74 Old Ford End

People’s experience of using this service:

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. The service was not able to support people to have person centred, individual and meaningful activities. People did not always have choice and control over their lives and there was limited evidence of promoting independence and meaningful activities.

People had the opportunity to go out and do activities but these were often task based and not always person centred or regular. Goals were not very meaningful, not always implemented and relatives did not always feel involved in the planning and assessing of people’s care needs. Improvements were needed in this area.

The provider had documented risks but these did not always contain enough information to tell staff how to support the risk. This could mean less experienced staff would not know what to do to keep people safe.

Staff and relatives spoke well of the registered manager and the staff team, however relatives, staff and management felt that the provider did not support them or implement agreed plans.

The registered manager did not have a good oversight of the service or knowledge of their responsibilities. Improvements were needed in this area.

Staff supported people with choices of meals and drinks and accessed specialised healthcare when needed. However, staff did not always support people during meals in a dignified manner and the provider needed to make some improvements in this area.

Staffing skills and experience were suitable to meet the needs of people. However, there were several staff changes which meant relatives had concerns about the continuity of care.

Care provided by the staff team and staff interactions with people was good and encouraged positive relationships.

Staff had a good knowledge of how to keep people safe and received training in this area. People and relatives told us they felt safe and thought that staff were kind and caring.

One relative said, “My family member is happy and gets on well with all the staff and really enjoys it, they come home for a weekend and are desperate to get back, they are laughing. They are really happy and the staff are all very good and seem to know what my relative wants with hand signs and everything.”

The provider implemented safe systems for the management of medicines which included staff training and assessments of staff competency checks.

People decorated their rooms in ways they preferred and which met individual tastes. The provider suitably adapted the environment to meet individual physical and mental health needs of people.

Enforcement: We found three breaches of the Health and Social Care Act 208 (Regulated Activities) Regulations 2014. The service met the characteristics of Good in Safe and Caring. The service met the characteristics of Requires Improvement in Effective, Caring, Responsive and Well-Led.

Please see the action we have told the provider to take section towards the end of the report.

Rating at last inspection: At the last inspection (published 07 April 2016) the service was rated Good. Overall the rating has worsened since the last inspection.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will discuss improvements with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

74 Old Ford End provides care and support for up to six people with a learning and physical disability. There were six people living at the service when we visited.

The service has a registered manager. 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.

Staff had been trained to recognise signs of potential abuse and how to report them. People felt safe living at the service.

There were processes in place to manage identifiable risks. People had risk assessments in place to enable them to maintain their independence.

The provider carried out recruitment checks on new staff to make sure they were fit to work at the service.

There were suitable and sufficient staff with the appropriate skill mix available to support people with their needs.

Systems were in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and ongoing essential training to keep their skills up to date. They were supported with regular supervision from the registered manager.

Staff ensured that people’s consent was gained before providing them with support.

People were supported to make decisions about their care and support needs; and this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of the guidance and followed the correct processes to protect people.

People were supported to maintain a balanced diet and were able to make choices on what they wished to eat and drink.

If required people were supported by staff to access other healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff.

There were processes in place to ensure that people’s views were acted on. Staff provided care and support to people in a meaningful way.

Where possible people were encouraged to maintain their independence and staff ensured their privacy and dignity were promoted.

Pre-admission assessments were undertaken before people came to live at the service. This was to ensure people’s identified needs would be adequately met.

A complaints procedure had been developed in an appropriate format to enable people to raise concerns if they needed to.

There was a positive, open and inclusive culture at the service. The registered manager was transparent and visible. This inspired staff to provide a quality service.

Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

Is the service safe?

People told us they felt safe. They had been cared for in an environment that was safe, clean and hygienic. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The staff were knowledgeable about people's care and support needs, and people received medication from staff who had been trained to administer it safely. The recruitment practice was safe and thorough and the provider took action to ensure staff competence.

Is the service Effective?

People's health and care needs had been assessed and care plans were in place. They were happy with the care that had been provided and their needs had been met. Staff had received training to support people with various care needs. Some of the people had complex needs that meant they were not able to understand their care plans, we saw that some of these had been written in a 'easy read' format to enable people to understand their planned care and support.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with staff that they had a good understanding of the needs of the people living in the home and that they knew them well. The relatives of one person told us, "The staff look after people very well."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when needed. The service took account of individual preferences, and they were supported to access a variety of activities of their choice.

Is the service well-led?

At the time of our inspection, the provider did not have a registered manager in post. However, a new manager had been appointed, and we found they had started the registration process with the Care Quality Commission. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

During our visit on 1 May 2013, we observed a calm and relaxed atmosphere. Staff supported people to participate in activities of their choice, at a pace that was appropriate to them. Two people told us that they felt happy and safe living at the home. We saw examples of this in the delivery of care, where privacy and dignity were respected.

One person told us, "The staff are good to me. I feel safe and have help with what I need." Another person said, "I'm happy here."

We reviewed three care plans and associated risk assessments and found they were person centred and reflected individual wishes and preferred routines. The four staff we spoke with, were knowledgeable about peoples' specific care needs. This meant that care was safe and appropriate.

People were encouraged to participate in activities. A weekly activity schedule was in place for each person, but alternatives were offered by staff if people changed their minds. During our visit, people were supported to go to the day centre and were encouraged to take part in other activities, including listening to music or going for a walk.

We observed that people were offered support at a level which encouraged independence and ensured that their individual needs were met. Staff were friendly and polite in their approach to people and interacted confidently with them, respecting the individual's dignity and encouraging them to select their own activities.