Islington Social Services - 3 Wray Court

We found the following examples of good practice.

The service provider had kept guidance up to date around visiting arrangements and other safety guidance throughout the pandemic. This had helped to minimise negative impacts that people experienced not only around lockdowns but also how the home could re-open for visits by families.

A recent COVID-19 outbreak had occurred and the home quickly implemented safety measures to manage the situation. At the time of our visit it was positive to note that no-one was infected by COVID-19 and the short -term restriction on visiting, which had been implemented after advice from public health colleagues, was to be lifted shortly.

This inspection took place on 19 October 2018 and was unannounced. At our previous inspection on 26 February 2016 there was no registered manager in post and this had been the case for over six months. We imposed a requirement action regarding this breach of Regulation 5 of the Care Quality Commission (Registration) Regulations 2009. This matter was resolved a few weeks after that inspection and a manager was registered with CQC.

At the last inspection on 26 February 2016 the overall rating was Good.

At this inspection we found the service remained Good.

At the time of our inspection 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service is owned and run by the London Borough of Islington and adhered to the authority’s safeguarding adults from abuse procedures. Staff were trained in using these procedures, which they confirmed when speaking with us. Staff had a sound understanding of how to keep people safe from harm.

Risk assessments were detailed, and were regularly reviewed. The instructions for staff described risks and risk reduction measures.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS] to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately.

People’s health care needs were assessed and care was planned and delivered in a consistent way. Information and guidance was provided to staff about how best to support people which included how people’s health and nutritional needs were met.

Individual support was provided for people to maximise their opportunities to engage in day to day life, recreational and social activities.

Care plans described how staff could maximise opportunities for people to make as many choices that they were meaningfully able to make. People were treated with dignity and respect and we observed staff interacting with people in ways that demonstrated this.

The provider carried out audits and reviews of the service and regularly sought people’s feedback on how well the service operated.

At this inspection we found that the service met all of the regulations that we looked at.

This inspection took place on 26 February 2016 and was unannounced. At our previous inspection on 15 and 22 April 2014 we found that the service was meeting the regulations we looked at.

At the time of our inspection there was no registered manager and the previous registered manager had left over six months ago. Under the Health and Social Care Act 2008, the provider of this service is subject to a registered manager condition under Regulation 5 of the Care Quality Commission (Registration) Regulations 2009. For this reason we have rated the well-led section of this report as requires improvement. 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 is owned and run by the London Borough of Islington and used the authority’s borough wide safeguarding adults from abuse procedures. The members of staff we spoke with said that they had training about protecting people from abuse, which we verified on training records. We found that staff had a good understanding of how to keep people safe from harm and this knowledge helped to protect the people using the service.

Risk assessments concerning people’s day to day support needs, healthcare conditions and risks associated with daily living and activities were detailed, and were regularly reviewed. The instructions for staff were clear and described what action staff should take to reduce these risks and how to respond if new risks emerged.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way. We found that the information and guidance provided to staff about how best to support people was clear. This included how people’s healthcare and nutritional needs were met.

Significant efforts were made to engage and stimulate people with activities whether these were day to day living activities or those for leisure time. One to one time was often provided for people to maximise their opportunities to engage in everyday life experiences.

The care plans we looked at showed that staff had developed methods of communication best suited to people’s needs. The care plans described how they could ascertain each person’s wishes to maximise opportunities for people to make as many choices that they were meaningfully able to make. We saw that staff were respectful towards people and the way we observed them interacting with people demonstrated recognition of each person as an individual.

The service complied with the provider’s requirement to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service and regularly sought people’s feedback on how well the service operated.

At this inspection we found that the service met all but one of the regulations that we looked at, in so far as the service did not currently have a registered manager in post and was therefore in breach of Regulation 5 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations of people's care and interactions with staff during the inspection, speaking with staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people's daily activities were individually risk assessed and that support workers knew the potential risks that people faced in given situations. This could be about activities of daily living to other activities which people took part in within the wider community.

We observed how people either communicated with, or reacted to, the staff who were supporting them. From this we saw that no one had hesitation about approaching staff or showed distress when staff were providing their support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The eight people who were using this service each had a personal care plan. We looked at the care plans for three of these people. The care plans covered personal, physical, social and emotional support needs. These plans were reviewed regularly and described each person's own goals and objectives as well as people's achievements.

The service was recently accredited by the National Autistic Society and to achieve this was required to show that it used best practise in supporting people with autism. The care plans were redesigned to show in detail how each person lived their day to day life and how support workers should enable each person to be meaningfully involved.

Is the service caring?

Staff we spoke with were all able to describe how they recognised people's needs, and believed that the developments that had occurred had led to marked improvements in the way the service supported people.

We found that staff were committed to enhancing people's life experiences and were regularly looking at how to assist people to make the most enjoyable and beneficial use of their time. There was a detailed daily plan for each person that reflected their unique lifestyle and preferences.

We observed how people either communicated with, or reacted to, the staff who were supporting them. From this we saw that no one had hesitation about approaching staff or showed distress when staff were providing their support.

Is the service responsive?

At the time of this inspection there were no safeguarding concerns. However, two that had arisen since our previous inspection had been resolved effectively.

The staff we spoke with said that they have training about protecting vulnerable adults from abuse and were able to describe that action they would take if a concern arose. It was the policy of London Borough of Islington, the service provider, to ensure that staff had initial training which was then followed up with periodic refresher training.

We looked at systems for monitoring day to day matters at the service. We found that these included areas such as health & safety, care planning and audits of the effectiveness of the service to maintain effective performance in a range of areas.

Is the service well-led?

Each of the five support workers we spoke with was positive about the range of training opportunities available to them. The provider kept records which showed what training courses staff had completed, and when they did them. We looked at these records and saw that staff attended regular training updates which included refresher training on standard core skills that staff were required to have.

When we asked staff about supervision meetings with their line manager we were told that mostly these took place approximately every six weeks. We asked about what staff would do if they needed to speak about any issues in between these meetings and everyone told us that they could approach their line manager or senior staff at the service.

The provider had a system for monitoring the quality of care. We were told that the 2013 / 2014 quality audit had recently taken place and the report was being written by the independent organisation who had had carried it out.

Aside from the external quality audits the manager was required to compile regular reports for the provider about the conduct and events that happen within the service for monitoring purposes.

We found that support workers and the registered manager understood the application of the Mental Capacity Act in relation to people who use the service and that appropriate steps were taken to assess people, involve appropriate others and make decisions around people's accommodation, support and treatment when necessary.

People were supported in promoting their independence and community involvement.

We found that the service had access to a wide range of support services available under the Islington Learning Disabilities Partnership for people who use the service. The partnership provides integrated health and social care services including care management, psychology, psychiatry, occupational therapy and speech therapy services.

We found that a mixture of both mandatory training and service specific training had been provided over the last 12 months for support workers, and that staff felt supported in their role.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.