Archived: Fell Close

Fell Close is registered to provide care and accommodation for up to 4 people with learning disabilities, autism and/or physical disabilities. At the time of our inspection 4 people were living at this service.

The service had 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 independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with, or who might have, mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service did not use restrictive intervention practices. Care plans were in place to guide staff, in a person-centred way, in line with positive behaviour support principles should interventions be needed in the future. Where interventions were used the registered manager knew to record where lessons could be learnt to reduce the likelihood an incident would occur again.

Staff had awareness of peoples likes, dislikes and interests and supported people to maintain relations with friends and family members.

People were not always supported to have maximum choice and control of their lives in terms accessing activities in line with their interests and hobbies. Staff supported them in the least restrictive way possible; policies and systems supported this practice. People were provided with information in a way they could understand, and staff encouraged involvement in their care when they had the time available. Staff knew the importance of gaining peoples consent before delivering care and support for people.

Staff knew people well and cared about the people they supported. The service demonstrated positive outcomes for people to reflect the principles and values of Registering the Right Support. People were supported to make their own decisions, staff told us it was difficult due to staff dynamics to enable people to choose when they would like to go out or participate in activities to maintain their independence. Staff and relatives felt that people’s quality of life could be improved upon in this area. Staff sought the right support from health professionals when needed to support people’s emotional, physical and mental well-being.

We made a recommendation that the provider work with the local authority to improve choice of activities and events people could attend.

Care plans contained detailed and relevant information about how to meet people's needs. Staff communicated well between themselves to ensure handovers included relevant information.

Systems were in place to safeguard people from abuse or harm, which included safe recruitment processes. Detailed risk assessments were in place and overall medicines were managed safely. Accidents and incidents were recorded. The registered manager told us they would ensure these were analysed and preventative measures taken to prevent future repeat incidents.

Staff received an induction and annual refresher training to ensure they maintained their skills and knowledge. The registered manager was sourcing additional training specific to one person’s health condition and to support staff with managing behaviours.

Staff supported people to eat and drink when needed. People had input into menu planning and the registered manager advised that people were given healthy option choices.

Staff spoke positively about the registered manager. The service had been in the process of a management restructure and a new area manager was now in place to support the service.

Audits and quality checks were in place to ensure the service maintained good standards of care and continually looked to develop the service to ensure positive outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 8 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.

At our last inspection on 24 November 2014 we rated the service ‘Good’. We found the service remained 'Good' at this inspection.

Fell close is registered to provide long-term accommodation to four adults who have a learning disability and/or a physical disability. The service is situated in Newby, on the outskirts of Scarborough. There is limited car parking available to the front of the service and disabled access into the building. People have access to a garden area to the rear of the building and a selection of communal spaces within the service. These included a dining area and a lounge. Both floors of the service have communal bathrooms and toilet facilities. The bedrooms are all single occupancy. At the time of this inspection, four people were using the service.

The registered provider is required to have a registered manager, but at the time of our inspection the manager in post was not registered with the Care Quality Commission (CQC). For this report, we have referred to this person as ‘the manager’ throughout the text. 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.

We found that the care staff had a good knowledge of how to keep people safe from harm and the staff had been employed following robust recruitment and selection processes. We found that the management of medication was safely carried out.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

People that used the service were cared for and supported by qualified and competent staff that were regularly supervised. 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 received adequate nutrition and hydration to maintain their levels of health and wellbeing. People had been included in planning menus and their feedback about the meals in the service had been listened to and acted on.

People were able to see their families when they wanted to. There were no restrictions on when people could visit the service. We saw that staff were caring and people were happy with the care they received. People had access to community facilities and most participated in the activities provided in the service.

We observed good interactions between people who lived in the service and staff on the day of the inspection. We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s comments and niggles/grumbles were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that the manager met with people on a regular basis to discuss their care and any concerns they might have. This meant people were consulted about their care and treatment and were able to make their own choices and decisions.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these wherever possible.

The staff told us that the service was well managed. The manager monitored the quality of the service, supported the members of staff and ensured that there were effective communication and response systems in place for people who used the service.

We saw that people were encouraged to make day to day decisions for themselves. They were supported to make appropriate decisions when they were not able to do this for themselves. People's individual lifestyles were promoted.

The care plans were comprehensive and included pictorial information about their wishes and aspirations as well as the help and support they needed. Staff had a good knowledge of the dietary requirements of people who used the service and provided appropriate support.

We saw that staff had received training in the safeguarding of vulnerable adults and they understood their responsibilities in relation to keeping people safe.

We saw that medication was managed safely and people received their medication in line with the prescriber's instructions.

Staff received training to ensure they had the skills necessary to meet the needs of each person. Staff also received support through supervision and appraisals.

The manager told us about a range of health and safety audits which were carried out by the provider. For example, the provider carried out regular maintenance checks, portable appliance tests, fire checks and hot water temperature checks. Equipment used within the service was also regularly serviced. This helped to keep people safe.

We saw that care plans contained an individual daily diary that covered what activities they had done, who had visited and what they had eaten during the day. Information held in the care files indicated that people who used the service accessed other health and social care professionals. These included specialist learning disability services, dietician, dentist, optician and their doctor.

People who used the service had their own rooms and could access the gardens and other communal areas. Where people required equipment appropriate to their needs it was serviced at intervals recommended by the manufacturer. Staff told us that they were trained in the use of each piece of equipment.

We saw the staff rota's for the home. The staffing levels provided were seen to be appropriate for the level of individual needs. We saw a copy of the complaints policy. It provided clear guidance on what to do if someone had a complaint. There were also clear guidelines of how the organisation would respond to any complaints received.