had a complaints procedure in place.