SENSE - 85 Park Road

SENSE - 85 Park Road is a residential care home providing accommodation for up to 6 people who require personal care. The service provides support to people living with a learning disability, autistic spectrum disorder or sensory impairment, At the time of our inspection there were 6 people, all living with a sensory impairment living at the service.

People’s experience of the service and what we found:

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.

Right Support

People were not always supported safely with their individual nutritional needs. Training was ongoing.

An ongoing refurbishment plan was in place, we saw the windows and doors being replaced during the inspection. People’s bedrooms were nicely decorated and personalised.

Medicines were administered safely. We made a recommendation in relation to ensuring PRN protocols were specific. 2 staff checked in the medicines from the pharmacy and medicines administration record included allergy information in them.

Activities were undertaken, however, these were inconsistent and lacked engagement. Records included some information about aids to help people with communication. However, people were not consistently engaged by the staff team.

Right Care

The feedback about people’s care was mainly positive and that their privacy, dignity and independence was respected. We noted some kind and caring interactions however, the engagement between staff and people was limited, dependent on the staff on duty. One person had stained clothing on for a number of hours. Where changes in people’s behaviours were seen, the staff failed to always act on this. We saw people treated with dignity and they were supported and encouraged with their independence. Records were stored securely in line with GDPR requirements.

Risks were assessed and managed and systems were in place to ensure allegations of abuse were dealt with.

Care records had been completed. However, they did not always reflect accurately people’s current and individual needs. Family told us they had been involved in the development of care plans.

Right Culture

We observed differences in the skills of the staff team. We saw evidence of professionals involved in people’s care. Staff were recruited safely, although we made a recommendation in relation to ensuring suitable staff delivered peoples care.

People were mostly supported to have maximum choice and control of their lives and staff somewhat supported them in the least restrictive way possible and in their best interests; the policies and systems in the service somewhat supported this practice. The registered manager gave assurance they would ensure all staff understood how to protect people from unlawful restrictions. Complaints were managed and a range of positive feedback was noted. There was evidence of partnership working and we saw professionals visiting during the inspection.

People were engaged and involved, meetings were taking place. Staff were positive about the management and support they provided. Most relatives were positive, but some feedback was mixed.

Audits and monitoring was being undertaken. However, they failed to identify the shortfalls we noted at this inspection

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

Rating at last inspection

The last rating for this service was good, published 13 September 2017.

Why we inspected

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

Enforcement and Recommendations

We have identified breaches in relation person-centred care, meeting nutrition and hydration needs and good governance.

We made recommendations in relation to sufficient numbers of suitable staff, the management of medicines, ensuring staff understood how to protect people from unlawful restrictions, to ensure all staff regardless of knowledge and skills.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We found that staff had been recruited safely. The staff we spoke with were aware of how to safeguard vulnerable adults who lived at the home from abuse. There were safe processes and practices in place for the management and administration of medicines.

People who lived at the home were not able to give us their views directly due to cognitive and communication impairments.

Relatives told us they were happy with staffing levels at the home. During the inspection we found that there were a suitable number of staff available to meet people’s needs effectively.

Staff received appropriate training. Relatives felt that staff had the knowledge and skills to meet people’s needs.

People received appropriate support with eating and drinking and their healthcare needs were met at the home.

Staff respected people’s privacy and dignity. We observed staff at the home communicating with people in a kind and caring way. People looked relaxed and comfortable and moved around the home freely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe.

We saw evidence that people received care that reflected their needs and preferences. Relatives had been consulted about people’s care and were updated by staff regularly. We received positive feedback from relatives about the activities available and found that people were supported regularly to go out into the community.

People were encouraged to be as independent as possible. Staff used a variety of methods to communicate effectively with people who were visually and hearing impaired, including objects of reference and’ ‘hand under hand’ techniques. The ‘hand under hand’ approach is where the staff member’s hand performs the activity and the person’s hand rests on top of it.

The service had a registered manager in post. Relatives and staff told us they were happy with how the service was being managed. They found the registered manager and the deputy manager approachable and could raise any concerns.

The registered manager had sought feedback from relatives and staff about the care and support provided. A high level of satisfaction had been expressed about many areas of the service. Where improvements had been suggested, we found evidence that action had been taken.

Audits of many aspects of the service had been completed regularly. We found that the audits completed were effective in ensuring that appropriate levels of quality and safety were maintained at the home.

Further information is in the detailed findings below.

During our visit we observed staff responded to people in their care with kindness, patience and understanding. We found people's care and treatment was delivered in a way that was intended to ensure their safety and welfare. People were able to choose from a range of suitable activities, both inside and outside the home, which promoted enjoyment, improvement and independence.

Prior to our inspection we were told the service was relying on agency staff which was impacting on people's care. Staff told us there were now sufficient numbers of skilled and experienced staff to support people properly; this was also clear from looking at staffing rotas.

All the areas of the home, that we looked at, were clean and free from offensive odours. People were provided with a range of appropriate equipment to safely meet their needs and to promote their independence and comfort.

We found records were accurately maintained, were held securely and were kept in a way that allowed them to be located quickly when required.

We found people's needs were assessed and care, treatment and support was planned and delivered in line with their individual plan. People living in the home were not always able to vocalise their needs. However staff had been trained in specialised communication methods and records included clear information about how people communicated their needs and feelings. Staff also worked closely with parents, social workers and advocates which helped to make sure people living in the home were happy and received the care they needed and wanted. People were able to choose from a range of suitable activities which were in line with their preferences and abilities. One key worker said, "Activities are tailored to people's needs".

We found there were sufficient numbers of staff to meet people's needs and their time was available flexibly to meet people's needs. We spoke with two key workers who told us they were happy working at the home. One said, "I love it here; it's a very rewarding job".