No 39

Updated 20 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector.

Service and service type

No 39 is a care home. 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to communicate with us.

What we did before inspection

In planning our inspection, we reviewed information we had received about the service. This included any notifications (events which happened in the service that the provider is required to tell us about) and feedback from the local authority.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We took this into account in making our judgements in this report. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We communicated with two people who used the service and three relatives about their experience of the care provided. People who used the service were unable to talk with us and used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language.

We spoke with three staff members on site including the registered manager who is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We had discussions with a manager who oversees three of the services, including No 39 and a care and support worker. We also made contact with five staff members via email.

We reviewed a range of records. This included two people’s care records and two medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 20 August 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

No 39 is a residential three bedded care home specialising in supporting people living with Autistic Spectrum Disorder. At the time of our inspection the service was providing personal care to two people. The third bedroom was used for staff to provide sleep-in cover at the service. The service can support up to two people.

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

Right Support

Staff supported people to access health and social care support, which included a regular review of their prescribed medicines. However, medication practices needed to be strengthened, for example updating records swiftly when a person's medicines had been changed and keeping up to date with best practice guidance such as PRN protocols. These were addressed by the manager following our inspection.

Positive relationships had developed with local health care providers, who provided timely support. The staff considered people’s emotional and sensory needs for planned appointments and used social stories to help them attend appointments.

People had choice about how to decorate their bedrooms and were able to personalise their bedrooms and individual lounge areas. The environment was well equipped, well-furnished and clean throughout. However, urgent repairs needed to be reported and repaired more swiftly. We found two fire doors had been wedged open because the fire guards were broken. Following our inspection, the provider notified us that these had been repaired. People had access to a sensory area and each person had their own lounge bedroom and lounge area.

Periods of anxiety or emotional distress were recorded, which included the action taken by staff to support people. The registered manager considered these as part of the review process of people’s needs.

The service supported people to have the maximum possible choice, control and independence. The service encouraged people to be involved about their support and plans and were consulted daily using individuals’ communications tools so they could decide on activities and meals. People were supported by staff to pursue their interests and to achieve their aspirations and goals.

Right Care

The provider had followed their recruitment practices to ensure people employed were suitable to work at the service and support people safely. However, we were unable to find evidence of ID checks for two staff during our site visit. The registered manager sent confirmation following the inspection that these had been checked. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People’s dignity and human rights were promoted, and people were encouraged to make day to day decisions about the activities and events they wished to participate in. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact with staff and others involved in their care and support because staff had the necessary skills to understand them. People received care that supported their needs and aspirations and was focused on their quality of life

Where appropriate, staff encouraged and enabled people to take positive risks. For example, one person had been supported to go rock climbing and another swimming.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff could meet their needs and wishes.

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.

Relatives spoke of regular visits when their family members were supported to visit them or meet up outside of their home. A family member told us. “The staff are great. They provide person led care which is just right. There’s a proactive approach of getting people out and about.”

People appeared relaxed within their home and in the presence of staff. People were seen to be supported to choose activities of interest to them, which included swimming, walks, going out to eat and day trips. Staff supported people to identify and work towards short term and long-term goals and dreams and there were clear plans in place to help people achieve these. For example, one person had an education plan that included support with literacy, maths, fine motor skills and independent living tasks.

People and those important to them, were involved in planning their care. The service evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service valued and acted upon people’s views.

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

Rating at last inspection

This service was registered with us on 21 January 2020 and this is the first inspection.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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 COVID-19 and other infection outbreaks effectively.

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.