About the service:

The Bungalow is a residential care home, providing personal care and accommodation for five people who may have a learning disability and or complex/physical health needs.

People’s experience of using this service:

People were safe living in the service. Risks had been identified and people were looked after safely.

Staff were kind and caring and supported people to be as independent as possible.

People had access to healthcare professionals when required.

Staff knew how to care for people. Staff used their skills and the resources and equipment provided so the risk of accidental harm or infections was reduced. Staff had developed effective skills to meet he complex needs of the people at the service.

People were supported to have their prescribed medicines safely to remain well.

People were supported to eat and drink. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The registered manager had clear oversight of the service and worked alongside staff. Staff were respectful of the register manager and told us they were approachable and supportive.

We found the service continued to meet the characteristics of a “Good” rating in all areas; More information is available in the full report.

Rating at last inspection:

Good (The date of the last report published was 28 September 2016).

Why we inspected:

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

Follow up:

We will continue to monitor this service in line with our re-inspection schedule for those services rated as Good.

The inspection took place on the 24 August and 06 September 2016.

The Bungalow provides accommodation and support for up to four people who have a learning disability and multiple/complex needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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 were treated with dignity and respect and staff interacted with people in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

There was a regular and consistent staff team. The provider had appropriate recruitment checks in place which helped to protect people and ensure staff were suitable to work at the service. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported in their role.

We found that detailed assessments had been carried out and that the care plans were very well developed around each individual’s needs and preferences. There were risk assessments in place and plans on how the risks were to be managed. People were supported with taking every day risks and encouraged to take part in daily activities and outings.

We saw that appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves; to help ensure their rights were protected.

People were happy and relaxed with staff. Systems were in place for people to raise concerns and they could be confident they would be listened to and appropriate action was taken.

People’s medication was well managed and this helped to ensure that people received their medication safely.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice. We found that people’s healthcare was good. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians.

The provider had an effective quality assurance systems in place. People had the opportunity to feedback on their experiences. Staff tried to involve people in day to day decisions and the running of the service. The service was well managed.

We considered all the evidence we had gathered under the outcomes we had inspected to answer the questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People’s care records contained risk assessments and care plans to ensure the care provided was safe and appropriate for their needs. Care plans were reviewed in conjunction with the people who used the service, and their relatives where appropriate, to ensure care was provided in accordance with their wishes.

The Home had policies in place in relation to the safeguarding of vulnerable adults from abuse (SOVA), the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards .Mental capacity assessments were completed when people lacked capacity to make decisions in relation to their care and treatment and best interest decisions documented. Staff had received training and demonstrated an understanding of the implications of the policies in relation to their practice. This meant that people’s rights could be protected.

Policies and procedures to prevent and control the spread of infection were seen. Cleaning schedules were in place and the standards of cleanliness monitored through regular spot checks and audits to ensure that cleanliness was maintained. This meant steps were taken to protect people from infection and keep them safe.

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Is the service effective?

Full assessments of each person were undertaken prior to their admission to the service. Care plans were reviewed regularly and updated as necessary to ensure the care provided was appropriate to each person’s individual needs.

We saw that there was involvement of a range of professionals in the care of each person to ensure care was effective and specialist input obtained where necessary.

There was a structured approach to training and appraisal of staff to ensure staff were supported to function effectively in their job roles.

Is the service caring?

When we talked to relatives of people who used the service, they told us that staff were caring and understood people’s individual needs and preferences. Comments from relatives included " The staff are compassionate and genuinely care for the residents." " The bungalow where (person) lives is lovely, very clean, warm and homely". " I feel that (person) is very well cared for and we are always made to feel welcome by the friendly staff". We observed a good rapport between the people who used the service and the staff which demonstrated their empathy and sensitivity to people’s needs and wishes.

One person had a visitor during the inspection and the visitor told us they were able to visit at any time and staff always greeted them warmly and were welcoming. People were encouraged to participate in activities they enjoyed which promoted their well-being.

Is the service responsive?

Systems were in place to make sure that themes and trends from events such as accidents and incidents, complaints, and concerns were identified and lessons learnt to prevent recurrence. This reduced the risks to people and helped the service to continually improve.

Feedback on the service was sought from relatives and we saw a number of examples of improvements which had been implemented as a result of this feedback .

Relatives of people using the service told us they had had no need to complain but if they raised a concern or issue of any kind they were confident it would be addressed. "They said staff were second to none".

Is the service well led?

There were structures in place for clinical governance and quality assurance. We saw a planned approach to quality audits and evidence that action was taken as a result of these to improve the quality of the service provided.

Staff told us they felt well supported and encouraged to provide standards of care they could be proud of. They had received the training they required to deliver safe and effective care. There were systems in place for the appraisal of staff and personal development planning.

People using the service had complex needs and were unable to communicate verbally which meant that they were not able to tell us their experiences. Due to this we observed how staff interacted with people using the service.

We spoke with three relatives of people using the service, who told us that the care was good. Comments included, “They are absolutely excellent.” “The care has been good since [the person] went in there.” “I can’t fault the care.”

We found that staff supported people with their nutrition and hydration needs.

We reviewed medication records and found that appropriate arrangements were in place in relation to the recording of medicine and medicines were kept safely.

We spoke with five staff who told us they felt supported and had opportunities for training and development.

We found that the provider had systems in place to regularly assess and monitor the quality of service that people receive.

People using the service had complex needs and were unable to communicate verbally which meant that they were not able to tell us their experiences. Due to this we observed how staff interacted with people using the service.

We contacted four relatives of people using the service, who told us that people using the service were treated with dignity and respect. They told us that the care was good.

The provider had systems in place to ensure that staff were recruited appropriately and received the support and training they needed to do their job.

We reviewed medication records and were concerned that some appropriate arrangements for the safe administration of medicines were not taking place.

Those people who live at Southend Road are unable to communicate verbally, but from their actions they indicated that they were happy and appeared relaxed with the staff. Evidence gathered during our visit was through observation and people’s interaction with the staff. The home’s quality assurance report completed in March 2010 was used where possible to feedback the views of relatives and other professionals involved in the care of the individuals. They reported that the people living at Southend Road were treated as individuals and their rights and choices were respected. It also reported that relatives and health professionals rated the cleanliness of the home as excellent.

Staff were observed paying attention to the people’s needs and ensuring where possible they were involved in their care and offering choice and encouraging involvement. One relative spoken with was positive about the care their relative received.