Fisher Close is a care home that provides nursing support for up to 15 adults with learning and physical disabilities. Accommodation is provided within three separate purpose built bungalows which were adapted for equipment that people may need to support them. At the time of inspection 13 people were living there.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

At the last inspection we found that there were not always enough staff to meet people’s needs and at this inspection we saw that this had improved. There were enough staff and people were supported to be independent and to engage in activities at home and in the community.

Quality audits were completed in the home and were effective in highlighting any actions which needed addressing. The provider’s systems for reviewing the quality of the home and ensuring the registered manager understood what improvements were required were not always effectively implemented.

Risk management remained safe and this included ensuring that people received their medicines as prescribed. People continued to be protected from abuse and lessons were learnt when things went wrong. Infection control was managed to protect people.

Staff were still equipped to do their jobs well through training and support. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. People continued to have enough to eat and drink and their healthcare needs were met in partnership with other organisations. The building was designed and adapted to meet people's needs.

The service remained caring and staff demonstrated kind, patient interaction with people which upheld their dignity and privacy. Relationships with families and important people were encouraged by staff.

The service remained responsive because staff understood people's needs well. Care plans were up to date and people’s support requirements were regularly reviewed and amended. There were no complaints but there was a complaints procedure in place and information about how to complain was on display.

Further information is in the detailed findings below

This inspection was unannounced and took place on the 17 September 2015.

Fisher Close provides accommodation, nursing and personal care for up to 15 adults with learning and physical disabilities. Accommodation is provided within three separate bungalows at Fisher Close, all of which were fully occupied at the time of visit. There was a registered manager at this service. 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.

At our last inspection in June 2014 people were not fully protected from the risk of receiving care without appropriate consent or authorisation and their views about their care were not always sought or acted on. These were breaches of Regulations 18 and 10 of the Health and Social Care Act (Regulated Activities) Regulations 2010. Following that inspection, the provider told us what action they were going to take to rectify the breach and at this inspection we found that improvements were made.

At this inspection people were happy living at the service and they were protected from the risk of harm or abuse. People received safe care from a consistent staff team, who were properly recruited and fully understood people’s care and safety needs. Sufficient staff were consistently provided in two of the three bungalows at the service and often but not always in bungalow number two. The registered manager told us about the action they were taking to address this, which helped to mitigate the risk of people receiving unsafe care.

Staff supported people safely when they provided care and people’s medicines were safely managed and given to them when they needed them. Staff understood risks to people’s safety from their health conditions, their environment and from people’s behaviours that may challenge others and followed recognised care practice to mitigate these.

The home was clean, safe and mostly generally well maintained and a planned programme of redecoration, repair and renewal was being progressed throughout the service. Emergency contingency plans were in place for staff to follow in the event of emergencies in the home, such as a fire alarm and regular checks were made of the environment and equipment for people’s care and safety. A recent report from Derbyshire Fire and Rescue Service showed there were satisfactory arrangements for fire safety at the service.

People were supported to maintain and improve their health and nutritional status. Staff received the training they needed and they fully understood people’s health conditions, disabilities and related care needs.

People accessed external health professionals when they needed to and staff sought and followed their instructions for people’s care when required. People’s health related care plans were regularly reviewed in consultation with external health professionals when necessary, to check if they were working or revised when needed.

Staff understood and followed the Mental Capacity Act 2005 (MCA) to seek people’s consent or appropriate authorisation before they received care. This included authorisation by the relevant authority for any restrictions to people’s freedom that were deemed as necessary to keep them safe; known as Deprivation of Liberty Safeguards (DoLS).

People received care from helpful, kind and caring staff who knew them well and treated them with respect. Staff communicated well with people and promoted their rights, dignity and privacy when they provided care. People and their relatives were informed and involved in their care and daily living arrangements. People were supported to make decisions about this in a meaningful way, which met their needs. The provider’s arrangements helped to provide a voice for and represent people’s views about their care

People were supported to influence, engage and participate in home life and relevant social and recreational activities and to access the local and extended community. The service routinely sought, listened and responded to people’s experiences and concerns or complaints made about the service.

The home was well managed and run and people’s relatives, professionals and staff were confident about this. The provider’s arrangements to regularly check the quality and safety of people’s care helped to make sure that people received safe and effective care and improvements were made when required. Staff understood their roles and responsibilities and they were appropriately supported to share their views or raise any concerns about people’s care.

There were 14 people living at Fisher Close. Most people were not able to tell us about their care and experiences because of their medical conditions. We spoke with some people’s relatives, spent time observing how staff interacted and supported people, spoke with staff about people’s care and looked at some of their care records. Below is a summary of what we found the service.

Was it safe?

We saw that staff supported people safely and mostly followed the Mental Capacity Act 2005. One person was able to consent to their care and their records showed that the provider asked them for their consent before they received care and acted in accordance with their wishes.

Two people’s care records did not properly account for their best interests. This was because they did not show the necessary arrangements, where important decisions about their care and welfare had been made by others on their behalf. This meant that where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

People were protected against the risks of unsafe or unsuitable premises because the provider had taken steps to ensure the home was adequately maintained and equipped and mostly suitably designed.

Arrangements were in place for dealing with foreseeable emergencies, such as in the event of a fire or accidents or serious accidents and incidents. The local fire authority had inspected the home in March 2014 and found the provider fire safety arrangements were broadly compliant with their fire safety requirement.

The manager had undertaken checks of people's care and safety and the records required for this were mostly kept up to date. They were also introducing checking systems in for medicines and infection prevention and control. This helped to ensure that people were not being placed at unnecessary risk because the provider had systems to assess and manage risks to people’s health and welfare.

Was it effective?

Staff understood people’s needs and any known risks to their safety, which helped to ensure that people experienced care, treatment and support that met their needs.

Two people’s relatives told us they (people), received the care they needed. This was independently described by both as ‘excellent.’ One person’s relative said, “He’s been in a few homes and has been much better here.”

The provider had external management monitoring arrangements, which included a recorded annual audit. This audit was used to check the quality and safety of people’s care at Fisher Close. This was completed to show the provider’s systems that should be operating to ensure people’s safe and effective care. However, the record did not show whether these were met or whether any improvements were needed This meant it was not wholly effective in assuring the quality and safety of people’s care.

Was it caring?

Two people’s relatives told us that staff, were “brilliant” and “caring.”

We saw that staff communicated well with people, in a caring manner. Staff supported people with sensitivity, for example supporting them to move and to eat and drink. They promoted people’s privacy and dignity and helped them to make simple daily living choices. For example choice of meals and drinks.

Was it responsive?

We found there was usually enough qualified, skilled and experienced staff to meet people’s needs. We saw that staff communicated well with people, in a caring manner. They supported people at their own pace and in a way that recognised their individuality.

Work was in progress to develop approaches to people’s care. This included assessing and responding to people’s behavioural needs and developing a more person centred approach to meet people’s changing and complex care needs.

Some information was provided for people about their care in formats that were easier for them to understand. This included the use of pictures and symbols. A meals toolkit was being developed to further to assist people in choosing their meals. People’s care plans showed how they communicated their needs and instructed staff about this.

The home was comfortable, homely and equipped to meet people’s mobility and sensory needs. This included personal mobility equipment and sensory quiet rooms and equipment. All people’s own rooms were highly personalised. However, the design of the garden in Bungalow 1 restricted people’s use. This was because it was too difficult for staff to move people in their adapted wheelchairs on the soft grass and the patio area provided limited space.

We found that the provider properly responded to complaints and concerns they received. This included investigating, acting and responding to the complainant.

Was it well led?

The manager and senior staff involved people’s families, advocates and relevant health and social care professionals in people’s care when required. This helped to ensure that people’s health and social care needs were met, including for their routine health screening.

We found that the manager was consulting with staff and facilitating a review of their skills and deployment arrangements. Their stated aim was to develop proactive approaches to people’s care and to secure more flexible staff working across the three bungalows at Fisher Close for benefit the people living there.

The manager monitored accidents and incidents and errors and near misses to check whether improvements were needed to people’s care. Improvements being made included, developing care plan approaches for managing people’s behaviours that challenged others. This included the commencement of a programme of related accredited staff training.

We found that staff, were asked for their views about people’s care and treatment, and consulted about any changes. However, people’s views about their care and treatment; or their representatives where required, were not always obtained or accounted for.

One person’s care records did not fully account for their safety and welfare needs. This was because some of their personal care needs, relating to risks from their medical condition, were not being regularly reviewed. However, records showed that the manager had identified this and had instructed staff about the action to be taken and by when to rectify this.

At this inspection there were 14 people using the service. We used a number of different methods to help us understand the experiences of these people because they had complex needs. Most people were not able to tell us their experiences. We observed people’s interactions with staff and we spoke with one person and with two people’s relatives. We also spoke with four members of staff and read the care plans of three people, to find out more information.

We observed staff interacting positively with people. However, care plans did not always identify risks to people or provide guidelines to staff in managing these risks.

People’s relatives told us that people had a choice of food and their special dietary needs were catered for. One relative told us that the food was, “very good.” We noted, from reading records and our observations, that people’s nutritional needs were being met.

People felt safe and confident with staff administering their medication and said they received their medicines when needed. We found that medicines were being safely stored, administered and recorded.

Relatives felt there were enough staff to meet people’s needs. However, one person who used the service disagreed and we found evidence to show that safe staffing levels were not being consistently met.

Relatives told us they knew how to make a complaint. Staff were able to describe how people’s changes of behaviour and facial expressions showed if they were unhappy.

Most people who use the service were unable to share their experiences with us. People able to express their views said they were happy with the care and support they received, and felt their needs were being met. One person told us ''this is a good place to live as staff look after us well.'' People are given information to help them make choices and decisions about their lives, as staff explain things in a way they can understand.

People felt that staff respected their privacy, dignity and independence. They also felt listened to and able to express their views and raise any concerns with staff if they were unhappy.

Two relatives we spoke with praised the care and support their family member received. They felt that staff are caring and have a good understanding and respond to individuals needs.

On the two days of this inspection there were 14 people using this service. We used a number of different methods to help us understand the experiences of these people because they had complex needs. This meant that most of them were not able to tell us their experiences. We spoke with one person who used the service and with the relatives of two others. We spent time in each of the three bungalows and observed people’s activities, and how staff interacted with them, in two bungalows. We spoke with the staff nurses in charge and spoke in detail with two further members of staff. We also read the care plans of three people using the service, to find out more information.

The people we spoke with said that their privacy and dignity was respected at Fisher Close. One person said, “When I go to the bathroom staff cover me up.” People were involved, as far as possible, in planning their care. Staff respected their personal preferences and people thought that their needs were met. One person told us, “My one to one worker knows my ways…it makes it easy to be with them.”

People told us they felt safe at Fisher Close and were well treated by staff. Support workers had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One relative told us, “I feel so lucky [the person] is there.”