Archived: Number 14

People’s experience of using this service: People told us they felt safe and happy living at Number 14 and gave us positive feedback about the care and support provided. Number 14 had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published. We found the outcomes for people living at the home reflected some of these values and principles.

Since the last inspection, the registered manager had made several improvements, however some improvements were still needed. We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found there was a risk that people's rights were not protected as staff did not have a clear understanding of how to apply it in their daily work. We have made a recommendation in relation to mental capacity and the best interest decision making process.

People’s medicines were managed, stored and administered safely and appropriately by staff who had been trained and assessed as competent to do so. We have made a recommendation about PRN medicines. These are medicines used ‘as required’ to support people, for example because they are in pain.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People received personalised care from staff who knew them well and understood how to meet their needs. Support plans contained information about individual preferences and what was important to people such as interests and activities.

Risks associated with people’s complex care needs and the environment had been appropriately assessed and staff were provided with information on how to support people safely.

People were encouraged and supported to lead full and active lifestyles, follow their interests, and take part in social activities.

People were treated kindly and compassionately by staff and were supported to express their views and make decisions about their care. People and their relatives felt comfortable raising complaints and were confident these would be listened to and acted on.

The provider had an effective governance system in place. The management team continued to carry out a regular programme of audits to assess the safety and quality of the service and identify issues.

Rating at last inspection: Number 14 was previously rated as ‘Requires Improvement.’ The report was published on the 2 May 2018.

Why we inspected: This was a planned inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.

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

Number 14 had two registered managers 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 home is run.

Number 14 had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published, we found it followed some of these values and principles. These values relate to people with learning disabilities living at the home being able to live an ordinary life.

The home’s quality assurance and governance systems were not always effective. The provider used a variety of systems to monitor the quality and risk at the home. Although some systems were working well, others had not identified the concerns we found during this inspection.

Risks to people’s health and wellbeing were not always managed safely and the systems in place to manage risk could not be relied upon. We found some risks such as those associated with people's complex needs or the environment had not always been assessed or managed safely.

The provider did not have a systematic approach to determine the number of suitably qualified and competent staff required to meet people’s needs. This had led to one person being left on their own and some staff not receiving the necessary training to carry out the role required of them.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found the home was not taking appropriate action to protect people's rights. For example, where the home restricted or managed people’s access to the internet or mobile phone usage. There were no mental capacity assessments to show that people did not have capacity to manage their own use of the internet or mobile phones. There were no records to show the rational for these decisions, or whether this was being carried out in their best interests.

People were encouraged and supported to engage with a range of healthcare services and staff supported people to attend appointments. People received their medicines when they needed them and in a safe way.

People were cared for and supported by staff who knew them well. Both registered managers and staff understood their roles and responsibilities to keep people safe from harm and protect people from discrimination.

People were encouraged and supported to maintain links with the community to help ensure they were not socially isolated. People’s support plans contained detailed information about people’s hobbies and interests. Staff explained how they empowered people to manage their own needs independently and supported them to be as independent as possible with the planning, shopping and cooking their own meals.

People were aware of how to make a complaint and felt able to raise concerns if something was not right and people were encouraged to share their views. We received mixed views about the management of the home. Some relatives and healthcare professionals told us the home was well managed, and described the management team as open, honest and approachable. While others did not know who the registered managers were. Both registered managers were aware of their responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people who used the home.

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