Archived: White Horse Care Trust - 12A Masefield Avenue

We found the following examples of good practice.

¿ The provider’s policies and processes had been updated and reviewed in line with national and local authority guidance. This included policies relating to infection control and prevention, visiting and staffing. Regular audits and checks were completed by senior managers to ensure the service was meeting the provider’s requirements.

¿ Covid-19 related risks to people and staff had been assessed and measures were in place to reduce these risks. These included additional regular cleaning of ‘high-touch’ areas, measures to support social distancing, PPE stations at the front and back doors, symptoms checks being carried out on all staff and visitors, training and support for staff and visitors in use of PPE.

¿ Admissions to the service from hospital and other care settings were managed safely. Arrangements for one person’s move to the service had been adapted in the light of Covid-19 related risks. Health care professionals and Public Health England (PHE) had been consulted in relevant decision-making and staff had used social media and other virtual platforms to help the person adapt to the new service. The service was following national guidance in relation to people returning to the service following a hospital admission.

¿ People were supported to receive regular testing for Covid-19, taking into account their mental capacity and best interests. When people were unable to tolerate throat swabbing, nasal swabs were taken as a least restrictive option.

¿ Staff were compliant with weekly testing requirements and the registered manager ensured test results were chased-up when not received. When unclear results had been received, the registered manager and provider sought and followed advice from PHE.

¿ People were supported to stay socially engaged and not to become lonely. Staff helped people keep in touch with family members and to join in socially distanced group activities, or one to one activities, with a staff member.

Further information is in the detailed findings below.

White Horse Care Trust - 12A Masefield Avenue is a residential care home providing nursing and personal care to five people at the time of the inspection. The service was for younger adults with physical disability, learning disabilities and/or autistic spectrum disorder.

The service had 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.

The service was a fully adapted bungalow, the same size and appearance as other domestic properties in the residential area. It was registered for the support of up to six people. This is in keeping with current best practice guidance. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

People were safe and staff treated them with respect and dignity. People were happy and relaxed when interacting with staff and had formed positive relationships with them. Risks to people were managed through regular reviews and detailed support plans which included guidance from health professionals. This included regular use of best practice assessment tools to ensure people’s needs were identified accurately.

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. When restrictions were needed to maintain people’s safety, for example, when going out into the community, the least restrictive approach was taken. Arrangements made on people’s behalf were made in line with Mental Capacity Act requirements, when people could not consent to decisions about their care.

The service applied the principles and values of Registering the Right Support and other best practice guidance. People’s wishes and support needs were reviewed regularly with them (and their representatives) to ensure the support provided continued to meet their needs. The service was committed to ensuring people’s disabilities did not prevent them from living a fulfilled and happy life. Ongoing recruitment of regular staff and innovative approaches to staffing meant people were increasingly supported to participate in activities they enjoyed and were interested in.

People were empowered to contribute and be independent as far as possible, for example through use of technology to assist them to communicate. People enjoyed regular trips out and had maintained lifelong friendships with others they lived with. People were supported to maintain relationships with others who were important to them through social events.

The service was caring and person-centred. People using the service and the staff supporting them, were valued and listened to. The provider and registered manager understood their responsibilities and monitored the service to ensure any improvements needed were carried out. They worked openly and transparently with outside agencies.

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

Rating at last inspection

The last rating for this service was ‘Good’ (published 24 May 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.

At the last inspection in September 2014, the service was rated as ‘Good’. At this inspection we found the service had remained ‘Good’.

A registered manager was employed by the service but was not present during our inspection. Our inspection was supported by the home manager who has responsibility for the day to day running of the service. 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.

People received care from staff who had got to know them well. People’s care was not rushed enabling staff to spend quality time with them. We saw that people were treated with kindness and compassion in their day to day care.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care and support plans were personalised. People’s needs were reviewed regularly and as required.

People had a range of activities they could be involved in. In addition to group activities staff provided individual support as required.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting any concerns they had. Risk assessments were in place to protect people from the potential risk of harm or abuse.

There were safe medicine administering systems in place and people received their medicines when required. People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

Staff were aware of people’s dietary requirements. Where required people had access to specialist diets and guidance was in place to ensure staff met these needs accordingly.

People were supported by staff who had received training and support to maintain their skills and knowledge. The service followed safe recruitment practices to ensure staff were of good character and suitable for their role.

There were quality assurance systems in place which enabled the provider, registered manager and home manger to assess, monitor and improve the quality and safety of the service people received. A system was in place for people and their relatives to raise their concerns or complaints. Any complaints were investigated promptly by the home manager.

During an inspection visit in April 2014 we reviewed records and found the provider had taken the necessary actions to make the improvements required.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

People who lived at 12A Masefield Road were unable to tell us what they thought about the support and care provided. We spoke with two relatives who told us that they had confidence in the staff supporting their family member. They felt that their family member was safe whilst living at the home. They told us that staff treated people with dignity and respect. One relative told us 'The staff here are wonderful. They treat my son with respect, always explaining to him what it is they are doing.'

There was a member of senior staff available on-call in case of emergencies.

Recruitment practices were safe and thorough. Staff had received supervision and undertaken training in the safeguarding of vulnerable people. This ensured that staff were able to identify unsafe practices and take appropriate action to resolve them.

Senior staff organised the rotas, taking in to account people's care needs to ensure correct decisions were made about the numbers, qualifications, skills and experience required. There was a qualified nurse available on every shift. This helped to ensure that people's medical needs along with their social needs were being met.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications had been submitted, appropriate policies and procedures were in place. Staff had received training in the Mental Capacity Act and the application of DoLS. Staff were able to explain what actions they would take if they felt that people were unable to express their choices and wishes.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

The home had access to an advocacy service if people needed it. This meant that when required people could access additional support.

People's care and welfare needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Relatives we spoke with told us that they were involved in planning their family member's care. One relative we spoke with told us 'When my son first came to live here I was able to tell them exactly what it was my son needed. I felt they listened and also valued what I said'

Relatives told us that they were happy with the care that had been delivered and that their family member's needs had been met. Staff had received training to meet the needs of the people they were supporting.

People were protected from the risks of inadequate nutrition and dehydration. During our inspection we observed that people were offered food and drink regularly throughout the day. For people who required Percutaneous Endoscopic Gastrostomy (PEG) feeding this was provided as per the guidance in people's care plans.

Is the service caring?

We observed that people were supported by attentive and caring staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who lived at 12A Masefield Road were unable to tell us what they thought about the support and care provided. We spoke with two relatives. We asked for their opinion about the staff and how they supported their family member. Relatives were positive about the care which staff provided. One relative told us 'The staff here do an amazing job.' Another relative said 'The staff are always approachable, friendly and welcoming.'

Staff we spoke with confirmed that they were responsible for reading people's care plans and for ensuring that they were up to date with any changes. Staff explained how people were encouraged in their own way to make daily choices. We saw people being supported throughout the day to make choices about activities they would like to do and what they wanted to eat at lunchtime.

Is the service responsive?

People regularly attended a range of activities both in and outside the service. The home had its own adapted vehicle which helped people to remain involved in their local community.

Relatives knew how to make a complaint if they were not happy with services provided. One relative told us that they were quite happy to raise any concerns they had with the manager or other staff members. Any concerns raised were dealt with quickly and they were always informed of any outcomes.

Prior to the service starting relatives told us that they had the opportunity to plan their family members care and support needs with staff. One person explained how their son was allowed to visit several times before they moved in and this had helped them become familiar with the home and staff.

Is the service well-led?

The service worked well with other agencies, health professionals and family members to make sure people received consistency of care. We spoke with a visiting healthcare professional who spoke positively about working with the home.

The service had quality assurance systems in place. Records we reviewed showed that where issues had been identified actions had been taken to resolve them.

Policies and procedures were regularly reviewed throughout the year and were available for staff at all times.

People and their family members were asked their views about the care and treatment received and these were acted on.

Staff were clear about their roles and responsibilities and the needs of the people they were supporting. This helped to ensure that people received a good quality service at all times.

We found that people had detailed care and support plans in place that were regularly reviewed and updated to ensure that changing needs were identified and met.

We saw evidence that staff supported people to access the local community.

Staff were supported to undertake regular training and were receiving formal supervision.

Improvements had been made to the auditing and quality assurance systems used by the home.

We found that people were provided with detailed care and support plans that identified their individual needs and how these were to be met.

We found that that staff were knowledgeable and motivated towards providing a high standard of care and support. We observed staff interacting in a positive manner with people living in the home, providing information and explaining what was planned.

Staff worked well as team and received regular training and felt supported by the management of the home.

We found that there were shortfalls in the formal monitoring and auditing of the service by the provider. Appropriate systems were in place. However these were not being completed on a regular basis and action being taken to follow up improvements that were identified as being required.