IOTA Care

The registered manager assured us they had fully assessed the risks to people and staff who might be at higher risk because of their individual health needs. Whilst it was clear the registered manager knew people and staff very well; this information had not been formally recorded. Following the inspection, the registered manager confirmed that individual risk assessments were now being completed.

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Visitors were asked to consent to a rapid COVID-19 test, have their temperature checked, wash their hands and complete a health declaration before they would be allowed to enter the building.

Visitors to the service had been restricted to essential visitors only. Staff were supporting people to maintain contact with their relatives through use of social media groups and video calls.

Staff had received additional training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser. There were sufficient stocks of PPE available and staff were seen to be wearing PPE appropriately.

Staff took part in regular COVID-19 'whole home' testing and staff who tested positive, followed national guidance and self-isolated for the required amount of time. Due to people’s complex care needs they were not taking part in a regular COVID-19 testing programme at the time of the inspection.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches. In addition, the service carried out monthly infection prevention and control audits.

The provider had developed specific COVID-19 policies and procedures.

IOTA (Independence Opportunity and Transition into Adulthood) Care provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. The service were also supporting a person in a separate flat on a respite basis. IOTA Care provides care for people with a learning disability and associated conditions such as autism.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post, who was also the joint provider. 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 the last inspection, on 5 March 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.

Why the service is rated outstanding.

People living at IOTA Care had complex care needs and required a high level of support with daily care needs inside and outside the home. We met with both people during our visit and observed some interaction between them and the staff. People were not able to verbalise their views and staff used other methods of communication, for example sign language or visual choices.

When we arrived people were still in bed before they started their planned routines. These planned routines helped provide reassurance to people who were living with autism. People were living a full life and there was a busy and relaxed atmosphere during the day. As the day went on people were either enjoying time on their own, with staff interaction when they needed it or going out on a planned activity. One staff member said; “[Are they] safe?-Definitely. If I had a child I wouldn’t hesitate to let them live there. I think they are very safe.”

People were encouraged to live active lives and were supported to participate in community life where possible. Activities were developed for people who perhaps had not tried certain activities before. Other activities reflected people’s interests. The environment and the outside spaces had been designed for people living with autism to allow people to safely be on their own in the garden in most weathers and to have sensory equipment to entertain them.

The provider and registered manager had taken innovative steps to develop technology to improve the quality of people's care, communication with family members but most of all for the people who used the service. They had designed a programme call ‘Scrapbook Circle’ which was an instant private social media network for family, friends and staff and people who used the service. This allowed all parties to see what each other were doing and mostly to keep in touch with each other which was particularly useful if family and friends lived some distance away. The provider described the ‘Scrapbook Circle’ as “Provides a safe, supportive place for people to communicate with the people they really care about.” One staff member said; “I love it. Such a good way to enable them to communicate with family as they are not able to communicate themselves [verbally].”

People had their health needs met. People received visits from healthcare professionals, for example speech and language therapist and GPs to ensure they received appropriate care and treatment to meet their health care needs. Professionals confirmed staff followed the guidance they provided. The provider also pro-actively sought audits from external agencies to further assess how the service was performing. Staff took on champion roles in a meaningful way and ensured their subsequent specialist knowledge was used to benefit people. For example, there was an infection control champion and a Wellbeing champion to support staff.

People had complex communication needs and these were individually assessed and met. People were encouraged and supported to make as many decisions and choices whenever possible in their day to day lives, this was often through visual images. They were supported to access the community and promote their independence. For example, people who had previously been reluctant to go into the community for a long time, now had a programme developed and encouraged by staff to support them. Staff and relatives worked together to support people in their own home. Families and staff were very involved in care and risk planning and sourced different ways for people to access the community safely.

People were now able to access many areas in the community due to the support they had received from staff to further enhance their quality of life within their community.

Staff were observed supporting people with understanding about how individuals living with autism saw the world and displayed patience and kindness. Compassionate care was really important to the values of the service and was clearly reflected in how staff cared for people. Valuing people and enabling them to feel they mattered was important and staff enabled people to help in the running of the home. For example, the small step of collecting milk from the fridge was seen as a positive achievement for people and celebrated. The staff had built strong relationships with the people they cared for. Staff respected people’s privacy. People or their representatives, were very involved in decisions about the care and support people received.

Relatives and staff felt the service was extremely well led. Relatives and staff described the registered manager and provider as very approachable, available and supportive. Staff talked very positively about their jobs and took pride in their work.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. The registered manager and provider were very passionate about the service. They had very robust quality assurance processes in place. Audits were conducted to ensure any issues in the quality of care and environment were identified promptly. Accidents were investigated and, where there were areas for improvement, these were shared for learning with people, staff, other services and health professionals.

The provider had a complaints policy in place and the registered manager said any complaints received would be fully investigated and responded to in line with the company’s policy. Staff knew people well and used this to gauge how people were feeling. The policy was not provided in an accessible format for people as people currently living in the service would not understand the procedure. However, the registered manager and staff demonstrated they would always act on changes in people’s presentation.

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff confirmed there were sufficient numbers of staff to meet people’s needs and support them with activities and trips out.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to help ensure people could retain as much independence as possible. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed a range of training including safeguarding training and the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity and the Human Right needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and held comprehensive details about how people liked their needs to be met, taking into account people’s preferences and wishes. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety of the care people were receiving. The provider’s governance framework, helped monitor the management and leadership of the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We met and spoke with all three people during our visit. Due to people's complex needs people were not able to comment on all aspects of their care and support. However we were able to meet them and observed staff as they provided support. People used other methods of communication, for example pictures. A relative said; They provide individual care for these young adults.”

People’s mental capacity had been assessed which meant care being provided by staff was in line with people’s best interest. Staff understood their role with regards to ensuring people’s human and legal rights were respected. Staff had completed safeguarding training and understood what constituted abuse and how to report concerns. Staff described what action they would take to protect people against harm.

People’s medicines were managed safely. People received their medicines as prescribed and received them on time. Staff completed training and understood what people’s medicines were for. Staff 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 had access to healthcare professionals to make sure they received appropriate treatment to meet their health care needs such as epilepsy nurses. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People were relaxed and observed to be happy with the staff supporting them. Care records were detailed and personalised to meet each person’s needs. People and / or their relatives were involved as much as possible with their care records to say how they liked to be supported. People were offered choice and their preferences were respected.

People’s risks were documented and well managed. People lived active lives and were supported to try a range of activities, for example walking in the park opposite the service and regular day trips to local areas.

People enjoyed the meals offered and had access to snacks and drinks at any time. People were involved in planning menus, food shopping and preparing meals as much as possible. People were supported to say if meals were not to their liking.

People were protected by safe recruitment procedures. There were sufficient numbers of staff on duty to support people safely and ensure everyone had opportunities to take part in activities. Staff received an induction programme. Staff had completed training and had the right skills and knowledge to meet people’s needs.

Staff said the registered manager and registered provider were supportive and approachable and worked in the home regularly. Staff talked positively about their roles. A comment included; “I love coming into work.”

There were effective quality assurance systems in place. Any significant events were appropriately recorded 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 was sought from relatives, professionals and staff to assess the quality of the service provided.