Insight Teynham

The service is a care home. There were 9 people using the service at the time of the inspection.This is a specialist service for autistic people and people with a learning disability. It provides support for people who may display distressed behaviours.People are accommodated in 3 separate homes on the same site. These are individual, or small group households that share a kitchen, lounge and dining area. This helps create a familiar home environment where staff can support people in a more personal and flexible way.

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 MCA. 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.

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.

There had been two significant changes in the service in the last year. There was a new registered manager and a new owner of the organisation. Staff told us these changes coming at a similar time had been challenging for them as new ways of working had been introduced. One staff told us, “It was a rocky start due to the change of manager and provider. It was a family home, but now there have been some changes. We are getting used to it”. A relative concurred, “The change in the management of the organisation has been a bit bumpy, but it has not affected my family member’s care.” Staff were also clear that these changes had not affected the care and support people received. Staff described a positive culture at the service whereby everyone worked together as a team to support people to lead busy and active lives. Comments from staff included, “Everyone pulls together” and “The team spirit is amazing.”

The new provider had made improvements to the governance and oversight of the service through the introduction of new recording systems. Staff told us this enabled them to get a better picture of what was happening in people’s daily lives. The management team said they could access important information more quickly which helped them to identify any patterns, trends or concerns. There was learning culture whereby incidents and accidents were used as opportunities to look at what had gone well and what could be improved. For example, when a medication error had taken place, an investigation took place to identify the root cause. Staff were involved in a debrief and discussions which identified better communication within the staff team could have prevented the error. This learning was shared with the staff team.

The practice of positive behavioural support (PBS) had been established throughout the service. Positive behavioural support is an evidence-based, nationally recognised model of care. It is seen as the best way of supporting people who display or are at risk of displaying distressed behaviours which may cause harm to themselves or others. A PBS practitioner with a Diploma in Positive Behaviour Support had oversight for the whole organisation and a staff member was PBS lead for the service. Staff were knowledgeable about the actions they should take to reduce the risk of distress and harm to people and others.

People’s health, wellbeing, distressed behaviours and participation in the community was reviewed every 6 months to effectively monitor if people were achieving quality of life. Based on this in-depth analysis changes were made to people’s care and support, and further interventions and actions were identified. For example, it had been identified that the triggers for one person’s distressed behaviours were due to waiting for things they wanted and requests to complete tasks. Interviews with staff and additional observations were planned to help identify the most appropriate interventions.

Each person had a person-centred support plan that set out what was most important to the person, such as their needs, preferences, routines and goals. People had a range of goals that were meaningful to them as they were based on their choices and interests. Staff celebrated when people had made progress towards their goals. Staff told us if something had gone well with a person, they shared it with the staff team so it could be replicated.

Staff had opportunities for learning, development and reflective practice. They were enough staff provided to ensure people had consistent, effective and safe support. Staff knew how to identify, report and escalate concerns. They were assured the registered manager would act on any concerns they raised.

Medicines were managed safely. Effective processes were in operation to order, store, administer and dispose of people’s medicines. Staff were trained in administering medicines and their competency and skills in medicines management was regularly checked.

There were regular checks of the environment to ensure it continued to be a safe environment for people, staff and visitors. This included visual checks and on going maintenance of equipment and services.