About the service:

The Shires is one of two locations operated by Independence with Care Ltd. It provides accommodation for up to seven people with learning difficulties, who may require support with personal care.

People’s experience of using this service:

¿ People were protected by staff who understood how to protect them from avoidable harm. The risks to people’s health and wellbeing were assessed and action taken to reduce them. There were enough staff deployed to keep people safe. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. There were systems to learn from mistakes including the detailed analysis of accidents and incidents.

¿ Staff received training to enable them to do their jobs well. People were provided with care and support which protected them from discrimination. They were supported to maintain a healthy diet and had access to other health and social care agencies when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was adapted to meet their needs

¿ There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and felt that staff respected their wishes. Families were welcomed to the service at any time.

¿ People had care and support provided which met their preferences. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care.

¿ Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

More information is in Detailed Findings below:

Rating at last inspection: Good (report published 30 July 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this the overall rating for this service remained Good.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 20 and 21 June 2016 and was announced.

The Shires provides residential care for up to seven younger people who are living with a learning disability. At the time of this inspection there were seven people living within the home. The accommodation was over two floors with communal areas and private bedrooms for all those living there.

There was a registered manager in post. 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.

Staff had been recruited following appropriate checks to ensure they were suitable to work in health and social care. There were enough suitably skilled staff to meet people’s individual needs in a person centred way.

People received care and support from staff that were happy in their roles, felt supported and worked well as a team. They had received an induction and regular training and support to assist them in supporting the people who lived there.

An open culture was evident and people were encouraged to contribute to the running of the home. All people were treated with respect and the dignity and privacy of those living there was promoted. People had choice in their daily lives and were supported to be as independent as they wished.

The service had processes in place to help protect people from the risk of abuse. Staff had knowledge of how to protect, prevent, identify and report abuse and demonstrated they understood what symptoms may indicate a person was being abused.

The risks to individuals had been identified and suitably managed. The risks associated with the premises, environment and work practices had not been fully identified. However, the service had identified this and was working towards addressing this.

Accidents and incidents were robustly recorded and actions taken to reduce the likelihood of reoccurrence. They were used to help improve the service and reduce further risk. People received their medicines in a safe manner and as the prescriber intended.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was working within the MCA although not all staff had a working knowledge of the legislation. The service did not provide training in the MCA as part of its mandatory package.

People’s nutritional needs were met and there was a collaborative approach to meal planning and preparation. Access to a wide range of healthcare services was available and people got support to access these where required.

People received care and support that was person-centred and met their individual needs. People had been involved in planning the support they needed and their care plans were accurate and detailed. Although they weren’t always reviewed on a regular basis, staff knew the needs and preferences of those they supported.

The providers sought people’s views on the service in order to develop and improve. An auditing system was in place to monitor the quality of the service and this was effective. Regular meetings were held for the management team and staff so that the service provision could be discussed and opinions voiced.

The management team were visible and supportive. People spoke highly of them and their positive, open and considerate approach.

At the time of our inspection there were six people using the service. One adult social care inspector carried out the visit.

We spoke with four people who used the service, one of the company’s directors and one care staff. We reviewed four people’s care plans. Other documents that we reviewed included the provider’s policies and procedures, training records and the results from various audits.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

We saw people being cared for and supported in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people living in the house. There was an on-call procedure for staff to telephone someone senior during the out of hour’s period if they had any concerns. Processes for the prevention and control of infection were in place. Visitors to the house were asked to sign in and out. This helped to reduce risks in relation to health, safety and security.

People’s care plans contained appropriate risk assessments in relation to the care and support they received. This meant that steps were taken to reduce any risks that could present to the person. The assessments included risks in relation to using public transport and people managing their own money.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act (MCA), 2005. The safeguards apply to people in care homes and hospitals, and aim to make sure people are looked after in a way that does not restrict or deprive their freedom inappropriately. No one who used the service, at the time of our inspection, had a DoLS authorisation in place. People had given their agreement and consent to the information documented in their care plans and care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare

There were arrangements in place to deal with foreseeable emergencies. We noted that people participated in a ‘fire practice’ on a regular basis. Emergency plans were written in an ‘easy read’ format that helped to ensure people understood the content of them.

Is the service effective?

People’s health, social and care needs had been assessed with them individually. People were involved in reviewing their care plans and risk assessments. People’s communication needs had been documented in their care plan. Staff could explain the different communication techniques that helped people to understand what was being said or proposed.

From the training records we reviewed, we found staff had received training to enable them to meet the needs of the people who used the service. This included specialist training to help meet the needs of people with diabetes and epilepsy. We found that staff’s knowledge and skills had been put into practice and that they could effectively manage a person with these health conditions.

People’s goals and aspirations were documented in their care plans. The people we spoke with told us that they had been actively involved in the writing of their care plans. We saw that people were supported to develop and maintain life skills to help increase their independence. People’s outcomes were positive; the care and support they received enabled them to achieve their goals.

It was evident that staff knew the needs of the people they cared for very well. We observed positive interactions between the staff and people using the service.

The provider worked closely with other health and social care professionals. This included people’s general practitioners, social workers, physiotherapist and chiropodist. This helped to ensure that all of people’s needs were met by a multidisciplinary team.

Is the service caring?

We spoke with four people during our inspection. Each person told us that they were happy living in The Shires. One person said, “I am very happy living here. Everything is good. The staff are lovely.” Another person said, “I enjoy living here. The staff are nice. There is plenty to do. We go to the pub and places. I enjoy gardening and this year we have been growing tomatoes, strawberries and runner beans.” A third person said, “I’m alright. Everything is good. The staff are good.”

The staff had received training in person-centred care and this was evident during our review of people’s care plans as well as our observation of staff interacting with people in an individualised way. Staff understood the needs of people well. The level of support given to people reflected what had been assessed in their care plans. We saw that people were satisfied with their level of care and support. People told us that they appreciated being supported to remain as independent as possible.

Staff communicated with people using different communication techniques that were meaningful to the person. Staff spoke with people in a kind and calming manner. Any assistance given by the staff was not rushed or hurried. When staff were supporting people to undertake a task by themselves, we saw that they displayed both encouragement and patience. People’s dignity and privacy was maintained at all times, throughout our inspection.

Is the service responsive?

The environment and scheduled activities were planned to help meet people's needs. This included a lounge area where people could choose to spend their time, as well as the kitchen and dining area where we saw people sitting and chatting with each other. We noted that there was a secure garden that had provisions for people to grow vegetables and fruits.

It was evident that the care and support people received met their individual needs. People’s care plans included all activities of the person’s daily living. There were support plans in place for staff to follow to help ensure they responded to people’s needs in an effective way. We observed staff interacting with people in a positive way and this included encouraging people to develop certain skills to help them become more independent.

The service received minimal complaints. However, there was an effective complaints policy and procedure and all of the people we spoke with told us that they knew how to raise a complaint. The complaint procedure was also written in ‘easy read’ to help ensure people understood its content. Complaints were fully investigated and acted upon. This meant that the provider took account of complaints and comments to improve the service.

Is the service well-led?

The staff we spoke with told us that they felt well supported. One care staff said, “I feel very well supported and have no concerns. I am very happy working in the home.”

We saw that there was an effective management structure in place to support the care staff. The service had regular visits from the directors of the company. These included visits during the weekend to help determine if the care staff required any support or assistance.

The supervisions that we reviewed included discussion points and actions and agreements with staff. The care staff we spoke with told us that they felt supervisions and appraisals were both productive and beneficial. They said that the management team worked ‘alongside’ the care staff in helping to determine what their learning needs were. Staff told us that they were supported to undertake a programme of training and education that enabled them to meet their identified needs.

Quality assurance processes were present within the service. These included the auditing of care plans, medicines management, maintenance issues and infection control procedures.

During our visit we spoke with four people who were living in the home. We also observed how they were supported and looked at the records maintained about them.

All of the people we spoke with told us that if they had any concerns about how they were supported they could raise them with senior staff. They told us that they could choose how to live their lives and that they liked the food provided by the home.

People told us that they were encouraged by staff to take regular exercise. They also said that they could influence how the house was run. They said that they liked their rooms and that they had everything they needed. One person told us that they liked attending their day placement. Another person told us that they were hoping to move into their own flat, within another of the provider’s services, where they could live more independently.

People we spoke with told us that they did lots of things at The Shires, such as going to work, going out shopping with their friends, having holidays and hobbies.

People told us they could do what they wanted and that they had regular meetings where they talked about things that happened in the home. People also told us that staff did listen to what they said and that the meetings were good.

One person was helping with household tasks and said they liked, "To have lots of jobs to do".

People we spoke to told us how they liked to be in the garden and took it in turns to help cut the grass. People also told us that they each had areas where they grew vegetables and each person told us about the areas they were responsible for, such as runner beans, potatoes, spring onions and tomatoes.

One person said they also enjoyed playing 'swing-ball'.

People also told us that they met and interviewed new staff before they started working in The Shires.

All the people we spoke with told us that they felt safe living in The Shires and that the staff looked after them well.

Each person also said that they could talk to the staff if they weren't happy with anything.

People we spoke with told us that they liked the staff and that they were always there to help them.

One member of staff told us that whey would like to have a little more time for 'one-to-one with individuals'.

People we spoke with told us that they had recently been visited by a person who had spoken to them and had asked questions about what it was like living in the home.

People also told us that they were happy living in The Shires.

We saw that people were supported in promoting their independence and community involvement. One person we spoke with told us that they enjoyed going to a day centre three days a week, where they undertook activities such as gardening, cooking and swimming. The also spent one day a week with another organised group ‘out in the community’.

This person also told us: “I’ve been here 14 years and I’m still happy. I get on well with all the others.” They also said: “I like it here and I like all the staff. I like going shopping on my own and often walk into town on a Friday or Saturday.

Another person we met told us they were happy and we observed them choosing where they wanted to spend time in the home and playing a computer game.

We were told by one person: “We have house meetings every month, with two staff and everyone who lives here. They’re good and we talk about everything. We all have jobs; we keep our rooms tidy, help with the housework and we take it in turns to do the washing up.”

They also told us: “We never go hungry here! We can have whatever we want to eat; toad in the hole is my favourite and we have drinks whenever we want them.”

One person we spoke with said, of the staff: “I like all the staff. I feel safe here and I’ve never had any issues.” They also said: “I haven’t got any complaints. If I’ve got any problems I can talk to… [the manager] or any of the other staff.”