SENSE Holmlea

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We were assured the service met the principles of ‘Right support, right care, right culture’ and people received safe, person-centred and outcomes focused care and support.

Staffing levels were appropriate, and staff had the necessary skills to meet people’s comprehensive needs which included physical disability, learning disability, sensory needs and health needs. Staff had adequate training and their competencies were assessed to help them deliver safe, effective care.

A staff member told us, “I have had face to face training for first aid which covered the topics of emergencies, diabetes and recognising health conditions, and a separate face to face training for epilepsy. I am medication trained and had my assessment of competence.”Some staff had completed end of life training and others had not which was raised with the registered manager.

A staff member told us, “The team seems to all work well together and complement each other’s strengths. ”Another said, “I feel part of the team and respected.”

Staff told us they felt well supported by the management team and the out of hours support. One staff said, “I feel both my manager and deputy are responsive to my questions, and it is nice that they have an open-door policy.” Another said the out of hours on call was sometimes difficult as it could be covered by a manager who was not familiar with the service, However the on-call was a 2 tier system and the registered manager told us they were local and could be contacted.

The registered manager was complimentary about their staff and their abilities. Ongoing support and recognition of staff’s talents and skill set could be enhanced by the development of further champion roles, train the trainer and a greater take up of national recognised qualifications. There was a registered manager and deputy manager and a team lead had recently been appointed to enhance the running of the service.

The environment was appropriate to people’s needs and was spacious, personalised and very clean. People had the equipment they needed to support safe care. No risks to people’s environment were identified and regular maintenance checks helped ensure people’s safety.

We observed lunch time and interactions across the day between staff and people using the service. These were wholly positive and demonstrated to us that staff were skilled communicators and treated people with respect and dignity. A staff member told us, “We are a really good team, and all have the same goal to give our guys, their families all the love and support we can to make their lives fulfilling.” Electronic care plans clearly described people’s needs andvwhat was important to them to help ensure any care delivery was person centred.

Activities were provided sensitively around people’s needs and assessed risks. Whilst staff took people out and this included holidays and day trips, staffing levels did not lend themselves to people going out every day due to the high level of support people required with their mobility. The home had adequate transport and the service-maintained relationships with the external community, friends and family. We suggested that external entertainers might ease the pressures on staff and enhance people’s experiences.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). Whilst restrictions were in place: for example, a monitoring system, the rationale for this was clearly documented and there was a risk assessment and best interest decision in place. People had communication plans in place to support staff in understanding how people expressed themselves.

Deprivation of Liberty Safeguards (DoLS) authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice,control and freedom over their lives.

The service used learning from feedback, incidents and reviews to make service improvements. Staff confidently answered questions about safeguarding people in their care and received appropriate training. A staff member told us, “Management are with us every step, and very approachable and supportive, and I would not think twice about approaching if I had any concerns about another member of staff or the people we look after.” Safeguarding records were appropriate.

Medicines were managed safely and staff were conscientious.Tablet counts were completed multiple times a day and handed over to the next medication lead so if a medication error occurred, this could be quickly identified to ensure people’s safety. Medicines were regularly reviewed and the service worked closely with other services to ensure joint up care. A safeguarding concern had been raised when care between services had not been seamless and staff advocated for people as they knew them best.

There was a positive culture in the home and staff had confidence in the management team and the support they received. Staff felt valued and had the necessary skills to deliver appropriate care and were supported to develop their skills. Quality assurance systems were firmly embedded and helped staff to evidence their compliance with regulation and good practice. Electronic care plans had taken over from paper records and whilst these were detailed staff were still getting use to the new system. We discussed with the registered manager about making care plans accessible to parents where appropriate and where they held Power of attorney. Relatives told us communication was good but said sharing photographs and good new stories would be appreciated. The registered manager said they would be developing a newsletter.