About the service:

Denecroft Seeability is a residential care home for people with learning disabilities. The home can accommodate up to six people. At the time of the inspection there were five people living at the home. People at the home had a range of learning disabilities.

People’s experience of using this service:

People were cared for by sufficient staff to meet their needs. The management team were still in the process of improving the service in different ways. Staff and relatives all agreed that the home had gone from strength to strength in how it supported people living there. People were interacted with and engaged throughout the day by staff who knew them and made them smile. One relative told us, “I think its an excellent home for my daughter.”

The management team ensured that they worked in line with ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion to ensure that people with learning disabilities can live as ordinary a life as any citizen. The size of service met current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

People’s needs were consistently met and assessed to enable improvements and progress in their lives. Risks to people were assessed and managed to balance people’s safety and right to lead a non-restricted life. There were enough well trained staff to ensure people were supported safely at all times.

People were supported to communicate with their relatives and the managers when they were not happy or wanted to change their support. Staff cared about the people they supported and enjoyed working at the home.

People, relatives and staff were engaged by the service via meetings so that everyone could contribute to the development of the service. There was a credible strategy in place with plans for staffing improvements at the service. This was being implemented by the registered manager who was pro-active in considering how the service could be improved.

Rating at last inspection:

Good (July 2016)

Why we inspected:

This was a scheduled comprehensive inspection. We inspect all services rated as 'Good' within 30 months to ensure that we regularly monitor and review the quality and safety of the service people receive.

SeeAbility - Denecroft Residential Home is a residential home that provides support to up to six people with learning disabilities and who may also have a visual impairment. The home is located in the centre of Guildford. On the day of the inspection there were six people living at the home. The people who live at the home have a range of complex needs and are supported with a full range of daily tasks, including personal care, support with nutrition and activities.

The provider had recently recruited a new manager for the service who had an application in progress 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. The new manager was present during the inspection.

The inspection was unannounced and took place on 5 July 2016.

The service was not consistently safe as we found that the temperature in the conservatory was excessive and uncomfortable for people. Whilst medicines were stored, administered and managed safely we found that improvements needed to be made in relation to ‘as required’ (PRN) medicines and protocols. Medicines audits were not always completed. We have recommended that the home follows the Royal Pharmaceutical guidance regarding this.

People were protected from harm because staff had the training and the ability to understand risk, reported accident and incidents in a timely manner and understood how to report suspected abuse so that action could be taken if necessary. There was a system in place to investigate incidents and accidents to prevent them from re-occurring. Action was also taken to learn from these to help provide better care to people.

Risk assessments had been completed to ensure the home was safe for people to live in and there were emergency arrangements in place should there be an emergency.

People were supported by sufficient number of staff who were recruited safely and had the skills and knowledge to support people.

Whilst the principles of the Mental Capacity Act (MCA) 2005 were being followed on a day to day basis there were some mental capacity assessments that were not in place. We spoke to the deputy manager who said these would be worked on immediately. Despite this staff supported people in their best interests and staff had a good understanding of the MCA. They offered people choices and respected their decisions.

People’s nutritional needs were met and people had a varied diet. Mealtimes were a relaxed affair with people being given adapted cutlery and crockery to help maintain their independence. Where needed staff used pictorial aids to help people choose the food they ate.

Staff ensured people were supported to maintain their health and wellbeing and there were good links with other healthcare professionals.

People were cared for by staff who put people at the centre of all they did. Relatives informed us that they always felt welcome when visiting and that staff were available to speak to whenever they needed to. People were not rushed by staff and were treated with dignity and respect. People were encouraged to maintain relationships with their family and those that mattered to them.

People’s care was person centred and care plans and reviews reflected this. Staff were responsive to the needs and wishes of people. The environment was adapted to support people with a visual impairment and some equipment that had been introduced helped people maintain independence. The manager reviewed support needs regularly and learnt from experiences. People had a say on how the home was run and people and relatives felt comfortable in raising a concern or making a complaint. They told us they felt confident any complaints would be responded to appr

On the day of our visit there were five people residing in the home. All had learning disabilities and were also severely visually impaired. We were met by the team later and then joined by the registered manager. The manager told us that there were plans to relocate the service to another premises in the next few years and that these proposals were currently out for consultation.

We found that people were being asked for their permission to have care and treatment provided to them, and had the right to refuse care and treatment. We also found that staff had a proper understanding of mental capacity issues.

We found that people who used the service and their relatives were happy with the level of care they were receiving. We also found that a proper system of care planning and management was in place.

We found that staff were properly trained in safeguarding, and would be able to identify and report any instances of abuse.

We found that overall there were appropriate staffing levels in the service, and that care and staff were experienced and qualified to fulfil their roles. However we did raise some concerns regarding the arrangements for night time staffing cover.

We found that the provider regularly sought feedback from people who used the service and from staff. We also found they conducted regularly reviews and audits on all aspects of the service

During our inspection visit we spoke to management, staff and volunteers. Many of the people who use the service have complex needs including verbal communication difficulties. Although we did speak with residents the opportunity to obtain their opinion was limited.

A member of staff we spoke with told us "I love working here, to me it doesn't seem like work at all". They also told us "This is such a nice place. The staff and the residents are wonderful".

A volunteer we spoke with told us "I get a sense of fulfilment by helping here. It is lovely to see people encouraged to be independent".

We spoke with a person who used the service and they told us "They look after me here".

Following our inspection we spoke by telephone with relatives of people who live at Denecroft. One relative said "They are always there for my child. The staff are like big brothers and sisters".

People who used the service had complex understanding and communication needs. However, some people were able to communicate with us and some with the support of the care staff.

People who used the service told us that they made choices every day. These included choosing the meals they wished to eat, the clothes they wanted to wear and the activities they wanted to take part in.

People told us that they knew about their care plans and that they attended their annual reviews and that staff talked to them about their care plans.

They said that they were happy living at the home and if they did not feel safe they would talk to staff. They told us that members of staff were kind, they looked after them well and listened to what they said.