Fiennes House Residential Home provides accommodation and support for up to 12 adults with multiple disabilities. At the time of the inspection there were 11 people living in the service with varying degrees of visual impairment, moderate to severe learning disabilities and mobility needs.

We were only able to have limited interactions with people because of their language difficulties. We relied mainly on our observations of care and our conversations with people’s relatives and staff to understand their experiences.

At the last inspection in December 2014 the service was rated Good.

At this inspection in August 2017 we found the service remained Good.

Why the service is rated Good:

People remained safe at the service. Relatives felt people at the service were safe. There were sufficient staff on duty to meet people’s needs and meaningfully engage with them. Recruitment procedures were safe. Detailed risk assessments were completed to help manage identified risks. People received their medicines safely and as prescribed. Regular checking of the service environment and testing of the equipment used within it had been conducted.

People continued to receive effective care. Staff received training to ensure they had the required skills and knowledge to effectively support people. People’s healthcare needs were monitored by staff and advice was sought when needed. The service demonstrated a firm understanding in applying the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People received adequate supported to eat and drink.

The service continued to provide a caring service to people. Relatives commented positively on the staff and the care provided by the service. People appeared at ease with staff and we observed positive interactions when staff communicated with people. Staff understood people well, including showing a detailed knowledge of people’s non-verbal communications to express their needs or mood.

The service remained responsive. Care and support was personalised to each person. Care records were detailed and highlighted people’s communication methods and ability. People’s relatives felt the service was responsive to people’s needs and most felt informed about the care and support provided to their relative. There was a complaints procedure in operation and the service had acted in accordance with this procedure when needed.

The service continued to be well led. There was a registered manager in post and people’s relatives spoke positively about how the home was managed. Staff told us the management within the service were open and approachable and commented positively on the current staff team. The registered manager was actively involved in giving care and support to people. There were systems that monitored the health, safety and welfare of people at the service and the service had links with the local community.

Further information is in the detailed findings below.

This inspection took place on 18 December 2014 and was unannounced.

The service provides accommodation and support for up to 12 adults with multiple disabilities. At the time of the inspection there were seven people living in the home with varying degrees of visual impairment, moderate to severe learning disabilities and mobility needs. People had very limited verbal communication skills and they required staff support with their personal care and to go into the community.

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 were only able to have limited discussions with people living in the home because of their language difficulties. We relied mainly on our observations of care and our conversations with people’s relatives and staff to understand their experiences.

People received care and support in line with their personalised care plans and appeared to be happy with the staff who were supporting them. People often responded to staff with smiles or happy noises. One person’s relative told us “The staff are very caring. As far as I’m concerned the care is excellent”. Relatives were happy with the general standard of care but some thought the service could do more to improve people’s quality of life.

People were supported to maintain their family relationships. Relatives told us they were made welcome and were encouraged to visit the home as often as they were able to. Most people’s relatives lived out of the area and staff supported people to visit them several times a year.

Personalised communication plans were in place to help staff understand the ways people expressed themselves. This included tone and noise vocalisations, facial expressions, body language, touch, and sign language or symbols for people who had sufficient sight. Staff checked with people before providing care or support and then acted on people’s wishes. A member of staff said “We like to think people enjoy a good life here. Our priority is to ensure people are happy”. Where people lacked the mental capacity to make certain decisions about their care and welfare the provider knew how to protect people’s rights.

There were enough staff to meet people’s needs and to care for them safely. Staff received tailored training in how to support each person’s complex needs. Staff said they worked together as a supportive team and management were approachable and supportive. The service used local links to ensure people with disabilities were valued and involved within the local community.

People were supported to maintain good health. The provider had their own team of therapists and visual facilitators and worked closely with local health and social care professionals. Outside professionals visited the home or staff supported people to attend appointments according to people’s individual needs and preferences.

The provider participated in a range of forums for exchanging ideas and best practices. This helped the service to maintain standards of care and promote further service improvements.

At the time of our inspection visit there were six people at home, two were out participating in activities. We met and spoke with two people who used the service and the five staff who were on duty. We spent time observing how people were supported by staff. We looked at three care records and records for the management and administration of the service. We used information from the provider’s own quality assurance processes. We spoke with two relatives following the inspection visit. We used information from the local authority and Somerset Continuing Care NHS professionals. We also used information we had received about the home since the last inspection in March 2013.

We reviewed how the service administers medicines because of reports of incidents of errors where medicines were omitted or given at the wrong time. We reviewed the processes of how medicines were administered, recorded and stored and found that appropriate systems had been implemented to ensure they did not reoccur.

When we spoke with relatives we were told, “X enjoys living at Fiennes House, and since X has been there he has ‘spread his wings’ and become more independent and enabled to make decisions.” They added “Top marks!” Another relative said, “They have done so much for X, makes decisions for himself and appears to have grown up.” Relatives told us about their experiences with staff. They had observed, “Staff had a good understanding about people.” And “Staff are really, really lovely.”

There were eight people living at the home on the day of our visit. We met with all of them however the majority of people were unable to share their views and experiences with us verbally due to their communication difficulties. We spoke with two people living at the home and we spent time observing the care and support offered to people. We spoke with two family members and six members of staff. Following the inspection we spoke with two health care professionals.

We saw that staff treated people with respect, and their approach was friendly and inclusive. We saw staff offered choices to people and encouraged people to make decisions about daily activities. We received positive feedback overall from parents and health care professionals. One parent said, “Staff are very caring”. Health professionals told us they did not have any concerns about the service. One told us, “They take our instructions on board”. Another said, “The service has a person centred approach”. Both professionals felt that the home managed complex needs well.

We found that the home was meeting the outcomes we inspected. The provider acted in accordance with legal requirements where people did not have the capacity to consent. People were cared for in a clean, hygienic environment. People were protected by the effective recruitment and selection processes in place. There was an effective complaints system available which meant that complaints people made were responded to appropriately.

The people living in Fiennes House had extremely limited verbal communication. We observed care and spoke with staff to find out people’s experience of the home.

We found that staff spent a great deal of time explaining things to people in ways that suited people’s communication needs. When staff talked or approached people they positioned themselves at an appropriate level to help people either hear or see them. Staff were respectful, caring and patient.

Staff offered people choices in what they wanted to do and what food and drink they preferred. Staff told us that people were always offered choices, they gave examples of how they ensured people were involved in decisions, such as, what they wanted to wear, what to buy when shopping and what food they preferred on the menu each month.

People attended care reviews with the support of staff to ensure they were involved in decisions about their care.

On the day of the inspection one person went out swimming with the support of two staff. Some other people in the home had stories read to them by a volunteer. Staff told us there was less time to spend with people on a one to one basis since the day centre people used was closed. We were told that staff advocated on behalf of people to review the services people received. Staff said that any suggestions they had made in the past to improve services had been listened to and acted on.