Archived: All Hallows

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service:

People who lived at All Hallows had limited verbal communication and comprehension. They were not able to converse in any depth with us. We were contacted by two families who were very positive about the care and support staff provided at All Hallows. One relative said, “Despite setbacks, [family member] has made amazing progress since first joining All Hallows and clearly loves and trusts the staff.” We also spent time with people and observed interactions with staff, spoke with social care professionals and looked at comments made on the home’s surveys. This helped us to understand people’s experience at All Hallows.

The registered manager was on long term leave when we inspected. An acting manager was managing the home until the registered manager’s return.

People indicated they felt safe and enjoyed living at All Hallows and staff were kind and friendly.

Care planning involved people, gave them choice and guided staff in how to provide care that met people's needs. Staff supported people to manage risks and to stay safe. Medicines were managed safely and according to national guidance.

People were cared for by staff who had been recruited safely, appropriately trained and supported. Staffing was sufficient to provide safe care. Staff had skills, knowledge and experience to support people with their care and social needs. People had opportunities to be involved in activities and leisure interests of their choice and were known and involved in the local community.

People were helped to eat and drink the right amount to keep them healthy. Meal times were relaxed and organised around people's individual daily routines. People were supported to attend healthcare appointments to assist their health and wellbeing. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Their end of life wishes were recorded so staff were fully aware of these.

The house was clean and maintained and staff practised good infection control. People had been able to personalise their rooms with their own furniture and personal effects.

People were helped 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. Staff assessed people's capacity to make decisions and supported them with making decisions. Staff were given guidance in how to manage complaints. Although people were unable to formally complain, information was available for their representatives. Also staff often knew through people’s non-verbal communication when they were unhappy with something.

Staff worked in partnership with other organisations to make sure they followed good practice and

people in their care were safe. The management team used a variety of methods to check the quality of the service. This helped All Hallows to improve and develop good practice.

Rating at last inspection

At the last inspection the service was rated requires improvement (published 19 April 2018).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if any issues or concerns are identified.

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

“The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”

There was not a manager registered with CQC. The previous registered manager had left the service in November 2016. The service had attempted to recruit and register a new manager since this time. They had recruited three managers who had left before completing the registration process. This had left staff without stable leadership over this period and had affected the governance of the home.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 20 November 2015 the service was rated Good.

At this inspection carried out on 28 February 2018 the service was rated Requires Improvement. This is the first time the service has been rated Requires Improvement.

Care plans were personalised and involved people and their families, but some important health information was not documented or was not available on inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the registered provider had failed to ensure records maintained were accurate and reflected people’s needs.

The management team completed audits to assess and monitor the quality of the service. However these had not always been effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance) as the provider had failed to ensure methods to assess and monitor the quality and safety of the service and mitigate the risk to the health, safety and welfare of service users provided accurate information.

The service had not discussed with people and documented their preferred end of life wishes.

We have made a recommendation about this.

There were procedures in place to protect people from abuse and unsafe care. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. We saw risk assessments were in place which provided guidance for staff in how to safely support people. This minimised potential risks.

People indicated with their relaxed and cheerful reactions and responses to staff that they were comfortable and content at All Hallows. We observed staff spoke with people in a respectful way and were sensitive and caring when supporting people. They responded promptly when people needed assistance. Professionals spoken with were confident people were supported in a caring and responsible way.

There were enough staff to support people with personal care and social and leisure activities. People indicated they enjoyed a variety of meaningful leisure activities in the home and in the local community.

Staff said they were supported to develop their skills and knowledge to assist them to carry out their role. They had skills, knowledge and experience required to support people with complex care needs.

Medicines were managed safely. Medicines were stored securely, administered as prescribed and disposed of appropriately.

We saw people had access to healthcare professionals and their healthcare needs were met promptly. Staff provided care in a way that respected peoples’ uniqueness, dignity, privacy and independence.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). People had been 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. We saw staff were focused on providing personalised care that helped maintain people’s well-being.

People were supported to shop for and choose their meals. Staff were familiar with people’s dietary needs, likes and dislikes and these had been met. Mealtimes were flexible and taken individually or as a group depending on people’s routines.

We looked around the building and found it had been maintained, was clean and hygienic. The design of the building and facilities provided were appropriate for the care and support provided. We found equipment had been serviced and maintained as required. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

The service had a complaints procedure which was made available to people who lived at All Hallows and their representatives. There had been no complaints. The service had information with regards to support from an external advocate should this be required by them.

You can see what action we have asked the registered provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

There were six people living at All Hallows when we inspected. They all had communication difficulties and were unable to have a detailed conversation about the care and support they received. However where possible we talked with people in a general way and we observed how people were supported by staff.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. Relatives told us they felt that their family member was safe and their rights and dignity were respected. They told us they were receiving safe and appropriate care which was meeting their needs. One relative said, 'We are sure our son is safe and happy at All Hallows. The staff are kind and supportive and want the best for everyone.' Another relative commented about their family member's care, 'We feel happy that All Hallows is the best place to meet all his needs.'

The home had policies and procedures in relation to the Mental Capacity Act and best interests meetings had been carried out to assist with particular decisions. Staff were aware of Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Is the service effective?

People's health and care needs had been assessed with them, or where appropriate their relatives. Specialist dietary needs had been identified where required. We saw that care plans were up to date and reflected people's current needs. Relatives confirmed that they were able to see people in private and that they could visit whenever they wished. One relative told us, 'We see him frequently and can just turn up at the home at any time.' There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Is the service caring?

People were supported by kind, attentive and informed staff. We saw that staff showed patience and gave encouragement and guidance when supporting people. Good care practices were observed. We saw people expressing pleasure when interacting with staff. Relatives were very happy with the support their family members were receiving. One relative told us, 'The staff have always been very approachable and we are welcome to discuss anything at any time.' Another relative said, 'They manage any behaviour really well, they do not make a drama out of issues. Any incidents are dealt with calmly and positively.'

Care plans had been maintained, recording the care and support people were receiving. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We found a range of meaningful work, educational, social and leisure activities were organised to encourage skills and enjoyment. We observed people getting ready to participate in these and they were enthusiastic about them. Relatives said how much they benefitted their family members. One relative said, 'There is always so much going on. Staff also make sure that they support our son so he is always involved in all our family occasions and celebrations.'

Relatives said they were happy with their family member's care and had no concerns or complaints. One relative told us, 'The staff have always been very approachable and we are welcome to discuss anything at any time.'

Is the service well-led?

The service had a quality assurance system in place. Records showed that any identified problems were addressed promptly. Staff reflected on whether any incidents could have been managed more effectively or if lessons could be learnt. As a result of these measures the quality of the service was continuously improving

Staff had a good understanding of their roles and responsibilities and of the ethos of the home. Staff meetings were held regularly so staff could discuss support needs and any changes in care or routines. Staff also received regular supervision to assist with their development. This helped to ensure that people received a good quality service at all times.

Relatives were complimentary about the care and support their family member received. One relative said, 'The manager has been in post for a number of years. She is very approachable and involves us fully. We can talk to her or to any of the staff to discuss anything.'

We observed staff communicating with people. We saw that they were able to communicate effectively together. We observed people being treated with respect and dignity

Person centred care records were in place providing information about people. These were updated frequently and showed that people were involved in decisions.

All Hallows was maintained and decorated for the comfort of the people living there. Bedrooms were personalised according to people's wishes.

Relatives felt the home was staffed well enough to provide their family member with individual and group activities and outings. They felt there were always enough staff available