About the service: Talbot Court is a nursing care home that was providing personal care to 8 people who may have a sensory impairment and/or a learning disability and/or autism at the time of the inspection.

People’s experience of using this service:

People were supported by staff that were caring, compassionate and treated with dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

The care people received was person centred care and based on their individual needs and preferences. Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people. We found one individual who had a change in circumstances did not have update to date risk assessments.

People and their relatives told us they felt well cared for by staff. In addition, people told us staff treated them with respect and dignity and encouraged them to maintain relationships and promote their independence.

The provider ensured people had consistency with staff members, as a result people and staff were able to build positive relationships. People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Where people lacked capacity, staff worked with the local authority to make sure they minimised any restrictions on people's freedom for their safety and wellbeing.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

Audits were completed by staff and the registered manager to check the quality and safety of the service. Action was taken to address any issues identified following audit reports.

The registered manager and operations manager worked well to lead the staff team in their roles and ensure people received a good service.

More information is in Detailed Findings below

Rating at last inspection: Good. (Report Published 03 July 2017)

Why we inspected: This inspection was conducted due to concerns we received in relation to alleged neglect of one individual who was currently living at the service. Following our inspection the service remained at an overall rating of good.

Enforcement:

No enforcement action was required.

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.

Our inspection took place on 12 June 2017 and was unannounced.

At our last inspection on 03 November 2014 the service was meeting all of the regulations that we assessed.

The provider is registered to provide accommodation and nursing care to a maximum of ten people. On the day nine people lived at the home. People had complex nursing needs in relation to their learning disability/ associated conditions and or/physical disability.

The manager was registered with us as is required by law and they were present on the day. 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.

Overall, medicine systems confirmed that people had been given their medicines as they had been prescribed. However, some aspects of medicine management needed to be strengthened to enhance the systems further. Staff were provided and available to keep people safe and to meet their needs. Procedures were in place for staff to ensure the risk of harm and/or abuse was reduced. Recruitment processes prevented the employment of unsuitable staff.

Staff received the training they required to give them the knowledge they needed to support people safely. Staff were aware that people’s care must be delivered in line with their best interests and that they must not be unlawfully restricted. Where possible people were encouraged to make decisions about their care. Their families were also involved in decision making. People’s food and drink preferences and special dietary needs were catered for. Input from a range of external healthcare professionals to address people’s healthcare and social care needs.

A homely atmosphere was promoted within the service. People were supported by staff who were friendly, helpful and caring. People were treated with dignity and respect and their independence was promoted. People could see their family whenever they wished to and their families were made to feel welcome by staff.

People and/or their families were involved in their pre-admission assessment of need and follow on reviews. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to. People were offered in-house activities and were given the opportunity to access the community.

People, relatives and staff felt that the quality of service was good. The registered manager had been in post sometime and that promoted consistency of management. The provider had an audit system to determine shortfalls or to see if changes or improvements were needed. However, this had not always identified shortfalls that needed to be addressed.

Our inspection took place on 3 November 2014 and was unannounced.

The home is registered to provide accommodation and nursing care to a maximum of ten people. The people who lived there had a range of conditions the majority of which related to a learning disability. Due to their needs the people who lived there could not give a detailed account of their experiences about living at the home. On the day of our inspection only seven lived people there.

A manager was registered as is required by law. 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.

At our last inspection on 1 October 2013 the provider was meeting all of the regulations we inspected.

During this inspection staff we spoke with understood their responsibilities to protect people from harm and abuse. People and their relative’s told us that the people who lived there were safe. We saw that there were systems in place to protect people from the risk of harm and abuse.

Our observations and conversations with staff and relatives confirmed that staffing numbers and the skill mix of staff was adequate to meet people’s needs and to keep them safe.

We found that people were happy with the meals on offer. We saw that they were supported to have a nourishing diet and drinks were offered throughout the day so that they were less at risk of dehydration.

We saw that interactions between staff and the people who lived at the home were positive. Staff were friendly, polite and helpful to people.

We saw that people were supported to take part in individual interests and leisure time pursuits in the home and in the local community.

We found that people received care in line with their best interests. People who had restrictions placed on them to prevent the risk of harm were protected by staff that operated within the law.

Staff told us that they were provided with the training that they required. This ensured that they had the skills and knowledge to provide safe and appropriate care to people. Staff also told us that were adequately supported in their job roles.

We found that a complaints system was available for people to use. Relatives told us that if they raised issues that they were addressed satisfactorily.

We found that quality monitoring processes were in place to ensure that the service was run in the best interests of the people who lived there.

This repeat inspection was unannounced. No one knew we would be inspecting that day. There were ten people living there at the time of our inspection. We spoke with two people who lived there, five staff, and to the manager by telephone. One person who lived there told us, “I like living here”. Another person answered, “Yes” and smiled when we asked if they liked the staff. Staff confirmed that improvements to the premises and staffing levels had been made. One staff member said, “The staffing levels have been increased and it is much better”.

During our previous inspections of April and July 2013 we found that repairs to the roof were needed. We also noted that the back of the fixed bath seat on the assisted bath was damaged. The evidence we gathered showed that people were not being assured that repairs to the building or replacement of equipment was being undertaken quickly. During the same inspections we found that staffing levels were not adequate to meet people’s needs and to keep them safe. We carried out this repeat inspection to find out if improvements had been made and we found that they had.

We looked and we saw that the required repairs to the roof and bath chair seat had been completed. This meant that people living there were less at risk of injury due to the premises being unsafe.

All staff we spoke with confirmed that staffing levels had been increased. This was confirmed by staff rotas we looked at and the manager we spoke with by telephone. This meant that staffing levels could better ensure that people’s needs would be met and that they would be safe.

There were ten people living at the home on the day of our inspection. No one knew we would be visiting. During our inspection we spoke with four people who lived at the home however, communication with some people was very limited.

During our inspection of this home in April 2013 we found non-compliance with two outcome areas; care and welfare and staffing levels. We identified that improvement was needed as people were placed at high risk of stress and injury due to the non-compliance. We carried out this inspection to find out if improvements had been made and found the issues concerning care and welfare had improved but those regarding staffing still required improvement.

People we spoke with were all very positive about their home and the staff. One person said, “I like it.” Another person smiled and nodded their head that showed that they were happy.

We found that the reassessments of people’s needs were being undertaken and that care plans were being reviewed. We found that action had been taken by staff which made sure that people’s needs were being met and that their good health was being promoted.

Although we raised the issue in our last report we found that repairs to the roof had not been made. The damage of the roof mortar remained a risk to people, which could place them at risk of injury.

We found that staffing levels had not improved enough. Therefore the registered provider could not give assurance that people would always be safe or ensure that their needs would be consistently met.

There were ten people living at the home on the day of our inspection. No one knew we would be inspecting that day.

People we were able to speak with were complimentary about the home. One person said, “Yes I like it”. Another person nodded and smiled when we asked if they were happy.

As people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. Our observations showed that the care provided was ‘task’ orientated rather than being person centred. We observed instances when people’s needs were not adequately addressed and were told that activity provision was limited.

We observed that people were given the support and encouragement that they needed to eat and drink sufficiently to prevent ill health.

We looked at parts of the premises and identified a few areas that needed attention. However, overall we found that the premises were clean and safe.

Staff highlighted that due to people’s increasing needs they found it difficult to provide a personalised service. Our observations showed that at times there were not enough staff available which had an impact on people’s welfare.

We saw that a complaints procedure was in place. Staff we spoke with were aware of complaints processes and what they should do if the people they cared for were unhappy.

At our previous inspection of 19 October 2011 we found that there needed to be improvement with weight monitoring, care planning, some aspects of medication management and the quality monitoring systems to be compliant with regulations . We carried out this inspection to find out if improvements had been made in these areas and found that they had.

The people living at the home had a learning disability and not everyone was able to tell us about their experiences. As people were not able to tell us about their experiences, we used a formal way to observe people during our inspection to help us understand their experiences better. We call this a Short Observational Framework for Inspection (SOFI). We spent two hours in a communal area, observed a total of four people and recorded their experiences at regular intervals. This included people’s state of well being, how they interacted with staff members and other people who lived at the home and the environment. This helped us to understand what it was like to live there.

We did not see any poor interactions. We saw staff spending time with people and giving them attention. We saw that there were positive relationships between staff and people living at the home. When staff approached people, people responded by smiling and laughing.

We saw that staff treated people with respect and dignity and understood how to communicate with them in a way that they understood. People told us and we saw that choices were offered and that people’s views were sought and taken into consideration.

Relatives were not available during our inspection so we were not able to find out their views about the home. However, we looked at questionnaires that had been completed by relatives recently about the quality of the service provided and saw that positive comments had been made. One relative made the following comment "I have been visiting Talbot Court since 2004 I have always been impressed by the caring staff and the individual attention given to resident's". Another relative made the following comment "Resident's have their own likes and dislikes and these are known by staff".

We found that the atmosphere was friendly and happy. Three staff we spoke with told us that the home was always friendly and happy. Staff told us that they enjoyed working at the home. One staff member said "I think that we provide wonderful care here. People are happy, safe and well looked after". Another staff member said "We are one big happy family".

We found that people's needs had been assessed by a wide range of health professionals including speech and language therapists, physiotherapists, specialist doctors and the optician. This meant that people's health care needs were being monitored and met.

We found that medication systems and processes were safe which meant that people were protected as they were being given their medication as their doctor had prescribed.

Staff received a range of training which included caring for people with a learning disability and abuse awareness training, so that they had up to date knowledge and skills in order to support the people who lived at the home and keep them safe. Staff we spoke with knew about people’s needs and personal wishes. This meant that care could be provided in the way that people wanted it to be.

We saw that community based activities were offered to suit people's individual needs and choices. People nodded and smiled when we asked them about activities that they had been involved with recently.This showed that they were happy with the activities being provided.

We sampled personal records for three members of staff. We found that recruitment checking processes were robust and thorough which meant that unsuitable staff were less likely to be appointed so people were at less risk of harm.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

The location is registered to provide accommodation and personal care to a maximum of ten people who have a learning disability. At the time of our visit there were nine people living at the location. There was one vacancy.

We arrived at the location early and were fortunate in that we were able to meet all nine people.

We spent the day observing people, their routines and interactions with staff. Due to limited communication we only spoke with or engaged with three people living at the location. People indicated that they were happy living at the location.

Below are a few examples of what they said to us;

“I like it here”.

“The staff are nice”.

“I like my room and going out. We have been on holiday”.

We found that the atmosphere at this location was positive. The staff team were happy in their work and were committed to provide a good service to the people who live at this location. Staff told us;

“I don’t work here for the money. I enjoy my job. I like assisting and helping people to have a good life”.

“The people here are very well looked after. We have good staffing levels so we can take people out and spend time with them”.

“I think everyone here is free from harm. We would not allow it any other way”.

We found some shortfalls that could place people at risk. Medication systems are not as robust and safe as they should be. Record keeping was not being maintained as it should have been. The weighing scales had not been working since June 2011 so weight monitoring had not been carried out.