About the service:

15 Mossmead is a residential care home that is registered to provide personal care for up to four people with learning disabilities. At the time of the inspection there were three people living at the home.

People’s experience of using this service:

People’s medicines were managed safely. The home had been supported by a project linked to the local Clinical Commissioning Group to review their medicines management.

People were supported to attend social activities, such as activity centres and dance exercise classes. Staff knew people and their interests well. They spent time supporting people to maintain their hobbies in the home, as well as in the community.

People chose the colour of their bedrooms, as well as how their rooms were laid out. The bedrooms were personalised, with photographs and pictures that people wanted to have displayed.

The home was well maintained. It was clean and free from odours throughout.

There were plans to personalise the communal spaces, adding more sensory based furnishings based on people’s needs and preferences.

People’s care and support plans reflected their usual routines and choices. There were ‘working support plans’ in place which documented people’s communication needs. This was so that agency staff and visitors could see at a glance how they could communicate with a person.

The principles of the Mental Capacity Act 2005 (MCA) were applied to the care planning, with consideration for consent and capacity throughout. There were mental capacity assessments in place for specific decisions, such as having the flu vaccination; to assess people’s capacity to consent to these.

People were supported to be involved in choosing menu options. There were pictorial menu suggestions and people sat with staff once a week to set out the menu plan. There were variations of the main meal offered as an alternative. If people wanted something different, they could choose what they wanted on the day.

People’s health care needs were met with timely referrals to health care professionals. People were supported to attend health appointments such as the dentist and opticians. People were supported to attend age and gender related health appointments.

Risk assessments were in place, to protect people from the likelihood of risks to their health or safety occurring.

The supervisor and registered manager spoke with enthusiasm about wanting to continue to develop the home to be even more person centred. The values of the management and staff team put people at the forefront of everything that happened in the home.

There were quality assurance processes in place. These were to audit the service and identify where there were any areas for improvement.

Rating at last inspection:

In the last inspect in October 2017, we rated the home as Requires Improvement.

Why we inspected:

This was a planned, comprehensive inspection, based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service, to inform when the next inspection should take place.

At the last inspection in July 2016 we found breaches in relation to Regulations 9, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements on developing person centred support plans, to assess people’s capacity to make complex decisions and to ensure records were up to date. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. During this inspection we found some improvements had been made.

15 Mossmead is registered to provide accommodation and personal care for up to four people with learning disabilities. At the time of the inspection three people were living at the service.

This inspection was unannounced and took place on 11 October 2017.

A registered manager was 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.

Quality assurance systems were in place to monitor and assess the delivery of care. We found the registered manager had assessed the quality of the service and had found all standards fully met. However, medicine systems were not safe and continued improvements were needed with developing person centred support plans.

Audits of medicine systems were not effective. The internal audit carried out by the staff and records of medicines administered confirmed that there were persistent medicine errors. Protocols that gave staff clear and concise guidance on the application of “when required”, creams were not in place. However, “the manager’s self-assessment monthly audit” undertaken by the registered manager had not identified any shortfalls. The registered manager had indicated in the monthly audit that there was “evidence that medication procedures were adhered to”.

We found records of medicines administered were not signed on two consecutive days but as these medicines were in syrup form it was not possible to assess whether the medicines had been administered. While accident forms were completed for missing signatures no immediate action was taken to safeguard people from unsafe medicine management.

“My working support” documents included person centred and communication support plans that were in picture format. Communication care plans gave staff guidance on how people expressed their emotions, how they made decisions and the support needs. Support plans included detail on how staff were to support people to meet their assessed needs. We saw people were able to manage aspects of their care and the support required from staff to meet their needs. Consent care plans detailed the decisions people were able to make. However, life stories were not always included and continued improvements were needed with the support plans

One person told us they felt safe living at the service. Other people living at the service were not able to tell us what feeling safe meant to them. The staff we spoke with said they had attended safeguarding of abuse training. They knew how to identify abuse and the procedures for reporting their concerns.

Systems were in place to manage risks safely. Staff were aware of the individual risks to people and the actions needed to safeguard people from potential harm. Risk assessments were developed on how staff were to support people to take risk safely. Where people were diagnosed with medical conditions that placed them at risk of harm, risk assessments were in place on how to minimise the risk.

Incident and accidents reports were completed. Accident report included a description of the incident and the follow up action taken. Contingency and personal evacuation plans were developed on how staff were to respond to any emergencies and other

This inspection took place on the 7 July 2016 and was unannounced. At the previous inspection visit which occurred in January 2014 all standards inspected were met.

Three people were currently living at the service which is registered to provide accommodation for up to four people with learning disabilities.

A registered manager was in post but working reduced hours. The senior support worker was given additional responsibilities in the day to day management of 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.’

Mental Capacity Act 2005 (MCA) assessments were not always undertaken for specific decisions and relatives without legal powers to make best interest decisions were able to consent to care and treatment. For example, for family members without legal powers were able to undertake intimate checks. This meant some decisions were not legally authorised.

Deprivation of Liberty Safeguards (DoLS) applications to the supervisory body for continuous supervision were in progress for people living at the service.

Support plans lacked a person centred approach and were not up to date. Life stories were not part of the support plans. The person we asked confirmed there was a care file that that contained information about their needs and told us the information kept in their file was explained to them.

Quality assurance systems were not fully effective. Records were not up to date and were not reviewed regularly. The Providers visits were not regular and it was evident from the house development plan dated 2011 that there was a consistent theme for improving care planning, updating health action plans and increasing activities. People and staff had made suggestions for more one to one time with people. However, there was little improvement.

Staffing levels were arranged to provide one to one time with people. However, there was lone working during the week and at weekends. This meant during these periods activities for people to access were limited.

The person we spoke with said they felt safe living at the home. They said the staff and other people made them feel safe. The staff attended training in safeguarding adults from abuse . The staff we spoke with were able to describe the procedures for safeguarding people from abuse. These staff described the types of abuse and the action they must take for suspected abuse.

Risks were assessed and action plans were in place to minimise the risk. Members of staff had a good understanding on the potential risk to people and the impact they had on the person’s safety. Reports of accidents and incidents were completed and from the analysis of the reports patterns and trends were identified.

New staff received an induction when they started to work at the service. Staff attended training that helped them develop skills and insight into the needs of people. One to one meetings with staff’s line manager happened every eight weeks. At these meetings staff discussed areas of concerns and training needs. However, relief staff working regularly at the service did not benefit from having one to one opportunities to discuss their personal development. Staff said the team worked well together.

People were supported by staff with their ongoing healthcare needs. People were accompanied by staff on healthcare appointments. People had access to specialists and they had regular dental and optician check-ups.

People’s dietary requirements were met and they were involved in menu planning. We saw people ask for refreshments and snacks between meals and the staff responded to these requests.

The person we asked told us the staff were “caring.” We saw good interaction with staff. The staff we spoke with

At the time of our visit the home was supporting three people. During the inspection we spoke with four members of staff, including the registered manager and support staff. All of the staff were very motivated, caring and positive about working in the home and praised the teamwork and supportive atmosphere.

We spoke with two people who told us that they received good care and were always asked for their involved in their care planning and nutrition. Their comments included: "I picked my own breakfast today” and “I plan my meals with staff”.

We asked people living at Mossmead about the cleanliness of the home. People told us that they were happy with the standards of hygiene and that the home was clean. People told us "The staff clean the home every day and it’s always tidy”.

We saw that confidential personal information about people was stored securely. The provider had policies relating to record keeping, data protection and confidentiality of records.

We spent time with people before they went out for the day. One person told us they liked living in their home and showed us their collection of soft toys which they had given names to.

It was a positive visit and we could see that people were well cared for and supported. They were happy and positive about 15 Mossmead and the lives they were living. Staff were dedicated and caring. It was evident through observation and in discussions they enjoyed working in the home and supporting people.

During the day we joined a staff team meeting where we found that staff were very knowledgeable about the people in their care. We found that there were appropriate policies, procedures and systems in place to ensure the smooth running of the home.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with three people who lived in the home with varying levels of verbal communication. One person told us they liked living in the home and other people nodded in agreement.

The home had a policy on staff recruitment and induction. Staff said they had completed a Criminal Records Bureau (CRB) when they had been offered the job and that their references had been followed up. We looked at two staff files which contained confirmation of a satisfactory CRB, two references, photographic identification and a job description.

People were given support by the provider to make a comment or complaint where they needed assistance. People told us they would 'say something if they were not happy'. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the three care plans of the people who used the service. The care plans gave detailed information on all aspects of the person's daily life such as, communication, diet, personal hygiene, mental health and emotional well-being, cultural, spiritual and social values.

On the day of our inspection, a new carpet was being laid in the entrance hallway and stairs and in the communal lounge. The homes maintenance team said they were also carrying out small repairs.

We met with two of the people living at 15 Moss Mead. One person was able to tell us they were happy living at the home and that they liked the staff team. The other person was unable to directly give their views about the service. However, we observed that they were clean and well presented and appeared to be happy and relaxed in the company of the staff.

As people could not tell us whether staff were trained to meet their needs, we made observations. We saw that staff supported people appropriately.

We spoke to two healthcare professionals who were positive in their comments about the service.