66 Park Lane

At the last inspection, the service was rated Good. At this inspection the service remained Good.

66 Park Lane is a ‘care home’. People in care homes receive accommodation and 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.

66 Park Lane accommodates five people who need support with their mental well being.

There was a registered manager in place. 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.

People were safeguarded from avoidable harm. Staff adhered to safeguarding adult’s procedures and reported any concerns to their manager and the local authority.

Staff assessed, managed and reduced risks to people’s safety at the service and in the community. There were sufficient staff on duty to meet people’s needs.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff completed regular refresher training to ensure their knowledge and skills stayed in line with good practice guidance. Staff shared knowledge with their colleagues to assist with learning being shared throughout the team.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regards to any health needs.

Staff applied the priniciples of the Mental Capacity Act 2005 and Mental Health Act 1983/2007. 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. An appropriate, well maintained environment was provided that met people’s needs.

Staff treated people with kindness, respect and compassion. Staff empowered people to make choices about their care. Staff respected people’s individual differences and supported them with any religious or cultural needs. Staff supported people to maintain relationships with families. People’s privacy and dignity was respected and promoted.

People received personalised care that meet their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People participated in a range of activities.

A complaints process ensured any concerns raised were listened to and investigated.

The registered manager adhered to the requirements of their Care Quality Commission registration, including submitting notifications about key events that occurred. An inclusive and open culture had been established and the provider welcomed feedback from staff, relatives and health and social care professionals in order to improve service delivery. A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

Further information is in the detailed findings below.

66 Park Lane is registered to offer support and accommodation for up to five people who have a range of needs including learning disabilities and a past or present experience of mental ill health. On the day of our visit there were four people living at the home.

There was a registered manager in place. 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.

Staff supported people to maintain their safety. Assessments were undertaken to identify any risks to a person’s safety and management plans were in place to address those risks. Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour.

People were supported as appropriate to maintain their physical and mental health. People had care plans outlining the goals they wished to achieve whilst at the service and what support they required from staff to achieve them.

Staff worked in combination with other professionals to ensure people received adequate support. Any concerns about a person’s health were shared with the person’s care coordinator so they could receive additional support and treatment when required.

Safe medicines management processes were in place and people received their medicines as prescribed.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, in a friendly and respectful manner.

People were encouraged to express their opinions and views about the service. There were regular meetings with people and individual support was provided through a key worker system.

There were sufficient numbers of staff to meet people’s needs. There was a recruitment process in place however; it was not always followed to ensure people’s safety. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses.

Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service.

The management team undertook checks on the quality of service delivery. A range of audits were undertaken to ensure the service was delivered in line with the provider’s policies and procedures, and that people received the support they required.

We found one breach 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 this report.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People we spoke with told us they felt safe while being supported. They told us the care staff were good. One person told us "I cannot fault the staff they are great”. None of the people we spoke with had any concerns about the support they received. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

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

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to help minimise any risk that had been identified.

The fire log book showed regular checks of the fire alarm and emergency lighting systems were recorded. We also saw that regular fire evacuation exercises were conducted

We saw safety certificates were in date for gas safety, electrical wiring and for portable appliances.

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff were aware of people's needs and their preferences in how they wanted care to be delivered. We saw staff offered advice and support but they also enabled people to make their own choices and decisions. People we spoke with told us they were happy with the care and support they received from staff at the home.

Is the service caring?

We observed staff speaking to people appropriately and they used people’s preferred form of address; We saw people and staff got on well together.

People we spoke with told us they received the support they needed in the way they preferred. We observed staff listened to people and respected the choices they made. People told us the staff team were good. One person told us. “The staff are wonderful”. Another person said “The staff are great; you can have a laugh with them”.

Is the service responsive?

People we spoke with told us that they received the support they needed in the way they preferred and said that staff listened to them and respected the choices they made.

We saw people had regular reviews of the care and support they received. We saw review notes showed alterations had been made to people’s plans of care as people’s needs had changed.

People who used the service were asked for their views about their care and treatment and they were acted on. We saw one person raised a concern about their bedroom. They suffered from epilepsy and their bedroom was on the first floor as the home did not have any bedrooms on the ground floor. This person felt that their needs would be better met if they could have a downstairs bedroom. The provider listened to this person’s concerns and converted the garage into a ground floor bedroom. The conversion was carried out to a high standard and the person is now delighted with their new en-suite ground floor bedroom.

Is the service well led?

66 Park Lane had a policy and procedure for quality assurance. The provider organisation had a quality assurance manager who carried out unannounced audits of all of the providers services.

The manager told us that the last audit of 66 Park Lane was conducted on 1 May 2014. The manager and team leader told us that if there were any compliance issues from the visit then an action plan was produced to ensure that shortfalls were quickly rectified. We were told by the manager that a report was produced following the visit but to date this had not been received. However, the home did receive verbal feedback from the quality audit manager and no concerns had been identified. The manager said the quality assurance manager was very complimentary about the service.

The provider organisation also employed an operations director who carried out regular audits of the service provided by 66 Park Lane. The team leader also carried out a range of quality checks and audits at the home.

The manager held monthly meetings with staff to discuss a range of issues including; health and safety, maintenance, service user reviews, complaints, compliments and training issues. People who used the service were invited to attend these meetings but did not always choose to attend.

The provider took account of complaints and comments to improve the service. We saw

the home had a clear complaints procedure which was available for people in a suitable format. There were also procedures in place for people to pass comments and compliment the service.

The manager told us all staff received supervision every eight weeks where staff performance issues were discussed and additional staff training was identified as necessary. Staff also had a monthly group supervision session where staff could raise issues collectively and discuss and other issues that were relevant to the day to day running of the home. Staff we spoke with confirmed this.

On the day of our visit there were three people living at the home. We spoke with one of them and they described their life at 66 Park Lane. Telling us that they hoped to be able to leave the home and “Have a place of my own.

We spoke with two staff who told us about the changes which had recently occurred in the home. These included the introduction of supervision sessions and the training they had attended. They said they were able to speak openly with senior staff about any concerns. We observed staff being respectful, asking people if they needed support and only assisting when asked.

We carried out an inspection in January 2013 when we identified concerns with consent, care planning, medicines, staffing, supporting staff and complaints. We made compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and they sent us an update on their actions in May 2013.

We found that the provider had taken steps to improve processes and practice related to gaining consent, care planning, medicines, staffing, supporting staff and complaints and had worked on embedding the new systems. For example reviews of care plans and risk assessments.

On the day of our visit there were three people living at the home. We spoke with two of them and they described their experiences of care and how this had changed in the last five months since moving to 66 Park Lane. One person described their experience at 66 Park Lane as “Being able to do what I want”, “The staff are here to help but I can choose what I do and when I want to do it”. However we saw from the rotas that on most days there were not enough staff to facilitate all the people living at the home being able to do what they wanted to.

We spoke with three staff and the registered manager. Staff told us about the differences for them of working in a smaller home, their supervisions and how they feel working in a very small team. The staff we met also told us about the training they had attended recently and that they were able to speak openly with senior staff and the manager about any concerns. However, we saw that staff had not received training in areas that would enable them to meet people's needs.

During our visit we identified areas concern with all of the outcomes we looked at. For example consent to treatment, care and welfare and risk assessments and staffing.