About the service:

Barron Winnicott Home is a residential care home. It was providing accommodation and personal care to eight people who are Deaf or Deafblind and who have additional complex needs at the time of the inspection.

People’s experience of using this service:

• There were enough staff to meet people’s needs, although regular agency staff were used. The provider was actively recruiting to vacant posts, but everyone we spoke to during our inspection expressed concerns about staff changes and vacancies. People’s care needs continued to be met and staff provided individualised support.

• Staff felt supported by the management team, and received training, induction and supervision so that they could effectively perform their roles.

• People’s care records were personalised and identified what was important to them, although some sections were incomplete or had not been updated recently. The registered manager planned to address this.

• The environment was designed and adapted to meet people’s sensory needs. The registered manager had submitted a bid for funding to redecorate some areas. This would refresh the overall feel of the service.

• Risks to people and staff had been assessed and effective measures were in place to manage risks.

• Staff carried out checks and audits regularly at the service. Actions had been identified and were being addressed to improve the service and provide high quality care

• People were supported by staff who were kind and respectful. Staff knew people well, and knew how to communicate with individuals. People were happy living at the service, and they told us that staff were kind and caring.

• People were protected from the risk of harm. Policies, procedures and checks were in place to protect people and staff.

• Staff supported people individually to ensure their medicines were administered as prescribed and managed safely.

• People enjoyed a wide range of activities. Activities were meaningful and chosen by individuals.

Rating at last inspection:

Good (report published 13 October 2016)

Why we inspected:

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

Follow up:

We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.

This inspection took place on 21 and 23 September 2016 and was unannounced. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.

Barron Winnicott is registered to provided accommodation and care for up to nine deaf adults who may need additional support for conditions such as autism, learning or physical disability or their emotional development. At the time of our inspection there were eight people living at the service.

A registered manager was in post at the time of the inspection. 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’s medicines were managed and received by people safely. Staff had received training in ‘Care of Medicines’. People had the right to choose to manage their own medicines if they wanted to, with appropriate support from the service.

There were sufficient staffing levels to keep people safe and support the health and welfare needs of people living at the service.

People were protected from the risk of abuse. Staff demonstrated a good understanding of abuse and knew the correct action to take if they were concerned about a person being at risk. Staff had received training in safeguarding adults.

Risks to people were assessed and where required a risk management plan was in place to support people to manage an identified risk and keep the person safe.

People’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Staff understood the importance of promoting choice and empowerment to people when supporting them. The service enabled people to make their own decisions and assist the decision making process where they could.

People were supported by well trained staff that had sufficient knowledge and skills to enable them to care for people.

People’s nutrition and hydration needs were met. People had enough to eat and drink to keep them healthy and had good quality, quantity and choice of food and drinks available to them.

We observed that people were treated with kindness and compassion by the staff. Staff were committed and passionate about their role.

The service was responsive to a person’s needs. A care plan was written and agreed with individuals and other interested parties, as appropriate.

The service reviewed the person’s activities, aims and objectives annually. They sought the person’s views on the service provided and future goals. People were actively encouraged and supported to be involved in making decisions about their educational programme.

People were encouraged to maintain contact with their family and were therefore not isolated from those people closest to them.

Staff felt well supported by the registered manager. Staff were confident and knowledgeable of all aspects of the service. The registered manager encouraged an open line of communication with their team. Staff members confirmed that they would approach the registered manager if they had any concerns.

Through regular care plan meetings people and their representatives were encouraged to provide feedback on their experience of the service to monitor the quality of service provided.

To ensure continuous improvement the Head of Service conducted regular compliance audits. They reviewed issues such as; attendance, risk assessments, fire safety, day to day maintenance and health and safety checks. The observations identified good practice and areas where improvements were required.

The manager told us "people can choose what they want to do during the day. Some people go to college and others do projects like arts and crafts in the home. We saw examples of the work people did. The manager told us “we recently had an open day and lots of people were very interested in the art work we produce. We raised a lot of money."

We saw all the staff were caring and kind in their manner towards the people who use the service. We saw they communicated with people in a thoughtful and considerate way.

Staff received mandatory training and refresher courses in areas like safeguarding, health and safety and infection control. There was also training in areas like challenging behaviour and autism to assist staff members deliver care safely.

Health and safety audits and risk assessments were completed about the use of the premises and equipment. Other checks included fire equipment checks, portable appliance tests, and electrical checks and there was a maintenance log for repairs to the home.

We saw that the manager monitored and analysed the levels of accidents, incidents and complaints to ensure people who lived in the home were safe.

Because people had varying levels of hearing loss, staff communicated in different ways. For example, by use of sign language, pictures, photographs and by gestures. In addition, staff interpreted for us throughout the visit.

There were seven people living at the service at the time of our inspection. We spent time observing care practices, talking to people and looking at records.

We saw that people’s needs were assessed and support was planned and delivered in line with their individual care plan. People were involved in their care.

We saw that staff were respectful and caring. Staff gave time for people when they needed it. One person told us they were "very happy here". One staff told us they felt their role was all about "promoting independence" and "getting people out doing things, college courses etc".

We met with four people who used the service. People told us they were involved in their support plans and activities. One person told us they "keep busy". Another person told us they "make cakes". People told us that they felt safe and were able to talk to staff if they had any concerns.

Care plans reflected each person’s individual communication needs and preferences. We saw people were involved in developing their own pictorial versions where they did not read. Families were encouraged to be involved as much as possible.

The service had a system that identified people's concerns and acted upon them. All complaints were addressed straight away.

When we visited Barron Winnicott we took an 'expert by experience' with us. The expert by experience in this case was someone who is deaf themselves and has experience of communicating with deaf people with complex needs. We took an interpreter with us to further assist our communication with the ‘expert by experience’ and people who use the service. The purpose of involving an expert by experience is to help us understand the views of people using the service.

We saw that staff members acted promptly when people asked them for assistance.

One person told us “I can’t wait to see my new bathroom”.

One person told us “The staff are fine but some don’t sign very well, it would be great if all staff sign could sign well, but they can’t”.

We saw that the staff who were on duty, at the time of our visit, were caring and

kind in their manner towards the people who use the service. We saw them helping people in a thoughtful and considerate way. They were able to convey to us a good

understanding of the needs of people who use the service and what kind of care and support each person needed.

A staff member told us that people can be given “confusing messages”. They told us “We are doing something one way and then the management does it another way”.