Care service description

Casarita is a residential care home for seven people with learning difficulties. At the time of our inspection there were seven people living in the home.

There was a registered manager in the home. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

We found some concerns relating to the management of the water temperatures, this was raised with the manager who has taken action in relation to this. Other quality monitoring checks were effective and remedial action was taken where concerns were found.

Whilst no formal audits were carried out in relation to people’s medicines, the registered manager told us that they carried out checks and we found that people’s medicines were stored and administered in a safe way.

People’s safety was maintained and known risks were identified and managed. Staff knew how to keep people safe and understood their responsibilities in relation to safeguarding.

There were consistently enough staff to support people safely and staffing numbers were adjusted according to people’s needs. There were robust recruitment procedures in place to recruit suitable staff.

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.

People were involved in the planning of their care and were supported to be as independent as possible. People could make their own meals and risks relating to people’s nutritional intake were mitigated. Prompt referrals to relevant healthcare professionals were made to ensure people’s health and wellbeing.

Staff worked collaboratively with other agencies and professionals to provide coordinated and consisted care for people.

People’s dignity and privacy was upheld and staff were caring and attentive towards people. People’s care was personalised and their care records were reviewed and updated regularly.

There was a clear management structure in place and staff were supported to carry out their role.

Further information is in the detailed findings below.

This inspection was undertaken by one inspector on 19 February and was unannounced.

Casarita provides accommodation, care and support for up to seven people with a learning disability. At the time of our inspection there were six people living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe living in the home and the support staff showed good knowledge and understanding of the procedures for protecting people from harm. Where risks to people’s health had been identified, these were effectively and safely managed. People were safely supported with their medicines.

There were sufficient numbers of staff working in the home and staff were only recruited and employed in the home after satisfactory checks had been completed to ensure that they were of good character. Staff received appropriate support, supervision and appraisals from senior staff or management.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the manager and staff were knowledgeable about when a request for a DoLS would be required.

Staff had a thorough knowledge of the people they supported and clearly understood how to meet their care and support needs. Staff communications were also frequent and effective and regular team meetings took place.

People always had enough to eat and drink and individual dietary requirements were catered for as needed. People also received input, advice and support from relevant health professionals such as the dietician, district nurse, GP, physiotherapist and occupational therapist.

People told us the home was caring and staff interacted with people in a natural, warm and friendly manner. People’s privacy, dignity, individuality and independence was also consistently respected.

People chose what they wanted to do each day and where they wanted to be. Activities within the home were flexible and varied and took people’s differing needs and wishes into account.

People were involved in planning their own care and care records reflected people’s personal histories and preferences so that staff could support them with their preferred lifestyle. People were also supported to enhance and maintain their independence.

The home had an appropriate complaints procedure, which contained detailed information about the steps to be taken in the event of a complaint being received. People were given a copy of the complaints procedure, which was also available in an ‘easy read’ picture format, and people said they knew how to make a complaint if they needed to.

The manager and staff team welcomed and encouraged comments, suggestions and feedback from the people living in the home and their friends and family, as well as from relevant professionals.

People regularly made their views known during weekly house meetings and one-to-one time with staff. The provider also hosted monthly coffee mornings for people’s relatives. People using the provider’s services could also attend regular forums to discuss the services in general, as well as raise and discuss any concerns or issues. Annual quality assurance surveys gave people living in the home and their relatives, further opportunities to provide their feedback regarding the care and support they received.

Systems were in place to ensure the service provided was regularly monitored and the provider’s senior management team carried out regular in-depth internal audits. The registered manager had reported notifiable events to the CQC as required. (A notification is information about important events the provider must inform us about by law).

A single adult social care inspector carried out this inspection to follow up concerns identified during our previous inspection of 28 November 2013. One of the key questions we ask ourselves during an inspection is whether the service is effective. At the November 2013 inspection we identified that some staff training was significantly out of date. In addition some staff had last received supervision 17 months ago. This meant that the service was not operating effectively because people were not cared for by staff that had received appropriate training or supervision.

Is it effective?

This inspection established that improvements had been made. Whilst there were a few gaps in training provision, we were satisfied that significant progress had been made. All staff were undergoing regular supervisions. We spoke with three staff members, each of whom confirmed they were receiving regular supervisions. Consequently, the service was effective in ensuring that people were supported by staff who had received suitable training and support.

We spoke with two people in depth about the care and treatment they received. They said they felt happy with the care, felt safe and liked the staff. One other person was able to communicate with us by their gestures and behaviour that they enjoyed living at Casarita.

We observed other people who used the service being offered individual support by the staff in a caring and thoughtful manner and being spoken with respectfully. We observed staff successfully communicating using non verbal methods with people who experienced difficulties communicating verbally.

We saw evidence that people who used the service were involved in making choices about how they were supported and were engaged in ways that enabled their voices to be heard.

People who used the service were protected from the unsafe use of medicines. Appropriate arrangements had been made for the safe handling, usage and administration of medicines.

We saw evidence that sufficient numbers of staff were rostered to be on duty throughout a four week period and we observed satisfactory staffing levels on the day of our visit.

We noted that regular staff supervision had not been offered during a period of several months and that some mandatory staff training was not up to date.We were informed that the manager had been overseeing two other services during the preceding year.

This was a scheduled inspection to Casarita where we met with three people who used the service and three staff members.

We looked at care plans for three people and found the information comprehensive, clear in what care support was required and saw that risks had been identified and assessed.

The meals planned and offered were chosen and purchased by the people who lived in the home. Healthy options were available as well as the 'odd treats'.

The home was very clean and tidy on our arrival. Good practice was being adhered to to ensure correct infection control was in place.

The staff told us they were well supported by the company with suitable training and supervision and that the team of staff within the home were supportive on a day to day basis.

The home had not had any complaints but had various methods of ensuring the people who lived in the home were listened to. The manager and staff told us that they knew the people well and would recognise if and when something was troubling them.

The people we spoke with during our visit on 19 October 2011 were very complimentary about the way the home involves them in the choices made about their care and the way the home is run. We were told by two people about the methods used to ensure everyone had a voice such as weekly meetings and how people were communicated with in a method that is understood by them. They told us about the way they were encouraged and helped to live life to the full. One comment was, “I now do lots more things for myself and I have my own flat to do it in.”

Throughout the visit we were told how much the people liked their home and how supportive the staff are. A number of examples discussed with individual people told us how they feel safe and cared for in ‘their home.’ One comment was “I couldn’t wait to get home after being away.”

We were told the staff were good. One person told us they get all the support that they need to be as independent as possible.

Two people who we spoke with gave good accounts of how they are happy and well supported to lead their individual lives. We were told “I am able to voice what I think and I know I am listened to.”

Throughout the visit we noted how people were included and offered choices. Their body language, smiles and staff interaction showed us that people were content.