Archived: United Response - 14 Manor Road

United Response –14 Manor Road 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. United Response –14 Manor Road accommodates four people in one adapted building who had a learning disability and/or autism spectrum disorder with additional physical disabilities.

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.

A registered manager was in post. 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. Following the inspection we were informed the registered manager had left the organisation. The provider has asked an experienced manager to oversee the service in the interim.

We were also informed the provider had made the decision to close the service. This was in part because of the challenges they had faced recruiting and retaining staff in the geographical area. The provider is working with the local authority to find appropriate services for each person.

We saw the systems in place to assess risk and manage safety were not robust. This included the assessment of people’s needs in areas such as mobility and falls. The systems the provider had in place to assess the quality and safety of the service were not effective because they had not picked up on all of the issues found at this inspection. Where they had highlighted areas of concern action had not always been taken to improve. This included an action identified following a safeguarding process. The provider listened to our feedback and has implemented new systems and processes since the inspection in these areas.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We saw medicines were managed well and staff were trained in this area.

We saw staff had received supervision on a regular basis and an appraisal. Staff training was well managed to ensure they received appropriate knowledge to enable them to fulfil their role. There were enough staff on shift to meet people’s needs and they had been recruited safely.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions. Records to evidence such decisions were not always in place.

Positive interactions were seen between staff and the people who lived at the service. Staff knew how people communicated in their own way and we saw they used this knowledge to empower people to make their own choices. Staff behaved in a respectful manner and spoke about people in a caring way. People’s dignity was maintained and people were well cared for.

People were observed enjoying being included in day to day tasks such as food preparation and were supported to be independent where possible. People enjoyed their mealtime experience and we felt a real family atmosphere in the service.

People had their health needs recorded and staff followed advice from professionals to maintain their health. This included monitoring health and nutrition through regularly weighing people. We asked for a review of appointments needed for each person and this was organised quickly.

We saw people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Care plans were very person centred and written in a way to describe people’s care needs so that staff knew exactly how a person preferred to be supported. People and their families were involved in designing the care received.

People were supported to access the community and a wide range of activities including holidays. We saw they maintained relationships with people they cared about and staff supported this.

The provider had a system in place for responding to people’s concerns and complaints. All concerns raised had been acknowledged and the provider worked with the complainant to seek a solution.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the end of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

The majority of people living at 14 Manor Road were unable to tell us their views about the outcome areas we looked at. This was because they had complex needs and verbal communication difficulties, which meant they were not able to tell us their experiences. Instead we spent time observing people whilst they were at home. We had the opportunity to observe how care was being provided.

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

Is the service safe?

We observed people being cared for by a staff team that knew people they were caring for well. We observed when people interacted with staff that support workers were knowledgeable about people's individual care needs. We saw in care records that people's complex health care needs were being met safely by staff at the service, with support from health care professionals.

People were been cared for in an environment that was safe, clean and hygienic. We found there were safe systems in place to ensure that people were protected against the risks of infection. We saw that the home had all the necessary equipment in place to ensure that people were cared for safely. Systems were in place to make sure that equipment was well maintained and serviced regularly. This meant that people were not placed at unnecessary risk.

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

We contacted the organisation and were provided with evidence regarding their recruitment process. Recruitment procedures were rigorous and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice could be identified and therefore people were protected.

The care quality commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Arrangements were in place for senior support workers to receive updated training to confirm their understanding of when an application should be made and how to submit one.

Is the service effective?

Support workers were knowledgeable about the people they supported and knew people very well. People's health and care needs were assessed with people using the service, their relatives and health and social care professionals. Staff were able to demonstrate a good understanding of people's care and support needs.

The manager of the home told us how people living at the home participated in the recruitment of new members of staff. We spoke with staff who confirmed that people living at Manor Road had been involved in their interview process. This demonstrated that people who lived at this service were included in how the service was managed.

Staff had received training to meet the needs of people they supported. Comments included, 'The training I have had has been really good, interesting and in-depth.'

Is the service caring?

We observed a relaxed and friendly atmosphere in the home throughout our visit. Good professional relationships appeared to exist between people who used the service and support workers. We saw that support workers tailored how they communicated with individuals and gave lots of encouragement and praise to people.

Relatives were also asked for their opinion and they too were welcomed and kept well informed. One relative said, 'We trust the service and we have confidence in them to care for X well.'

When speaking with staff it was clear that they genuinely cared for the people they supported. One support worker said,' We have a lovely team here. We are all very supportive of each other.'

Our observations of the care provided, discussions with relatives and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People's needs were assessed and records we looked at showed they received specialist equipment or aids that they needed. Suitable aids and equipment were provided to promote and maintain people's skills and independence.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. The manager told us that there were regular 'house meetings' held which were usually held every three months. Records we saw confirmed this. This ensured that people living at Manor Road had the opportunity to share their views about the service, which were then taken into account.

Relatives we spoke with told us they knew who to speak to if they had any worries or concerns. They were confident that any issues they raised would be looked into and action taken.

Is the service well-led?

Effective management systems were in place to promote and safeguard people's safety and welfare.

Relatives we spoke with told us they thought the service ran well. One relative said 'Things have improved greatly as they now have a very settled staff team.'

The service worked well with other health care professionals and services to make sure people received the care they needed in a joined up way.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service had continuously improved.

Support workers had a good understanding of the organisation's ethos and the quality assurance processes that were in place. Staff told us they were clear about their roles and responsibilities. One told us that they felt 'valued' as they had recently been surveyed for their views. This ensured that staff who worked at the home were included in how the service was managed.

People's personal care records, and other records kept in the home, were accurate and complete.

We telephoned and spoke with relatives of people living at the home. We also spoke with a health care professional about the care and the support people received at 14 Manor Road. Everyone we spoke with told us that they were very satisfied with the overall care people received at the home.

We saw from people's care plans that people were supported to live as independently as possible. The home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with had received training in safeguarding adults.

We reviewed the level of staffing for the home. Records showed there was always enough staff to support people with their care needs.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

We telephoned and spoke with relatives about the care people receive at 14 Manor Road. One relative said 'The staff all seem nice and are very caring. They are on the ball and are doing a good job. I have no concerns.' Another relative said 'They (staff) are fantastic and are nice people to get along with. We have no concerns.'

We also spoke with health and social care professionals about the home. One told us "14 Manor Road is a very good home. They provide good quality care' another said 'This is an excellent service. I have no concerns as the home provides good care.'

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.