About the service:

18 Boundary Road is a small care home providing support to three people with learning disabilities.

People’s experience of using this service:

People told us they felt safe living at the service. The staff we spoke had attended training in safeguarding of people at risk. They described safeguarding procedures which included how to identify the signs of abuse and reporting of concerns.

Care plans were person centred and people were present while we reviewed their care records. They told us how they were supported by the staff.

Individual risks to people were assessed and action plans devised to ensure people were able to take positive risks. Action plans on how to minimise risks were in place for people that were identified at risk of harm.

People told us there were staff on duty at all times. Rotas confirmed additional staff were rostered three times per week to support people with maintaining their independent living skills. One member of staff was on duty at all other times.

Medicines were managed safely. People knew the purpose of their medicines. There were people who were competent to self administer their medicines and records were in place to support this decision.

The home had the appearance of a domestic dwelling. People told us they were in the process of choosing colour schemes for all areas of the home.

We were invited into people’s bedrooms and we saw their personalities reflected. People told us they participated in household chores. Cleaning schedules were in place and staff were responsible for the overall cleanliness of the home

The staff on duty told us the training officer managed all training. This member of staff said there was mandatory training set by the provider. Staff had regular one to one supervision meetings with their registered manager.

People told us menus were devised weekly. People made their own refreshments and prepared their breakfast and lunch. The evening meal was prepared by the staff.

People were supported by staff with their ongoing healthcare needs.

The abilities and skills of people had improved since our last inspection. The people we spoke with were more confident and told us how their independence had improved within the home and in the community. People made all their decisions and told us their choices were respected.

Quality assurance systems were in place. Action plans were introduced where shortfalls were identified.

Rating at last inspection:

The service was rated as Good at the comprehensive inspection dated 5 September 2016

Why we inspected:

This inspection was a scheduled inspection based on previous rating.

Follow up:

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

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

This service provides accommodation with personal care to three people with learning disabilities. This service was last inspected in December 2013 and all standards inspected were met.

A registered manager was in post but at the time of the inspection was on an extended period of leave. We were informed about the absence and the arrangements for the day to day management of the home. We were told the area manager was to take over line management responsibilities. 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 three people we spoke with said they felt safe living at the home and the staff made them feel secure. Members of staff knew the types of abuse and the responsibility placed on them to report allegations of abuse.

Risks were assessed and action plans developed to minimise the risk. Members of staff were knowledgeable about the actions they must take where risks were identified. For example epilepsy and for self-administration of medicines.

People said they had the attention they needed but there were staff shortages. Staff said the relief staff used were known to people. The area manager said during the registered manager’s absence, relief staff were being used to cover these hours.

Safe systems of medicines were in place. Staff supported people who were able to take control of their management of medicines which included ordering, storing and administration. Members of staff signed medicine administration records to indicate the medicines administered. Protocols which gave staff guidance on administering homely remedies such as pain relief from a stock supply were in place. The medicine cabinet was located in the bathroom and although there were checks of temperature of the cabinet, it was not taken at the time the shower was being used. This meant the temperature could be above the recommended levels.

Staff said they had an induction when they started work for the organisation. They said the induction took six months to complete and included shadowing more experienced staff. There was essential training set by the provider which the staff attended and included safeguarding of vulnerable adults from abuse, medicine and epilepsy. However, relief staff said they did not have refresher training to update their knowledge and skills.

People told us they made their own decisions about their care and treatment. Where there were concerns about people’s ability to make specific decisions Mental Capacity Act (MCA) 2005 assessments were undertaken. People were not subject to continuous supervision in the home and within the community.

People said they prepared their breakfast and their lunch, they made decisions about the menus and staff prepared the evening meal. We saw people make their lunch and refreshments and discuss with staff the evening meal to be prepared.

A record of healthcare visits was maintained. Health action plans were developed on how people were to be supported with their health care needs. People told us the staff knew how to meet their needs and were supported with their on-going healthcare. They said they were independent and needed minimal support from the staff with personal care

People told us their rights were respected by the staff. For example, staff knocked on their bedroom doors before entering. Staff gave us examples to describe how they respected people’s privacy and dignity.

Support plans described the person’s ability to manage their care for themselves and on how staff were to assist the person to meet their needs. Daily routines described how people spent their day in the home and the activities participated in. People knew information about them was kept. They said discussions on how staff wer

At the time of our visit there were three people living at the home. One support worker was available for the whole period of our visit. Staff we spoke with told us “Staffing levels are good here, we cover shifts amongst ourselves”.

People told us they felt their needs were met at the home by the staff and they were happy with the care and support they received. One person told us “I am quite independent but it is nice to know the staff are here to support me with the things I cannot do”.

People living at the home told us their dignity and privacy was respected. One person told us “I like to have a lie in on the weekends and staff are respectful and do not disturb me”.

People told us that care staff had sat with them to discuss what was recorded in their plans, involving them in their care planning. One person told us "We have meetings to discuss my care plan file and I have to decide what goals I would like to achieve".

People with spoke with during the visit made the following comments when we asked them how they were looked after “I have lived here for over 15 years and I would not like to live anywhere else, I am happy here” and “The best thing about living here is that I am encouraged to maintain my independence and I can go out whenever I like” and “I receive very good support from the staff and they have really helped me”.

People were given support by the provider to make a comment or complaint where they needed assistance. People living in the home told us “I have a leaflet on my bedroom wall which tells me how I could complain”

People that we spoke with during our visit told us "The staff are very nice and supportive of us, we always know which staff member is coming on duty next” and “I feel we have enough staff here to support us. Nothing is to much trouble”

The kitchen area was clean and tidy. We observed people being supported by staff to prepare snacks using colour coded knifes and chopping to prevent cross contamination with other foods. We saw that people were encouraged to wash their hands before and after completing this task.

The shared lounge had been decorated to a good standard and lounge furniture was very comfortable and in good condition. People living at the home told us “I really like this lounge and the colours” and “I helped choose the colours of this lounge”.

We saw natural, positive interactions between staff and the people living in the home. A person living in the home told us the staff recognised it was their private home, together with the others they shared the house with. They said they got up and went to bed when they chose.

We saw someone help themselves to items from the fridge to make themselves lunch when they were ready. They were then going out to meet a friend, as they had arranged. We saw how another person was supported to prepare for a shopping trip. They were reassured about where to go for the items they had listed, and how much money they might need.

People in the home had a monthly meeting to share information, ideas and wishes with the staff. They had person-centred support plans and health action plans. A person was receiving the help of an external advocate to help make sure their support matched their needs. The people living in the home decided together on their weekly menu.

The shared lounge was very comfortable and matched the gender and ages of the people in the home. The two bedrooms we saw were highly individualised and people seemed to be proud of their rooms.

People had an ‘easy read’ pictorial information sheet about how to raise complaints and we saw a person had displayed this in their room.