About the service:

Living Ambitions provides residential care for up to five people with learning disabilities and physical disabilities. The accommodation is a detached house arranged over two floors. The service is registered to provide accommodation for those who require personal care. At the time of our inspection, there were five people living at Living Ambitions.

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.

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

People’s experience of using this service:

People and their relatives told us they felt safe living at Living Ambitions. Risks to people’s safety had been assessed and measures implemented to keep them safe. A positive approach to risk taking was followed to ensure people’s independence was maintained. Staff were aware of their responsibilities in safeguarding people from abuse and had developed open and trusting relationships with people.

Staff had received training and support from healthcare professionals with regards to people’s individual health needs. This had enabled staff to provide people with individualised support in these areas.

People were offered choices in their food and how they spent their time. Relatives told us that staff were caring and treated them with respect. People were supported to maintain relationships. Staff had worked at the service for many years and positive relationships had developed between people. There was a warm and homely atmosphere and people were clearly comfortable living at Living Ambitions. People’s dignity and privacy was respected, with personal care and conversations taking place behind closed doors.

People received a personalised service and were involved in developing their care plans. Staff knew people’s life histories, preferences and routines. Activities were based around people’s choices and people were supported to take part in the running of their home. There was a positive culture within the service where people, staff and relatives felt listened to. The registered manager felt supported by the provider and this flowed through the service.

Why we inspected:

This was a planned comprehensive inspection to confirm the service remained Good.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This inspection took place on 14th November 2016 and was unannounced.

At the last inspection in September 2015 we found breaches of Regulations 11 need for consent, 12 (safe care and treatment), 15 (Premises and equipment), 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements have been made and these Regulations are no longer being breached.

Living Ambitions 330a Guildford Road provides residential care for up to five people with learning disabilities and physical disabilities. On the day of the inspection there were five people using the service. The accommodation is a detached house arranged over two floors.

There was a Registered Manager in post. 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 were aware of their responsibilities to safeguard people and to keep people safe. Staff were trained in how to respond in the event of a fire and contingency plans were in place to keep people safe. Staff learned from accidents and incidents that had taken place.

Safe recruitment practice was followed to ensure staff were suitable for their roles. People were administered their prescribed medicines by staff who had received medicines training. Medicines records were up to date to ensure medicines were administered safely.

Staff provided care in line with the Mental Capacity Act 2005. Records demonstrated that people's rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions.

Staff were well trained and had the skills and knowledge to support peoples individual needs. People were supported by staff who knew them and their needs well. They knew people’s history, what support people needed and how they could help people to stay well and independent.

Peoples nutritional and hydration needs were being met. People were able to choose what to eat and drink and were supported to prepare their meals.

The care plans were person centred and enabled staff to provide good quality care to people. They detailed people's routines, what they liked, what and who was important to them, their hopes and dreams, and how they communicated.

People were supported with their health and well-being. People had health action plans. These detailed their health needs and how they were to be supported to see health care professionals and what medication they were taking and its side effects.

People were encouraged to take part in activities that suited their interests and hobbies. Activities were flexible and based on people's individual needs and preferences.

The complaints procedure was available in an accessible format for people and regular meetings were held to obtain their views.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

Staff reported that the manager was supportive and responsive.

The registered manager works with others to ensure people received the care they needed. This included GP’s, social workers, and care practitioners.

This inspection was carried out on 9 September 2015. 330a Guildford Road provides residential care for up to six people with learning disabilities and physical disabilities. On the day of the inspection there were five people using the service. The accommodation is arranged over two floors.

On the day of our visit the registered manager was on leave. 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. We were assisted by the deputy manager and the area manager.

There were not always clear records around some people’s medicines. There was not always guidance in place around what signs staff should look out for before some medicines were administered.

Risks to people had not always been addressed in relation to the environment.  There was no guard on the hob and no signs to indicate to people that it was still hot when not in use.

The premises and equipment at the service was not always clean and well maintained.

Although staff were informed about their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS) this was not always put into practice. There was not enough evidence of mental capacity assessments specific to particular decisions that needed to be made.

Staff were not always kept up to date with the required refresher training that was specific to their role. This included epilepsy training, infection control and moving and handling.

Although some audits were taking place these were not always being used to improve the quality of the service provided.

People’s hydration and nutritional needs were being met. People had a choice of where to have their meals. However on the day of the inspection we found that there was limited fresh food available for people as they were due to go away at the end of the week.

We recommend that there is always sufficient nutritious appetising food available for people and that people are able to make choices about their meals.

However there was no evidence that people’s activities had been reviewed and that everyone had a choice about what they wanted to do. We recommend that people’s views are considered in relation to what their quality of care should be and how they want to live their lives.

People looked content and happy with staff at the service. One person said “I feel happy and safe here.” Relatives were confident that their family members were safe.

There were enough staff deployed around the service to meet people’s needs. Where people needed additional support from staff this was provided.

Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse.

People’s Medicine’s Administration Charts (MARs) were complete and up to date and there was a policy in place.

Other risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm.

In the event of an emergency there was a service contingency plan which detailed what staff needed to do to protect people and made them safe.

Accidents and incidents were recorded and the deputy manager analysed the information from this to look for trends. Staff recruitment files contained a check list of documents that had been obtained before each person started work.

One relative said “I am happy with the support (their family member) receives, there is nothing that I can fault, moving here was the best thing that ever happened to (their family member.

Staff gave examples of where they would ask people for consent in relation to providing care. At the time of the inspection there was no person that required a DoLs application to be made.

One member of staff said that they had a full induction which was thorough. They said that before they provided any care they shadowed other staff to get to know people first.

There were systems in place for most staff to meet with their manager on a one to one basis. Subjects discussed at supervisions included any training needs and how well staff communicated with people living at the service.

There was evidence that people had access to health care professional including the GP and dentist.

One person told us that the staff were caring. Relatives felt that staff were kind and considerate. One relative said “I am delighted with the care that (my family member) gets, the attitude of the staff is excellent.”

We observed staff interacted with people in a kind and compassionate manner and responded promptly to people who were requesting assistance

Staff ensured people’s privacy was protected by ensuring all aspects of personal care were provided in their own rooms. Staff had good knowledge of individuals and knew what their likes and dislikes were.

Where able people were involved in the planning of their care. Relatives said they felt involved in care planning. One relative said “I am always involved in the care review; I think they (staff) do an excellent job.”

The care plans for people included sufficient information to enable staff to provide appropriate care and support. Communication was regularly shared with staff about people.

There was a complaints procedure in place for people and relatives to access. One person said that if they ever wanted to make a complaint then they would speak to the support worker.

People and relatives were complimentary of the activities that were on offer. On the day of the inspection, which was during the summer holidays, people were taking part in various activities.

One person who used the service and relatives said the management of the service was good. One relative said that the manager always contacted them if there was a problem at all. Staff said that they felt valued and supported.