About the service:

Inshore Support Limited – 108 Barnfield Avenue provides accommodation, care and support for up to four people with autism and learning disabilities. There were three people using the service at the time of the inspection.

People’s experience of using this service:

People continued to receive safe care. Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Good staffing levels were in place. Staffing support matched the level of assessed needs within the service during our inspection.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the manager and senior team, and had one to one supervisions. The staff we spoke with were positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before any care was provided where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Staff continued to treat people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner. Our observations during inspection, were of positive and friendly interactions between staff and people.

People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured complaints could be raised. Concerns were acted upon promptly and lessons were learned through positive communication.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection:

Good (report published March 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

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.

We inspected Inshore Support Limited - 108 Barnfield Avenue on 16 February 2016. The inspection visit was unannounced.

108 Barnfield Avenue provides accommodation and personal care for up to four people with learning disabilities or autistic spectrum disorder. At the time of our inspection there were four men living at the home.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection.

Relatives and staff told us people were safe living at the home. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff knew about processes to minimise risks to people’s safety. Medicines were stored safely and securely and people received their medicines as prescribed.

There were enough staff to support people safely in the home and outside in the community. Identified risks were assessed and managed in a way that promoted people’s safety. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service.

Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively. The registered manager understood their responsibilities under the Mental Capacity Act (MCA) to ensure people were looked after in a way that did not inappropriately restrict their freedom. This included authorisation by the relevant authority for any restrictions to people's freedom that were deemed as necessary to keep them safe; known as Deprivation of Liberty Safeguards (DoLS).

People received care from familiar staff who knew them well. Staff were seen to be caring and had the right skills and experience to provide the care people required. People were supported in a range of activities during the day, although activities in the community were limited after 4pm due to staffing levels. Staff supported people to maintain personal relationships with people that were important to them.

Care plans contained information for staff to help them provide personalised care. Plans were regularly reviewed and included information on maintaining the person's health, their daily routines and preferences. People were supported to have enough to eat and drink and had access to a range of healthcare professionals.

There was a stable management team who staff said were approachable and supportive. Staff felt confident they could raise any concerns or issues with the managers and that these would be listened to and acted on.

There were processes to monitor the quality of the service provided. This was through a programme of checks and audits by the organisation and the management team to ensure the quality of the service was maintained.

We visited the service in response to some concerns that had been raised with us. During our inspection we looked to see whether we could answer five key questions; Is the service safe, effective, caring, responsive and well led?

At the time of our visit there were four people living at 108 Barnfield Avenue. People who used the service had limited verbal communication skills but were happy to be introduced to us. We observed people moving freely around the home, taking part in activities and making choices about how they wanted to spend their time.

We spoke with the deputy manager as the registered manager was not present during our visit. We later spoke with the registered manager. We spoke with seven members of staff. We also spoke with two relatives of people who used the service and looked at records at the home. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our inspection we saw people were treated with respect and dignity by staff.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place. Before our inspection a staff member spoke to our inspector about an issue they were concerned about. We raised this issue with the registered manager of the service. The registered manager was clear that staff could raise issues of concern with the service under a whistle-blowing procedure which would ensure the member of staff was protected during any subsequent investigation.

We looked to see whether there were the right levels of staff working at the service. We looked at the staff rotas which showed sufficient staff to meet people’s needs throughout the day. People received a consistent and safe level of support. Recruitment procedures were rigorous and thorough.

Safeguarding procedures were robust. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). We saw no recent applications had been submitted. Relevant staff at head office were trained to understand when an application should be made, how to submit one, and could offer the service advice and expertise in this area. We saw that one person at the service had recently had a DoLs in place, which had been regularly reviewed and later removed. The provider might like to note that recent Supreme Court judgments may have implications on whether people at the service will require an updated assessment of DoLs. The provider should review their current procedures with regard to this.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to improve.

We checked whether people’s medicines were being managed safely. We found people’s medication was being appropriately administered and managed.

Is the service effective?

People’s health and care needs were assessed with them or their relatives before they came to 108 Barnfield Avenue to determine their needs and make sure the service could meet them effectively. Specialist dietary, communication and equipment needs had been identified in care plans where required.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people’s care and support needs remained appropriate and accurate.

People had access to a range of health care professionals some of which visited the home.

It was clear from our observations and from speaking with staff they had a good understanding of people’s care and support needs and that they knew them well.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived there.

People and relatives we spoke with were positive about the care provided by staff.

Is the service responsive?

We saw people were also able to access help and support from other health and social care professionals such as the Speech and Language Therapist, Social Worker and Psychologist when necessary.

We saw there were advocacy services available if people needed advocacy support.

We saw people were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that met their individual interests.

People who used the service, their relatives and other professionals involved with the service completed satisfaction surveys. Where shortfalls or concerns were raised these were analysed and addressed.

We looked at how complaints had been dealt with at the service and found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and dealt with in a timely way.

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. Records seen by us showed that identified improvements were addressed promptly. As a result the quality of the service was continuously improving.

The staff employed to work at the home had the skills and experience needed to support the people who lived there.

People’s personal care records, and other records kept in the home, were accurate and complete.

At the time of our visit there were three people living at Inshore. People who used the service had limited verbal communication skills but were happy to be introduced to us. We observed people moving freely around the home, taking part in activities and making choices about how they wanted to spend their time.

We were able to observe people in the communal areas of the home and we spoke with two relatives of people who lived at Inshore. One relative told us, "My relative is happy, we are lucky we have them there."

People who used the service were protected from the risk of abuse. There were appropriate policies and procedures in place to provide guidance to staff if they suspected abuse. We saw rigorous recruitment procedures were in place to ensure staff were safe to work with vulnerable adults.

There were appropriate numbers of staff present to meet the needs of people who used the service. Staff numbers allowed for individual attention for people whilst others were involved in activities outside the home.

During our visit we asked about the process for monitoring the quality of the service. We saw the home had good monitoring procedures in place. Evidence was available to show checks were regularly made on records and care plans.

On arrival at the home we spoke with the manager. The manager was an interim manager who had recently applied to be the registered manager. The registered manager shown at the top of this report had recently resigned.

We were able to meet two people who used the service at the time of our visit. People who used the service had limited verbal communication skills but were happy to be introduced to us. We observed people moving freely around the home, taking part in activities and making choices about how they wanted to spend their time.

We spoke with relatives and advocates of people who used the service. One person told us "They take people out and about for walks and other activities." Another person told us "My relative always seems happy there and is pleased to go back after a visit.”

People who used the service were protected from the risk of abuse. We saw rigorous recruitment procedures were in place to ensure staff were safe to work with vulnerable adults.

There were appropriate numbers of staff present to meet the needs of people who used the service. The staff numbers allowed for individual attention for some people whilst others were involved in activities outside the home.

During our visit we asked about the process for monitoring the quality of the service provided. We saw the home had good monitoring procedures in place. Evidence was available to show checks were regularly made on records and care plans.

People who use the service were unable to express their views to us. There were no visitors at the home on the day of our visit. We spoke to staff on duty and observed people and saw that they were well looked after, had a good relationship with staff who were kind and patient. People appeared to be at ease in their surroundings and the home was comfortable and well maintained.