About the service: Fethneys Living Options – Care Home Physical Disabilities is a residential care home for people living with a severe physical disability and/or acquired brain injury. It is registered to provider personal and nursing care for up to 10 people; at the time of our inspection, seven people were living at the home.

People’s experience of using this service: People were involved and consulted about how the service was run. People were aware of changes that had occurred at the home and of issues relating to the management of the home in the past few months. A registered manager was not in post, but the new manager was in the process of registering with CQC. Concerns had also been raised by the local authority in relation to safeguarding issues. People indicated they had no worries and were happy with the way the home was managed and with the staff who supported them. Residents’ meetings provided opportunities for people to be engaged in the running of the home and to make suggestions. We observed the new manager being introduced to people as it was their first day in post. People were comfortable in the company of senior managers and support staff. People were involved in the interviewing and recruitment of new staff. A relative felt that improvements had been made following an unsettled period. They stated, ‘I’m not sure how Fethneys can improve further as they are a cut above the average home in my opinion’. People, their relatives and staff now felt the home was well-run. A range of quality assurance systems measured and monitored the quality of care and the service overall, which was of a good standard.

People were safe and were supported by staff who were trained to recognise the signs of any potential abuse or harm. Staff had been trained in safeguarding and knew what action to take if they had any concerns about people’s safety. People’s risks were identified and assessed appropriately. Any accidents or incidents were recorded and lessons learned to prevent any reoccurrence. There were sufficient staff to meet people’s needs, to enable them to engage with activities outside the home and to provide the support they required. People were supported by staff whose suitability was checked at recruitment. People’s medicines were managed safely.

We observed people were comfortable in their surroundings and felt safe and happy. We spent time talking with people who were relaxed and comfortable to have a conversation with us. Throughout our inspection, we observed positive interactions between people and staff, underpinned with banter and laughter. Staff spent time with people and listened patiently to anything they had to say. People were treated with dignity and respect and had the privacy they required. Staff had completed equality and diversity training and treated people equally, regardless of their disability.

Before they came to live at the home, people’s needs were fully assessed and referrals made by local authorities and commissioners. Staff completed training and were experienced in their roles to provide effective care to people. Staff received regular supervisions. People were encouraged with a healthy diet and contributed to the planning of menus and food preparation. People had access to a range of healthcare professionals and services. 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.

People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed in the information and guidance provided to staff. Staff encouraged people in decisions relating to their care and in care planning. People chose their keyworker who supported them in all aspects of their care, including the planning of activities. Complaints were logged and managed appropriately. No-on

The inspection took place on 20 June 2016 and was unannounced.

Fethney’s Living Options provides accommodation, care and support for up to ten people living with a physical disability or acquired brain injury. The aim of the service is to promote and build on people’s independence skills so that they can move out of the home into independent or supported living accommodation. Fethney’s Living Options is a large, older style, detached property situated close to the seafront and town centre of Worthing. All rooms are of single occupancy and communal areas include a large dining area/kitchen and a separate sitting room.

A registered manager was 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.

People were looked after by staff who had been trained to recognise the signs of potential abuse and knew what action to take. People’s risks were identified, assessed and managed appropriately and their independence was promoted. There were sufficient numbers of staff on duty to support people and the home benefited from the input of volunteers which the provider had introduced. Medicines were managed so people received them safely from trained staff. People were protected from the risk of acquired infections and the home was clean and hygienic.

Staff had been trained in all essential areas and additional training had been completed to meet people’s specific needs. New staff completed the Care Certificate, a universally recognised qualification. Staff received regular supervisions and attended team meetings. People were supported by staff who understood their responsibilities under the Mental Capacity Act 2005 legislation and put this into practice. People had sufficient to eat and drink and were encouraged to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services.

Staff were kind and caring with people and positive relationships had been formed. People and relatives spoke highly of the staff at the home. People were encouraged to express their views and to be involved in making decisions about their care. They were treated with dignity and respect.

People were supported by their keyworkers, who co-ordinated all aspects of their care. They were encouraged to be as independent as possible, to pursue a range of activities in the home and out in the community. Care plans provided staff with detailed information about people and how they needed to be supported. Complaints were managed in line with the provider’s policy.

People spoke highly of the service and attended residents’ meetings. The provider obtained feedback from people, their relatives and staff on a national basis. Staff felt supported by the registered manager and of the improvements that had been made since he came into post. A range of audits measured and monitored the overall quality of the service and actions were identified and implemented to drive improvement.

This inspection was carried out by one adult social care inspector. We considered all the evidence we gathered under the outcomes we inspected. We spoke with two people using the service and one relative. We also spoke with three staff and the manager. During this inspection we looked at outcomes relating to consent to care and treatment, care and welfare of people who use services, management of medicines, suitability of staffing and assessing and monitoring the quality of service provision. We used the information to answer the five questions we always ask; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

Individualised care plans detailed the support and care each person required. People confirmed that they received care that they needed in a way that they preferred. The service ensured relevant healthcare professionals were involved as needed.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We also saw that systems were in place for recruitment and selection of qualified and skilled staff with appropriate checks in place.

Is the service effective?

We observed people being supported to make their own choices and direct their day to day activities. Staff were observed to support people in a calm and respectful manner and with dignity. People told us they were involved in decisions about their care and they had choices about how they wished to spend their time. One person we spoke with told us "I'm really happy here. Staff help me to do things for myself."

Is the service caring?

People were positive about the staff and management of the service. We saw that people were supported by staff who were kind, attentive and took the time to support them in a way that empowered them to be as independent as possible.

Is the service responsive?

We saw that care plans were reviewed regularly in line with people’s assessed needs and that their views had been taken into account in how their care and treatment had been planned. We observed staff supporting people with meal preparation and planning their schedules to meet their identified needs.

Is the service well-led?

The service was well managed and there were clear lines of leadership and communication in place. We saw a number of feedback processes in place for people, their representatives and staff to provide feedback on the service and we saw that this feedback was acted on.

The inspection was begun at 09.40, and was completed at 15.00. There were ten people living at the service. We spoke with four people who received a service, the manager, two staff, a visiting professional, and a relative of one person. The manager told us that the service aimed to assist people to learn and acquire independence skills that will equip them to live more independently.

One person who used the service told us “It’s been fine, it’s been good here.” Another said “It’s going really well. I’m learning more independent skills living here.” A relative said there was “A great atmosphere.” A visiting professional said it was “Quite a vibrant place.”

People’s needs had been assessed and their views had been taken into account in how their care and treatment had been planned. They told us that the support they received had helped them achieve more independence and quality of life. One person told us “Things are going really well. I get support with meal preparation and food shopping. My keyworkers ask me what I want to do for the next week then they do my timetable and sort things out with me.”

Staff understood how to raise concerns and keep people safe, and people we talked with said they felt safe living at Fethney’s.

Staff received appropriate professional training and development. More than 90% of recommended trainings had been completed by staff, and arrangements were in place to ensure staff refreshed their training at the recommended intervals. Staff we spoke with said that they felt well supported. One said “the manager is approachable.”

The provider took account of complaints and comments to improve the service. The relative of one person who used the service told us “Things get sorted very quickly if there’s a problem.” Records showed that the provider regularly reviewed the quality and safety of the service, and made changes accordingly.

We spoke with four people who use the service. They told us the new manager had improved their ability to make choices and decisions about their daily routine. One person said, “The atmosphere has changed. I can get up when I want now”. We spoke with two members of staff. One told us, “People have much more choice now, it’s more service user led”.

People’s needs were assessed and care was delivered in a way that met the needs of most people. We looked at three care plans and observed care and support being delivered. Three of the people we spoke with told us their needs were met. One said, “The standard of care is really good”. However, another person said, “They haven’t met my needs”.

People we spoke with told us they felt safe. One said, “If I had any problems I’d go to the manager”. The provider had responded appropriately to an allegation of abuse. We saw that appropriate referrals had been made to the safeguarding authority.

The building had been adapted to meet the needs of people using the service and was well maintained.

There were enough skilled and experienced staff to meet people’s needs most of the time. The provider was taking steps to increase staffing levels to address shortages that occurred at certain times of day.

People were asked their views about the service and the provider took account of complaints and comments to improve the service. Additional training was being delivered to address areas of concern.

We spoke with 2 care managers who told us that Fethneys Living Options provides a good service to people and that they have no concerns about the service. The comment from one care manager was; “Fethneys is a hugely caring and supportive environment; staff really do enable young people to get on with their lives, to develop relationships; they support them in risk taking, and, in maximising learning, independence and confidence. They also provide excellent care in meeting quite complex physical care needs”.

The father of a person told us that he was happy with the care being provided and said that people are treated extremely well. He also said that staff take a great deal of care, are most helpful and re-assuring.

Another father of one person said “I have complete confidence in all the staff at Fethneys”.

All of the relatives of people we spoke with told us that the home communicates well with them and keeps them informed. They all went on to say that if they had to make a complaint they would speak with the manager and were confident that any issues would be dealt with quickly and appropriately.

Staff told us that they would always respect people’s wishes and said that people who use the service are involved in all aspects of their lives and that people are actively encouraged to express their views and opinions.

Staff members who we talked to told us that their recruitment was robust and that the people who use the service were involved in the recruitment process. They said that the training provided is very good and that they regularly attend refresher courses to maintain their knowledge, skills and competency.

Staff spoken with told us that the staffing levels were about right and that if they planned to go out with people to support them with activities or trips then the manager would ensure that there was sufficient staff on duty to enable this to take place.

People told us that they were happy with the personal care they receive and said that staff helped them to do things for themselves and that any help is given in the way that they want. People said that they liked living at Fethneys Living Options and they said that they felt safe in the home.

Two people we spoke to told us that staff always knock on the doors to their rooms but do not always wait for a response before entering. The also said that the activities provided during the day could be improved.