All inspections: Talbot Street - Care Quality Commission

About the service

Talbot Street is a residential care home. This service supports people with autism; The service is registered to care for three people; there were three people living at the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

We saw many examples where staff had supported people to become more independent, make choices and increase their physical and emotional wellbeing. With staff support and by increasing their understanding, personalised daily routines were established, reflecting people's preferences and healthy eating was promoted.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Talbot Street is located in an area that enabled people using the service to participate in their own local community. People were active each day to local places of interest and shops and enjoyed activities at a day service. Social activities also took place at home, with regular trips to local restaurants and pubs.

The service was highly effective at promoting people's independence. People had made significant achievements. This included personal care and daily activities such as laundry, cleaning their home, shopping, preparing snacks and drinks.

Staff had developed effective communication with people. This meant that they were able to make their own decisions about their support; staff ensured they were supported to make choices on a day to day basis. Pictures depicting activities, places, people and meals were used, together with picture boards to demonstrate people’s activity plans.

Risks that people faced had been assessed and those identified were safely managed. Medicines were managed safely. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm.

People were encouraged and supported to eat and drink well. People were given a choice of suitable meals and snacks. Staff supported people to make meals of their choice throughout the week. People were supported to access healthcare when needed.

People were offered choice and control and where able consented to their care and support. Staff supported people to be as independent as possible with activities of daily living, such as personal care, shopping, cooking and laundry.

Staffing levels were appropriately managed, and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs, keep them safe and give them the opportunity to take part in their chosen activity.

Staff received a range of training appropriate to their role and people's needs, and were supported by the registered manager through regular supervision.

Effective systems were in place to check the quality and safety of the service. The environment was clean and safe and in a good state of repair and decoration.

The leadership of the service promoted a positive culture that was person-centred and inclusive. The registered manager and the staff team showed a desire to improve on the service provided and in turn the quality of life experiences for the people at Talbot Street.

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 9/05/2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Talbot Street is a residential care home for up to three vulnerable adults who require residential support. The home is situated in a residential area of Southport, close to local amenities. The home has three separate bedrooms, a shower room and bathroom, two lounge areas, dining area, kitchen area and rear and front garden. The service is part of the organisation Autism Initiatives.

At the last inspection, in March 2015 the service was rated Good.

At this inspection we found the service remained Good.

The home operated within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We were provided with information in relation to capacity assessments and processes which needed to be in place to make decisions in a person’s best interest. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Medication was administered safely by staff who had received the appropriate training. Medication records were accurate and systems were in place to order repeat medication, dispose of medication and record any medication discrepancies. An audit of the administration of medicines was completed each week.

All care files contained individual care plans and risk assessments which were regularly reviewed and updated in order to minimise risk. Care plans were person centred and contained relevant information in relation to a person’s wishes, choices and preferences.

Risk assessments were in place for the three people who lived at the home. The assessments offered key information about significant areas of risk and how such situations would need to be managed for the safety of everyone living at the home.

Staff expressed how they were supported in their roles as support workers; they had completed specific training in order to fulfil their roles effectively and explained that there was an open door policy where they could seek support, advice and guidance whenever they needed to.

A formal complaints process was available at the home but relatives explained that any complaints or concerns could be openly discussed with the staff and managers as and when they needed to be.

Further information is in the detailed findings below.

The inspection took place on 10, 11 and 12 March 2015 and was announced.

72 Talbot Street provides accommodation and support for up to three adults who have autism. The service is provided by Autism Initiatives UK. The house is a large detached property situated near the centre of Southport, with access to local shops, transport links and other services.

There is a registered manager for the service. They were on long term absence from work. Autism Initiatives had appointed a temporary manager who had applied to be registered with the Commission. 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.

During our inspection we used a number of different methods to help us understand the experiences of people who lived at Talbot Street. This was because the people who lived at Talbot Street communicated in different ways and we were not always able to directly ask them their views about their experiences. Our observations showed people appeared relaxed and at ease with the staff. People were kept safe because there were arrangements in place to protect them from the risk of abuse. Staff understood what abuse was and the action to take should they report concerns or actual abuse.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The manager informed us people who lived at Talbot Street were supported to make key decisions regarding their care. We found the area manager, the home manager and staff knowledgeable regarding acting in people’s best interests. We saw this followed good practice in line with the Mental Capacity Act (MCA) (2005) Code of Practice. Applications had been made for standard DoLS authorisations for the three people who lived In the home.

Each person who lived at the home had a plan of care. The care plans we looked at contained relevant and detailed information. This helped to ensure staff had the information they needed to support people in the correct way and respect their wishes, likes and dislikes. A range of risk assessments had been undertaken depending on people’s individual needs to reduce the risk of harm. Risk assessments and behavioural management plans were in place for people who presented with behaviour that challenges. These gave staff guidance to keep themselves and people who lived in the home safe in the home and when out in the community.

Medication was stored safely and securely. Staff had completed training in medication administration. The manager told us they carried out practical competency assessments with staff to ensure they were administering medication safely. The systems we saw ensured people received their medications safely

We looked around the building. We found it was clean and well maintained. Staff had a rota in place to ensure cleaning was completed daily. We found audits/checks were made regularly to monitor the quality of care provided and ensure it was safe and standards of cleanliness and décor were maintained.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff were only able to start work at the home when the provider had received satisfactory pre-employment checks.

We saw there were enough staff on duty to support people as needed in the home. This included support with personal care, to attend employment and take part in regular activities when they wished to. We saw the staff rotas which confirmed this.

Staff received an induction and regular mandatory (required) training to update their practice and knowledge. Records showed us that staff were up-to-date with the training. This helped to ensure that they had the skills and knowledge to meet people’s needs. Staff told us they felt supported in their roles and responsibilities.

People who lived in the home were supported to make their own drinks and snacks, with staff support. As well as indicating they wanted a drink or snack we saw staff asking them throughout the day. Staff had good knowledge of people’s likes and dislikes in respect of food and drinks and people’s routines in respect of meal times. We saw that people who lived in the home had plenty to eat and drink during our inspection.

People who lived in the home took part in a variety of activities both in the home and in the community. Some people attended a day centre, a work placement; others enjoyed activities both in the home and in their local community. They completed daily activity planners using pictures as a way of knowing and understanding what they were doing at different times of the day.

During our visit we observed staff supported people in a caring manner and treated people with dignity and respect. Staff knew people’s individual needs and how to meet them. We saw that there were good relationships between people living at the home and staff, with staff taking time to talk and interact with people.

A procedure was in place for managing complaints and family members we spoke with were aware of what to do should they have a concern or complaint. We found that complaints had been managed in accordance with the home’s complaints procedure.

The temporary manager was applying for registration with the Commission. We found they provided an effective lead in the home and was supported by a clear management structure.

Systems were in place to check on the quality of the service and ensure improvements were made. This included carrying out regular audits on areas of practice.