St Marks

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Culture:

Audits were carried out and where shortfalls were identified they were promptly addressed. We identified areas where records could be more detailed, for example, clearer advice in care plans, daily records and documentation related to fire drills.

People’s relatives felt that there was good communication, and they were kept informed and equally could contact the service if they had any concerns.

Right support:

People told us they felt safe living at St Marks, and we observed through their interactions with staff that they were relaxed in their company. Safeguarding concerns had been responded to promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

There were enough staff to meet people’s needs and wishes. Emphasis had been placed on ensuring that staff had the skills, knowledge, and experience to meet people’s needs. People received their medicines safely.

People were supported to participate in activities of their choice. People told us they enjoyed what they did and had regular opportunities to attend activities such as swimming, clubs, pubs, shopping, and restaurants. Everyone was supported to have an annual holiday or days out if that was their preference, 3 people had just returned from a trip to the Isle of Wight.

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 5 July 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Marks on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was following government guidance in relation to visitors. We were told essential maintenance visits were safely implemented in line with government guidance. For example, all visitors wore personal protective equipment (PPE) and were advised to remain socially distant from people and staff. All essential visitors had their temperature taken on arrival and they were asked to carry out a Lateral Flow Device (LFD) Covid -19 test before they could enter the home. The result was recorded.

There was a programme to ensure people and staff were tested regularly. This was alongside daily temperature testing for everyone and observing people for any signs or symptoms of Covid -19. The registered manager spoke highly of staff and was proud of how staff worked to ensure the home remained Covid-19 free.

The registered manager followed current guidance in relation to infection prevention and control. There were daily, weekly and monthly cleaning routines and all were clearly recorded. The home had remained Covid-19 free but had contingency plans in place should any person or staff come into contact with anyone with Covid -19 or test positive. All staff wore PPE and had received training on infection control, putting on and taking off PPE and hand washing.

Individual risk assessments had been written for people and staff to consider specific risks for each person in relation to any underlying health conditions or specific considerations. Should any person require hospitalisation they had a hospital grab pack which included a ‘my hospital passport, a distress and discomfort assessment tool (DisDat tool) and an autism Covid -19 passport.’ These items provided information for hospital staff in relation to each person’s individual needs, how they cope with pain/distress, how they communicated and how their autism affects them.

We asked one person how they were coping with lockdown and they said, “It’s ok because I know it won’t last forever, it will end one day.” Where possible people kept to their usual routines but often this was not possible. Instead of using the gym two people now went running locally. Another person who liked to go to the pub, now bought a drink from the local shop and sat on a bench locally. The home used technology to enable one person to do virtual tours some of which were interactive. Another had a new laptop and was communicating with family that lived abroad on a regular basis. All of this had helped to maintain people’s wellbeing throughout a very difficult time.

St Marks provides accommodation for up to seven younger adults who have a learning disability within the autistic spectrum. There were seven people living at St Marks at the time of our inspection. People required varying levels of support, some lived fairly independent lives and others required the support of staff to go out.

This was an announced inspection because sometimes the registered manager is out of the home supporting people and we needed to be sure that they would be in. Also, people needed to prepare for unfamiliar visitors due to their autism needs and to reduce any possible anxiety this may cause.

There is a registered manager at the home who was also the registered manager for three other homes owned by the 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.

There were systems to audit and monitor the quality and management of the home. The registered manager had identified areas where improvements were needed, this included people’s support plans. Work was taking place to ensure these continued to improve and develop.

Some incident forms had not been fully completed and we made a recommendation about this.

Staff had a good understanding of people as individuals, their needs, interests and hobbies. They were committed to ensuring people lived happy and enjoyable lives. They worked with people to help them reach their goals and achievements and were supported to maintain and improve their independence. They communicated well with people, responded to their needs promptly, and treated them with kindness and respect.

There were systems in place which ensured people received their medicines when they needed them. Medicines were managed safely.

Risks to people were well managed. There were risk assessments which reflected people and staff had a good understanding of the risks associated with the people they supported. Staff had a good understanding of what to do to protect people from the risk of abuse.

There were enough staff on duty to ensure people’s needs and choices could be met. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

Staff received the training and support they needed to enable them to meet people’s needs. They received regular supervision and felt supported by the registered manager and their colleagues.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to enjoy a variety of food and drink that met their individual choices.

People were supported to have access to healthcare services and maintain good health. People had health plans which included information about their health needs and how they would like to be supported.

People were regularly asked for their feedback. They were listened to and their opinions valued. A complaints policy was in place and this was available in accessible language with pictorial aids to support people to understand how to make a complaint.

The registered manager had developed an open and transparent culture. She knew people and staff well. She was approachable and supportive and took an active role in the day to day running of the service.

This location is registered to provide accommodation and personal care to a maximum of seven people with adults with complex needs within the autistic spectrum. Seven people lived at the service at the time of our inspection. Some people could communicate using words and short sentences. Some people had non-verbal communication skills. We talked directly with people and used observations to better understand people's needs.

The home 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.

Some new staff had not yet attended relevant training and other staff required refresher training in some areas. The training system in place was not sufficiently robust to ensure that staff training needs were fully met. We have made a recommendation about training.

The provider had consulted people to obtain their feedback to develop and improve the service.

We have made a recommendation that the provider reviews the formal consultation process.

Staff responded to people’s individual needs and support people to meet their individual goals and aspirations. However one person required additional support to ensure their person-centred needs to move on from the service were met.

We made a recommendation that the provider works proactively with people and their funding authority to help people move on from the service.

Some records were not available on the day of the inspection, some records were not securely stored and other records required were not in place.

There were audit processes in place to monitor the quality of the service and promote continuous service improvements. However, audits were not sufficiently robust. Shortfalls we found had not been identified as part of the provider’s audit process. There was no service improvement plan in place to determine how the service would continuously develop and improve.

Staffing levels were adequate and were flexibly deployed to ensure people received appropriate support at all times to meet their individual needs.

Staff we spoke with understood how to protect people from abuse and harm. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored and administered safely and correctly. Staff were trained in the safe administration of medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS assessments were not required at the time of our inspection to ensure people were lawfully deprived of their liberty.

People’s needs and personal preferences had been assessed. People’s care plans had been regularly reviewed to ensure they were up-to-date and met people’s individual preferences and needs.

Staff supported people to have meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and needs.

Staff communicated effectively with people, responded to their needs promptly, and treated people with kindness and respect. People’s privacy was respected and people were assisted in a way that respected their dignity. The registered manager demonstrated a high level of knowledge about people and their individual autism needs. They supported people with kindness and compassion.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

Staff responded to people’s individual needs and support people to meet their individual goals and aspirations.

People were provided with accessible information about how to make a complaint and received staff support to make their views and wishes known.

There was an open culture that put people at the centre of their care and support. The registered manager demonstrated a high level of commitment to meeting the needs of people at the service. They knew people well and had positive relationships with people and staff.

Staff held a clear set of values based on respect for people, ensuring people could make choices and have support to be as independent as possible.

We saw a busy 'family' home. We talked with the manager, the assistant manager, and a senior team leader. We met with other staff members on shift change. We observed people living in the house going in and out about their daily business. We saw good rapport and great goodwill between staff and people, with much good humoured discussion ranging from the weather, to 'in pub evenings', to individual plans for the next day, alongside previous holiday experiences and future considerations for holiday choices.

We talked to the people living in the home. People said they were happy. One person showed us their room telling us about their choice of decoration, their model car collection and showed us postcards from their own and family trips. We observed people helping with meal preparation including setting the table, all while watching a game show on the television.

We reviewed records, policies and procedures. We discussed money and medication handling and talked about support and success.

During our inspection we observed people coming back from morning activities, making their own lunches and interacting well with each other and staff. The people living in the house took responsibility for some household tasks.

People we spoke with told us about the things they liked to do, we heard them talking with staff about their afternoon activities. Two people told us they had been on holiday and enjoyed this. Staff said that people were able to holiday together as a group or in smaller groups if that was what they wanted.

Staff told us there were opportunities each week for the people in the house to meet up with each other and staff and discuss any issues. We looked at records and found that people were involved in decisions about their care and support. They were able to meet with their key worker, and discuss changes in their support or activity programme. Records indicated that placements were reviewed, and people were actively consulted about this and who should attend.

We looked at staff training and supervision records and found they were provided with opportunities to develop their skills and competencies.

We found that systems were in place to enable the provider and manager to monitor that a good standard of service delivery was maintained.