About the service:

• Park House is residential care home providing personal care for up to four people with a learning disability.

• At the time of the inspection it was providing a service to four people.

• 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.

People’s experience of using this service:

• People at the service were kept safe, staff had an understanding of their safeguarding responsibilities and knew how to identify abuse.

• People were encouraged to take positive risks in their lives and risk assessments were in place to protect people at the service and reduced the risk of harm people may face.

• Relatives were happy with the service and told us their family member was kept safe.

• People were looked after by staff who had gone through a thorough recruitment process.

• Accidents and incidents were recorded and analysed by the service. Staff told us they took part in debriefing sessions after the incident to learn from the incident to prevent it happening again in the future.

• People’s medicines were managed safely and safe practices were followed in the administration of medicines.

• The service was clean and free from malodour, hand washing guidelines were displayed to minimise the risk of infection.

• People were assessed by the service before being placed and staff observed people at the service to ensure care was being provided in accordance with their care plan. People’s nutrition and hydration needs were met by the service and healthy eating was encouraged.

• Staff were supported to give effective care as they received appropriate training relevant to their role, supervision and appraisal.

• People were comfortable with staff and staff spoke in a kind and caring manner to people. Relatives thought staff were caring and treated people with respect.

• People’s care plans were personalised and regularly reviewed and updated as the needed.

• People were supported to communicate in a way that helped them as the service provided information in easy read format.

• There was a complaints policy, there were no complaints made by people living at the service. Complaints received from outside the service had been responded to promptly.

• The service had strong quality assurance processes to check the quality of care people received and systems to drive improvement.

Rating at last inspection:

• Good (report published 7 March 2017)

Why we inspected:

• This was a planned inspection based on the previous rating.

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 made two recommendations in our inspection report on diversity in care planning and documenting people’s end of life wishes. We will follow these up at our next inspection.

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

This inspection took place on 23 January 2017 and was unannounced.

At our previous inspection on 5 and 6 August 2015 there were four breaches of legal requirements due to a lack of person centred care planning, people not being protected from risks, poor maintenance of the home and people not receiving one to one staffing that they needed. At this inspection we found improvements in these areas. Care plans had improved but were still not fully person centred. People were protected from risks to their safety and were receiving the one to one staffing they needed. The maintenance of the home had improved but there were maintenance issues outstanding at the time of this inspection.

Park House provides accommodation and care for six people who have a learning disability, some of whom also have mental health needs, an autistic spectrum condition and other complex needs. At the time of this inspection there were six men living at Park House. Each bedroom has ensuite bathroom and one of the six rooms is a flat where a person could live more independently.

We found that the person registered with us as manager was no longer managing the home. A new manager had been appointed and they were in the process of applying to become the 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 2008 and associated Regulations about how the service is run.

People living in the home gave us positive feedback including a comment that, “the standard of care is good, it’s excellent.” Another person said, “mostly it’s good. There’s just tiny things…” and, “They’re doing a real good job.” Another person signed to us that staff were his friends which suggested he felt comfortable with staff. Staff had formed good relationships with people and were able to describe their needs and personalities well.

People’s families gave mixed feedback about the home. The comments ranged from, “I couldn’t think of anywhere nicer” to saying the communication between the home and the family was “poor” and being unhappy with the care provided. People who had lived at the home for longest and their families were the most satisfied. Some families felt their family member would benefit from a more specialised service.

People received support with their medicines and health care needs and were happy with the food.

Staff were happy with the training provided to them and felt well supported by the manager and the provider, Sequence Care Group. People received support from the provider’s multidisciplinary team which included a psychiatrist, psychologist, speech and language therapist and occupational therapist.

People were supported to have choice and control over their lives as much as possible. Four of the six people were living a good quality of life, going out every day, following their interests and maintaining regular contact with their families. Staff were trying to support the other two people to lead a more active life.

We made two recommendations at this inspection. One was to ensure people had suitable handwashing facilities and support to wash their hands. The other recommendation was to arrange a more responsive and timely repair and maintenance service.

We made this follow up inspection because when we last visited the hospital in April 2013 we were concerned that the regulations relating to requirements relating to workers and monitoring of the quality of care and treatment were not being met. On this visit we found that there were plans in place to ensure the appropriate recruitment checks would be carried out next time a vacancy occurred. Job descriptions had also been reviewed and future job applicants would require more experience for some grades of post. We also took the opportunity to make checks on the care and welfare of people who used the service.

We saw evidence that data was being gathered and analysed to help to improve the service. We saw that this information was informing patients' care plans and risk management plans. There was learning from experience. Members of the multi-disciplinary team were frequent visitors to the hospital, three were present for part of our visit.

Four care files were reviewed and were found to be up-to-date with good quality information. We spoke with and observed three of the four patients who were present on the day of our visit. We saw that they were comfortable with the staff on duty. When we asked staff members to explain patients' needs to us, their answers showed that they knew them well. Staff members felt they received good support from others within the team as well as management. One relative spoke to us by telephone.

There were five men living at Ferme Park House at the time of our inspection, three of whom were detained under the Mental Health Act. We met the men but we were only able to speak briefly with them. We also spent some time observing people to see what their experience was like.

We were able to ask one person what it was like to live at Ferme Park House and he said, "it's a bit noisy." We were not able to get any other comments from people. We arrived when people were waiting to go out so we had limited opportunity to talk to people, but we did observe some confusion as people did not have clear plans for what they were doing.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that staff treated people with kindness and patience. People were supported to go out regularly to a variety of places and staffing levels were good. Some staff did not have sufficient training on learning disability and autism to fully understand people's needs. We found that staff's conduct in previous employment had not always been checked and some staff had no previous experience of working with this client group which meant there was a risk of there not always being enough suitably qualified, skilled and experienced staff to meet people's needs.

We found that there was not enough evidence of a robust quality assurance system and lessons being learned from incidents.

We met five of the six people living at Ferme Park House. Four of the six people were detained there under the Mental Health Act. One person was in bed all day so we did not have opportunity to meet him. We spoke to four people individually. The other person was not able to talk with us so we read his care records and observed his experiences on the day of the inspection.

The four people who talked to us said they felt safe at Ferme Park House and liked living there. Comments included; "it's fine, " "it's alright," "I feel safe here, the other people are fine," "everything is alright" and "It's a good place." One person told us they were very happy and it was better than other hospitals that he had been in. He said Ferme Park was "wonderful" and "excellent."

We spoke with relatives of two of the five patients. They told us:

“I feel that my son is generally treated well by staff members but there are some areas that could be better. I would like to see better continuity of care. Staff changes can upset my son as he likes routine. I would like staff to listen to my points of view more frequently, and also explain things clearly to me. I’m not sure if he has a care plan but we do have monthly reviews sent to us by e mail and are invited to attend meetings”

“I am satisfied with my son’s care. The staff are very good and respectful to my son and to us but I feel that, at times, I have to ’keep on top of things’ to make sure that they get done. He has a care plan in place, which is reviewed three times a year but I would like more frequent reviews. I worry that he is sleeping too much during the day but realise that he doesn’t sleep well at night. He goes out supported by staff and does engage in various activities”.

There were five patients at the hospital when we visited. Their comments to us included:

“It’s boring here”

“It’s alright here. I go to restaurants, cafes, the cinema and the staff take me for long drives. They take me wherever I want to go. I have enough to do and they help me with my religious needs. The food’s good, there’s a choice and I get support to keep healthy. It’s noisy here, but I feel safe and I have never seen anyone getting hurt”.

A patient told us that he had a care plan and kept his own copy of it.

This inspection took place on 5 and 6 August 2015 and was unannounced. The previous inspection was on 10 October 2013 which was a follow up inspection to check if improvements had been made in the areas of staff recruitment and monitoring the quality of the care. We found the service was meeting those standards at that inspection. At the time of the last inspection this service was a small independent hospital for people with a learning disability. Since then, it has changed to become a care home. There is no longer any nursing care provided.

This care home provides accommodation and care to up to six people who have a learning disability, some of whom also have an autistic spectrum condition or mental health need and associated challenging behaviour. At the time of this inspection there were five men living in the home in single bedrooms with ensuite facilities.

The service had 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 2008 and associated regulations about how the service is run.

We found people were cared for by staff who knew their needs well. Staff supported people with their personal care and to take part in activities such as shopping, eating out, visiting family and physical exercise such as the gym, football or walks.

Staff supported people with their physical and mental health needs but one person’s health needs may not have been fully met due to the lack of a detailed care plan for some health conditions.

People’s care plans contained information setting out how each person should be supported. There was limited evidence of people being involved in planning their own care or having copies of a care plan that they could understand.

People were lawfully deprived of their liberty where appropriate for their own safety and they were involved in this decision making process.

People were supported by professionals employed by Sequence Care Ltd including psychologist, speech and language therapist and art therapist.

Senior staff from Sequence Care Ltd visited the home on a regular basis to carry out audits and tell the registered manager what improvements were needed. They then checked if the improvements were made at the next meeting.

We found breaches of four regulations. People’s staffing needs were not being consistently met as they were not receiving all the one to one staffing hours they needed. People were not always protected from the risks of aggression from others. People’s medicines were not always managed safely. There were some maintenance issues in the home which needed to be acted on to ensure the home was safe and well maintained. People were not fully involved in planning their care as their views were not recorded in their care plans. The provider, Sequence Care Ltd, had not ensured these concerns were acted on quickly through their auditing process.

You can see what action we told the provider to take at the back of the full version of the report.