About the service:

Conway House is a care home that is registered to provide care and accommodation to people who need support as they have needs related to learning disabilities or autistic spectrum disorders. The service does not provide nursing care. At the time of our inspection there were eight people living at the home.

People’s experience of using this service: People and their relatives told us they felt safe with staff. Staff could tell us how they should keep people safe and minimise identified risks to their safety.

People were supported by staff that we saw were caring and expressed interest in people who lived at Conway House. People we saw received good care and support that was based on their individual needs and preferences. Whilst care records were not always accurately documented, staff were knowledgeable about people, their needs and preferences and we saw they had a good relationship with the people.

People were supported by care staff who had a range of skills and knowledge to meet their needs, although there were some areas where training updates were needed to refresh their knowledge. The registered manager was aware of and planned to provide these updates. Staff understood, felt confident and well supported in their role, although there was an inconsistent approach to formal staff supervision. People's health was supported as staff worked with other health care providers to ensure people’s healthcare needs were met.

People were supported to have maximum choice and control of their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans with limited exception reflected people’s needs and preferences but the staff and registered manager could explain any recent changes to people’s care or gaps in records. Where there was changes staff knew how they should provide care to ensure people were safe, their needs were met, and preferences respected.

People’s representatives knew how to complain. Relatives and staff knew how to identify and respond if people were unhappy with the service. People told us they had no complaints, although where concerns had been raised the provider had responded appropriately and met with people face to face, with the involvement of other professionals to try and reach a suitable conclusion for all parties.

People, relatives and staff gave a positive picture as to the quality of care people received and said the registered manager and staff were approachable. People and relatives said staff would listened and responded to any concerns they had.

Quality monitoring systems were in place but were not always effective or comprehensive however. The registered manager was aware of this shortcoming and told us they would make the necessary improvements.

Please see the detailed findings for more information

Rating at last inspection: The rating for the service at our last inspection was ‘requires improvement’ (Published on 09 December 2017).

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Our inspection took place on 30 August 2017 and was unannounced.

At our last inspection on 13 April 2015 the service was meeting all of the regulations that we assessed.

The provider is registered to provide accommodation and personal care to a maximum of eight people. On the day seven people lived at the home. People had needs in relation to their learning disability/ associated conditions and or/physical disability.

The manager was registered with us as is required by law and they were present on the day. 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.

The registered manager had been in post for a number of years and this promoted consistency of management. People knew who the registered manager was. We saw that the registered manager was visible within the service and had a good insight into the overall operation of the service. Provider visits and quality monitoring processes ensured the service was run in the best interests of the people who lived there. However, the provider had not met their legal duty to notify us of Deprivation of Liberty Safeguarding [DoLS] authorisations. A breach of regulation limits the highest overall rating the service can be awarded to ‘Requires Improvement’.

Staff were provided in adequate numbers to keep people safe and to meet their needs. Procedures were in place for staff to ensure the risk of harm and/or abuse was reduced and people were kept safe. Recruitment processes prevented the employment of unsuitable staff. Medicine systems confirmed that people had been given their medicines as they had been prescribed.

Staff received the training they required to give them the knowledge they needed to support people safely. Staff received supervision on a regular basis and felt supported by the management team. Staff were aware that people’s care must be delivered in line with their best interests and they must not be unlawfully restricted. Where possible people were encouraged to make decisions about their care. People were offered the food and drink they preferred. Health and social care professionals were involved to promote people’s health and well-being.

A homely atmosphere was promoted within the service. People were supported by staff who were friendly, helpful and caring. People were treated with dignity and respect and their independence was promoted. People could see their family whenever they wished to and their families were made to feel welcome by staff.

People and/or their families were involved in their pre-admission assessment of need and follow on reviews. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to. People were offered in-house activities and were given the opportunity to access the community regularly.

The provider is registered to accommodate and deliver personal care to eight people. People who lived there had a learning disability or associated need.

Our inspection was unannounced and took place on 13 April 2015. Five people lived there at the time of our inspection.

At our last inspection in 2013 the provider was meeting all of the regulations that we assessed.

A manager was registered with us as is required by law. 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 knew the provider’s procedures they should follow to ensure the risk of harm to people was reduced and that people received care and support in a safe way. We found that where people received support from staff with taking prescribed medicines, this was done in a way that minimised any risk to them.

People and their relatives told us that staff were available to meet their [or their family members] individual needs. We found that staff were trained to support the people who lived there effectively and safely. Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

Staff supported people with their nutrition and health care needs. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered. Systems were in place for people and their relatives to raise their concerns or complaints.

People were encouraged and supported to engage in recreational activities which they enjoyed. Staff supported people to keep in contact with their family as this was important to them.

People were encouraged and supported by staff to be independent and attend to their own personal hygiene needs when they could.

All people received assessment and treatment when needed from a range of health care professionals including their GP, specialist consultants and nurses which helped to promote their health and well-being.

The registered manager had identified through monitoring and audits that some record keeping required improvement and some policies and procedures were in need of updating. They had a plan of action to address this.

People we spoke with communicated to us that the quality of service was good. This was confirmed by the majority of relatives we spoke with. The management of the service was stable, with processes in place to monitor the quality of the service.

There were eight people living at the home on the day of our inspection. No one knew we would be inspecting that day.

As people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there. People were smiling and they looked happy. One person confirmed, “Yes” when we asked them if they liked living at the home. Another person confirmed, ”Yes” when we asked them if they felt they were safe and well looked after.

We saw that people were treated with respect and dignity.

People's needs had been assessed by a range of health professionals including dieticians and specialist consultants. This meant that people's health care needs had been monitored and met.

Improvements had been made concerning medication management. This meant that there was less risk of medication errors which could have impacted on people’s health and well being.

We saw that a complaints process was available for people to access if they were not happy with the service that had been provided.

We found that quality monitoring processes were in place to make sure that the service provided was of a good standard and benefitted the people living there.

There were seven people living at the home on the day of our inspection. No one knew we would be inspecting that day.

As people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there. People were smiling and they looked happy. We spoke with a relative who was very complimentary about the care provided and the staff. They said,” I am so pleased with the care that they receive. I think it is a very good home”.

We saw that people were treated with respect and dignity. People's needs had been assessed by a range of health professionals including dieticians and specialist consultants. This meant that people's health care needs had been monitored and met.

Although some improvements had been made concerning medication management further changes to systems were needed to prevent medication errors and risks to people using the service.

Staffing levels were adequate which meant that people living at the home received the care and support that they required.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.

Because of limited communication and understanding due to learning disability and associated diagnoses we were unable to hold conversations with people. We met seven of the eight people living at the location. Staff introduced us to people so we were able to have some engagement. We spent time in a communal area where we could observe and hear some staff and people interaction.

During our time at the location it was clear that staff had a good relationship with people in their care. Staff were patient and polite, in turn people responded positively when they were approached by staff.

We spoke with staff below are a few examples of what they said to us;

“I know without doubt that all people living here are very well looked after”.

“I have worked in care places before and this one is the best. I like the way that we treat everyone as individuals”.

“I enjoy my work. It is very rewarding”.

Our inspection findings showed that people were looked after and that they have a decent quality of life. Staff and management were committed to providing a good standard of care to the people living at the location.

We found some areas that need to be improved upon to make sure that people are safe and free from harm. Medication systems and processes need some changes to make sure that they are robust and safe. Record keeping and care planning need to be developed to show what people’s care needs are and how they should be met.