Ball Tree Croft

The service was divided to provide respite care for four people and permanent accommodation for up to 16 people. The premises were arranged in three adjoining houses each with a self-contained kitchen, lounge and dining area. At the time of the inspection the service was provided to 12 permanent people. The respite care had been paused due to the COVID-19 pandemic.

There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Risk assessments were carried out to make sure people received their care safely and had opportunities to take part in activities which interested them and promoted their independence.

Medicines were managed safely, and staff had a good knowledge of the medicine systems and procedures. Staff had received training and had competency assessments of their practice. There were adequate numbers of staff to meet people's needs.

We observed kind and caring interactions between people and staff. Staff showed genuine regard for the people they supported.

The registered manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. The service had a quality assurance system and any shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

People were not fully supported to have maximum choice and control of their lives due to the layout and model of the service. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People did not always receive care that was personalised to their needs.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, Right Care, Right Culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service is made up of a main building where people normally have meals, rather than in their individual shared houses, food was fully prepared by staff. The medicines are kept in the main building and transported to the houses for administration.

The service was undertaking a review of these things, as during the recent COVID-19 outbreak people had been eating meals in their own shared houses to avoid cross infection. Each house has a kitchen that is fully equipped but very small and it would be difficult for more than one person to cook with staff support. There had been a new kitchen installed in the shared dining area of the main building and this was used to support people to prepare lunches for themselves with support. The service was trying to mitigate the limitations of the environment. The service was registered in 2011, it would be unlikely that this type of service model would be eligible to be registered with CQC now. Right support: • Model of care and setting maximises people's choice, control and independence Right care: • Care is person-centred and promotes people's dignity, privacy and human rights Right culture: • Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives