Archived: Dick O'th Banks Road

At the last inspection in March 2016, the service was rated Good. At this inspection we found the service Required Improvement.

We were unable to speak to people to ascertain their views as to the approach of staff in caring for them due to their limited verbal communication skills. We spent time observing interactions between staff and found staff to be friendly and kind in their approach towards people.

People were supported by staff they knew well and trusted. However they did not have maximum choice and control of their lives and therefore were not supported in the least restrictive way possible. People did not always receive care that was responsive to their needs and improvements were required to the home’s approach to person centred care.

People were living with a learning disability, autism or had needs relating to their mental health, which affected their ability to make some decisions about their care and support. Staff showed a good understanding of the Mental Capacity Act 2005 (MCA) and their role in supporting people’s rights to make their own decisions. However they required more training and support to meet people’s communication needs.

Care plans were personalised and evidenced how people would like to receive their care, however information held within the care plans was out of date. At the time of the inspection reviews were taking place, which meant care plans would be updated and transferred to the providers on line monitoring system.

Staff understood their responsibilities with regard to reporting suspected abuse in order to safeguard people from harm. Guidelines were followed by staff to minimise the risk of harm to people and minimise re occurrences of any incidents. However there were not enough staff to minimise risk.

There were not enough staff to support people that presented a risk to themselves and others. There were not enough staff to provide meaningful activities for people and to be supported to pursue individual interests. Recruitment checks were completed to assess the suitability of the staff employed.

People had their medicines ordered, stored, administered and recorded safely. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines. People were supported by staff to attend medical appointments.

Staff told us the majority of the cleaning duties took place each night. However cleaning records showed this was not done consistently. Staff had completed infection control training. When things went wrong lessons were learnt and actions put in place to improve safety.

Systems and processes were in place that monitored the quality of the service. However these audits were not fully effective at identifying the shortfalls in the service we found during our inspection. Systems and processes had not identified people were at risk of social isolation or having appropriate support to meet their communication needs or information in records were out of date.

Arrangements for oversight of the service required improvement to identify and respond to concerns and risks. The new manager was also under a new management structure. There were planned changes to the registration of the service and staff told us they were aware of changes to the service and were awaiting training on how to deliver support under the new registration of supported living.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.

The service had a 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. The registered manager is also the joint provider of the service.

We met and spoke to all four people during our visit. People were not able to fully verbalise their views and used other methods of communication, for example pictures and symbols. We therefore spent time observing people.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapist.

People’s care records were very detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their care plans, therefore family members supported staff to complete and review the care plans. People’s preferences were sought and respected.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input in preparing some meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

People who required it had one to one staffing at particular times. Staff confirmed there were sufficient staff to meet these requirements. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme when they started working for Encompass. People were protected by safe recruitment procedures.

All significant events and incidences were document and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, professionals and staff.

During our visit we were unable to speak directly with people who lived in the service due to their complex needs. We spoke with the relatives of two people who lived in the service, via the telephone. People's relatives told us that they felt positive about the quality of care people who used the service received, and their relationships with the staff and manager. We observed residents moving freely around the home and interacting with the staff in a relaxed way.

We saw people making choices and decisions about their daily lives; and saw that people's choices and decisions were respected by the staff. A relative told us, 'Since (the registered manager) has taken over he has been provided with more options.'

The service had procedures to ensure people received their medicines as prescribed. Medicines were handled in a secure way.

We found that there were sufficient numbers of staff, with the right competencies. A senior support worker told us, "It's a nice place to work."

People benefitted from safe quality care due to the service monitoring the quality of its service and appropriately managing risks to people's wellbeing. The service was taking account of comments or complaints.

We found the environment was clean and well maintained, and there was a relaxed atmosphere in the home. People were calm and at ease in the company of the staff supporting them. Staff who worked at this home were well supported through one to one supervisions and a training programme which appropriately equipped them for their role.

We noted staff were courteous in their approach to people and interacted confidently with them. We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met.

We noted that people were encouraged to make personal choices and were involved in planning their care and making decisions about their support and how they spent their time. One of the four people who used this service attended day centres, and the remaining three people were provided with one to one support to participate in activities of their choice either in the home or in the local community.

There were systems in place so that people could raise any concerns, make complaints or convey their compliments to the provider.