About the service:

19 Berryfield Road is a residential care home. It provides accommodation and personal care for up to four adults with a learning disability. At the time of the inspection there were three people living at the service. The home is a semi-detached property in a residential area of Bradford on Avon.

People’s experience of using this service:

People were supported by a small and consistent staff team. People told us the staff were kind and caring and that they had good relationships them. People were encouraged and supported to maintain their independence. 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.

Care plans were person centred and included people’s individual goals for the coming year. People told us they were actively involved in their care plans and that they were supported to attend activities and do the things they wanted to do. People had active and varied social lives.

Regular feedback was sought from people and staff through meetings and questionnaires. People told us they felt comfortable in raising any concerns or issues.

Rating at last inspection: Good (September 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: we will continue our on-going monitoring of the service and all information we receive. We will use theis information to determine when we next inspect the service.

This inspection took place on the 29 September 2016 and was unannounced. At the last inspection on June 2014, we asked the provider to take action to make improvements on medicine management and quality assurance, and this action has been completed.

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

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.

The people we spoke with told us they felt safe with the staff and their comments indicated they were helped to understand what safeguarding from abuse represented. Members of staff were knowledgeable about the procedures for safeguarding people from abuse.

Systems for managing risk were effective. People were able to take risk safely and staff knew the actions needed to minimise the risk to people’s health and welfare.

Plans were in place in the event of an emergency which ensured people had continuity of care, for example in the case of an outbreak of fire.

Staffing levels were maintained with relief and agency staff and recruitment for permanent staff was in progress.

Medicines systems were safe. Medicine administration records (MAR) charts were signed by staff to indicate the medicines administered. Protocols were in place for medicines to be administered as and when required (PRN) by the person.

Staff responded to people in a person centred manner. Members of staff were committed to respecting people’s rights and ensuring people remained independent. People received kind and compassionate care. For example, providing one person with a focus as their dementia progressed. Staff were supporting one person to develop their life story book to share memories and for reminiscing. The staff were motivated and inspired to meet people’s goals. For example, helping one person to organise their birthday celebration and for another to support them with “foreign travel”.

There were opportunities for staff to review individual personal development with the registered manager. Training courses were available monthly to the staff. One to one meetings with the staff were regular and were based on performance, concerns and training needs.

People were able to make decisions that involved their care and treatment. Mental Capacity Act 2005 (MCA) assessments were carried out for specific decisions such as flu vaccines, medicine administration and inserting hearing aids.

Meals were varied. People participated in menu planning and menus were in picture format. We found a good range of food which included fresh fruit and vegetables, tinned and frozen foods.

Systems were in place to ensure people received the care and treatment they expected. Care plans were person centred and included aspects of care people were able to manage for themselves and how they wanted staff to support them with their needs.

People told us they felt confident to raise complaints and they knew who to approach with their concerns. Their feedback about the service was gathered through one to one time and tenants’ meetings.

Quality assurance arrangements in place ensured people's safety and well-being were monitored. The registered manager conducted internal audits and assessed the service. They told us where shortfalls had been identified action plans were developed on how to meet the set standards

During our visit we met two of the three people who lived at the home. The remaining person had gone bowling with a club they regularly attended. We were greeted at the door by one of the people using the service. We were able to spend time with both of the people at the home in private, where they shared their views of the service.

Both people told us they were “happy” living at 19 Berryfield Road. They said they enjoyed the food and drink. One person said they “enjoyed making cakes.” They said the staff supported them well.

We met with one agency worker and two permanent members of staff. Staff confirmed people living at the home had capacity to make their own decisions. Staff had received training on the Mental Capacity Act 2005.

At the time of our visit there was extensive building work being carried out to improve the premises. We saw consideration had been given to ensure the safety of the people living there during this time. One person told us they were looking forward to moving into a new bedroom when the work had been completed.

Staff confirmed there was enough staff on duty to meet the needs of the people living there. Staff confirmed they could use bank staff if necessary.

The provider had policies and procedures in place to enable people to raise a concern, if they wished to do so. Each person had a copy of this information kept in their bedroom. There were no on-going complaints at the time of our visit.

People living in the home were positive about the support they received and evidence suggested that they were consulted and involved in how they wished to live their lives.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that staff received appropriate training and support to be able to meet the needs of people living in the home.

We found the quality of the service was being monitored and evidence indicated that concerns were promptly acted upon. Systems were in place to meet peoples health, welfare and safety needs.

People told us they liked living at 19 Berryfield Road. One person said that it was “like a real home”. Somebody else told us that the best thing about being there was the staff. People could make a lot of decisions for themselves, for example about what to do during the day and the meals they wanted. We saw that people were treated with respect and staff made sure that the home was well maintained and a nice place to live.

People said that the staff helped them with shopping and with doing things they liked such as going to the cinema. They went to different clubs during the week which reflected their individual interests. People had meetings together to talk about the day to day arrangements and any concerns.

People told us they managed a lot of their personal care themselves, but had help when they wanted it. Staff supported people with seeing the doctor and with having health check ups. Overall, the home was meeting people’s needs well.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the care staff gave and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff spoke to people in a caring, friendly and respectful manner. There were many positive interactions between staff and people who used the service. Staff spent time with people and encouraged people’s involvement in conversations and decision making.

Is the service responsive?

Staff were aware of people’s needs and promoted their rights to choice and independence. Social activities were arranged and undertaken in response to people’s preferences and individuality.

People had access to a range of health care services to meet their health care needs.

People had a support plan in place which gave staff detailed information about preferred routines. However, some information was not dated and had not been reviewed to show more recent changes.

Improvements had been made to the environment in response to a person’s decreasing mobility. This included the development of a ground floor bedroom and en-suite facility. A sun-room had been built to enable people more space and a greater choice of seating arrangements.

Is the service safe?

The home was well maintained and there were systems in place to ensure the safe use of equipment. However, measures had not been taken to minimise the risks to people from hot surfaces. This included a towel rail which caused a person an injury and a radiator that was not covered, exposing a very hot surface.

People were relaxed within the vicinity of staff. People were clear about ways in which they could raise a concern. There were various forums for people to discuss their views and any worries they might have.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications from this home had been required. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People were given their medicines in an effective manner by staff who had been trained in the safe handling of medicines. However, the lack of documentation in relation to the application of topical creams and medicines to be taken “as required” increased the risk of inappropriate care and treatment.

Training was given priority to ensure staff had the knowledge and skills to undertake their role effectively. Staff felt well supported and used both formal and informal supervision to discuss and review their practice.

The environment was clean, well maintained and effectively met people’s needs. Staff had undertaken training in infection control and guidance was available as required.

Is the service well led?

The manager had worked at the home for a number of years and knew people well. There were regular meetings to ensure information was shared and views could be given. The systems in place enabled good communication within the staff team.

Whilst senior managers undertook audits as part of their monthly visits, the manager checked practice on a day to day basis. These checks were not recorded and formal audits were not undertaken.