Quarryfields

We found the following examples of good practice.

The home had a suitable system in place to support people to maintain important relationships with their relatives and friends. This included promoting visits within the home and in the local community. Visitors were required to follow various safety measures such as completing a COVID-19 test prior to entering the home.

The premises were clean. Staff completed enhanced cleaning of frequently touched surfaces to reduce the risk of the spread of infection. However, some areas of the premises required refurbishment to ensure they could be effectively cleaned. The provider had already identified this, and the necessary refurbishments were planned.

Staff had received training about how to keep people safe from the risk of infection and how to use personal protective equipment (PPE) correctly. The provider ensured there was enough PPE available for staff at all times. We observed staff wearing appropriate PPE in the correct way.

Quarryfields is a purpose-built home on the outskirts of Doncaster close to local facilities and transport links. It accommodates up to 25 people with a learning disability or autistic spectrum disorder, who require personal and/or nursing care. The home comprises of a four-bedroomed house, a one-bedroomed house, two eight bedded bungalows, a two-bedded flat and two-single occupancy flats.

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.

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

Without exception the people and relatives we spoke with praised the home. One person told us, “This is a good place to be.” Staff understood how to keep people safe. Risks to people's health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible.

People received their medicines safely and as prescribed. There were enough numbers of care staff and nursing staff employed to ensure people's needs were met. The home was spacious and well furnished. Checks and audits were completed for such things as infection control and medicines, which helped to protect people’s well-being.

People received kind, responsive person-centred care from staff who were well trained, motivated and supported by a dedicated registered manager who led the staff team to provide the best care they could. People and their relatives were placed at the heart of the service and involved in choosing their care and support, from pre-admission to living in the home.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting 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. Staff had time to sit and engage people in conversation and to support people's involvement in social activities. Staff worked well together as a team. This partnership working enabled people to maintain their wellbeing.

People knew how to complain, and any complaints had been resolved to people's satisfaction. People were asked their opinions on the service by attending meetings and completing surveys, suggestions had been acted upon. There was an open and transparent culture within the service. There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 12 September 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Quarryfields is a purpose-built home on the outskirts of Doncaster close to local facilities and transport links. It accommodates up to 25 people with a learning disability or autistic spectrum disorder, who require personal and/or nursing care. The home comprises of a four-bedroomed house, a one-bedroomed house, two eight bedded bungalows, a two-bedded flat and two-single occupancy flat. 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.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

Since our last inspection the service has not sustained the rating of good in all areas. The registered manager acknowledged that the service needed to make improvements in some areas. The registered manager and registered provider had commenced an action plan to capture and address the shortfalls that had been identified during the inspection.

People were not always protected from risks of harm or abuse. We looked at a sample of people’s daily records and saw incidents had not always been referred to the local authority, or escalated to senior staff so appropriate actions could be taken. Staff told us they did know how to report safeguarding concerns. Staff had been trained in safeguarding although we saw that a significant proportion of safeguarding training had expired. This meant staff’s knowledge may not have been up to date.

There was enough staff on duty to meet people's needs and we saw staff were effectively deployed. There was a recruitment system in place that helped the employer make safe recruitment decisions when employing new staff.

New staff told us they received a structured induction and training at the beginning of their employment. A significant number of staff had not received refresher training to update their knowledge and skills. Where this had not taken place, the registered manager said they had identified these shortfalls. However, refresher training had not been arranged in a timely way and some staff had not received training updates since 2017. Formal supervision did not always take place. However, staff told us they were supported and able to speak to the manager.

We saw there were systems in place to make sure the premises and equipment was maintained and serviced as required. Records we looked at showed gas and electrical safety tests were carried out at the correct intervals. Records also showed that fire equipment had been serviced. Fire exits were clear and staff understood what to do to support people in the event of an emergency evacuation.

Risks to people’s health and welfare had been identified. These had been regularly reviewed and evaluated.

Safe systems were not in place for medicines and we could not be sure that people were receiving their medicines on time or as they were prescribed. Staff received appropriate training and competency assessments; however, these were not effective due to the medicines errors that were identified.

People were generally protected by the prevention and control of infection procedures. We found some minor areas of poor infection control which were rectified during the inspection.

The requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were being met so people who may not have the capacity to make decisions for themselves were protected. The MCA sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

DoLS were only used when it was in the person's best interest. This legislation is used to protect people who might not be able to make informed decisions on their own. The registered manager demonstrated a good awareness of their role in protecting people's rights and recording decisions made in their best interest.

People were offered a well-balanced diet and their food choices were respected. People had access to health care services where this was required to support their health and wellbeing.

People told us staff were kind and caring and their privacy and dignity was respected.

There were processes in place to monitor the quality and safety of the service. However, these had not always been effective, had not identified all issues and needed to be more robust.

The registered manager was not fully aware of their duties under the Health and Social Care Act 2008. They had failed to inform CQC of all statutory notifications and had not always informed the local authority of safeguarding incidents.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 12; safe care and treatment, Regulation 13; safeguarding, Regulation 17; good governance and Regulation 18; staffing. You can see what action we told the provider to take at the back of the full version of the report.

Quarryfields is a purpose built home on the outskirts of Doncaster close to local facilities and transport links. It accommodates up to 24 people with a learning disability or autistic spectrum disorder, who require personal and/or nursing care. The home comprises of a four bedroom house, a one bedroom house, two eight bed bungalows, a two bed flat and a single occupancy flat.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living in the home. Throughout our inspection we saw staff encouraged people to be as independent as possible while taking into consideration their wishes and any risks associated with their care. People’s comments, and our observations, indicated people using the service received appropriate support from staff who knew them well.

People received their medicines in a safe and timely way from staff who had been trained to carry out this role.

There was enough skilled and experienced staff on duty to meet people’s needs. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. New staff had received a structured induction and essential training at the beginning of their employment. The majority of staff had received timely refresher training to update their knowledge and skills. Where this had not taken place the registered manager had identified shortfalls and was arranging further training.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The Deprivation of Liberty Safeguards were only used when it was considered to be in the person’s best interest. This legislation is used to protect people who might not be able to make informed decisions on their own. The registered manager demonstrated a good awareness of their role in protecting people’s rights and recording decisions made in their best interest.

We saw people received a well-balanced diet and were involved in choosing, shopping for and helping to prepare what they ate. People’s comments indicated they were happy with the meals provided. We saw specialist dietary needs had been assessed and catered for.

We found people’s needs had been assessed before they moved into the home and they had been involved in formulating support plans. Records reflected people’s needs and preferences so staff had clear guidance about how to support them. Support plans and risk assessments had been regularly evaluated to ensure they were meeting each person’s needs, while supporting them to reach their aims and objectives in a safe way.

A varied programme of activities and education took place both in-house and in the community which was tailored to each person’s individual needs and interests. People told us they enjoyed the activities they took part in, which they felt enhanced and improved their lives and abilities.

The provider had a complaints policy to guide people on how to raise concerns and there was a structured system in place for recording the detail and outcome of any concerns raised.

There was a system in place to enable people to share their opinion of the service provided and the general facilities available. We also saw an audit system had been used to check if company policies had been followed and the premises were safe and well maintained. Where improvements were needed the provider had put action plans in place to address these.

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

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

Is the service safe?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The home was clean and fresh throughout. We saw there were effective systems in place to reduce the risk and spread of infection.

The provider had systems in place to ensure the service was safely run. For example we saw regular audits were carried out on topics such as housekeeping and medication practices.

Records, and people's comments, indicated there were enough qualified, skilled and experienced staff on duty to meet their needs in a timely way.

The company had policies and procedures in place to help protect people who used the service from abuse. We found staff had received training in relation to safeguarding vulnerable people from abuse and update sessions took place annually.

Is the service effective?

People's health and care needs were assessed on a regular basis and care plans updated to reflect their changing needs. People who used the service, and the visitors we spoke with, said they were involved in writing and reviewing care plans.

People told us they were encouraged to be involved in social activities, attend day centres and carry out day to day living skills, such as cooking and doing their laundry. One person described how they were involved in growing vegetables and maintaining the garden. Another person said they enjoyed horse riding, undertaking educational courses and going to community discos.

We saw staff had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People were supported by enthusiastic, caring staff who were knowledgeable about their needs and preferences. During our visit we saw staff interacting with people positively. They encouraged them to be as independent as they were able to be, while providing support as needed.

We saw people looked well-presented and cared for. We spoke with five people who used the service and two visitors. They said they were happy with the care provided and raised no concerns. One person told us, 'They (staff) help me make meals and keep my room tidy.'

Care records contained good information about people's needs and preferences. This included the people important in their lives and their personal aims, as well as their aspirations and goals.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs, outside agencies had been involved to make sure they received the correct care and support. For example, we saw staff had monitored some people's behaviour, and if additional support was needed timely referrals had been made to GPs or other healthcare professionals.

The home had a complaints procedure which was available to people using and visiting the service. We saw when issues had been raised action had been taken to address them.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People's comments indicated they were mainly happy with how the service operated and the home's facilities.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included in-house and company audits as well as various surveys. The deputy manager told us action plans were put in place to address any shortfalls and these were monitored by the company management team.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

There was an effective complaints system available, although no one had made any complaints.