We carried out a review of the data available to us about Reach Lower Cippenham Lane on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Reach Lower Cippenham Lane, you can give feedback on this service.
Reach Lower Cippenham Lane is a residential care home providing personal care to 12 adults at the time of our inspection. The service can support up to 12 people with learning disabilities or autism spectrum disorder. The building is a converted residential house with a ground and first floor and adapted facilities.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Twelve people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People were protected against abuse and neglect. People's risks were satisfactorily assessed. There was enough staffing deployed. The building was clean and tidy with appropriate cleaning to prevent infections. Clinical and general waste storage conditions on the outside of the home required closer monitoring to mitigate any risks. Accidents and incidents were logged. Improvements to the storage of refrigerated medicines were made as part of the inspection.
People's preferences were assessed and documented. Staff support was appropriate and showed that the training, supervisions and performance appraisals were up to date. People received enough food and drink. Any healthcare issues were referred to external healthcare professionals. The service was compliant with the provisions of the Mental Capacity Act (2005).
Staff were kind and caring. We received positive feedback from health and social care professionals when we approached them for their views. There was good engagement between staff and people who lived at the service. There was evidence of people's and relatives' involvement in the care planning. Reviews were undertaken regularly. People's dignity and privacy was respected.
People's care plans are very person centred and people's preferences were detailed and documented. Complaints were appropriately documented and managed. People had access to an active social life, both within and external to the care home. Plans were in place for end of life care.
There is a positive workplace culture; staff said it was a great place to work. The provider and the registered manager had implemented robust quality assurance systems. Actions were taken when improvements were required. There was good engagement with people, relatives and staff. There were positive remarks about the management team; staff said they felt supported and listened to.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (last published 2 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the time of the inspection, there was a registered manager. 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.
Since transitional registration under the Health and Social Care Act 2008 on 18 January 2011, Reach Lower Cippenham Lane has not always maintained compliance with the relevant regulations at each inspection by us. However, the most recent inspection was a routine planned visit on 3 September 2013. The inspection checked five outcomes, all of which were compliant. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first comprehensive rating under the Care Act 2014.
People were safeguard from abuse and neglect. There was a robust system in place to ensure that people’s safety was maintained. People’s behaviour was well monitored and controlled. This was in part due to the registered manager’s emphasis in staff identifying and addressing triggers. This meant decoration and personalisation of the service was able to be present and at less risk of damage.
Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection. The building and premises risks were assessed and managed to ensure people, staff and visitor safety at all times.
Enough staff were deployed to support people. Care workers we spoke with were satisfied that there was sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at certain times, but overall calm and relaxed and staff were dedicated to the people they supported.
Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. Storage of medicines was correct. The community pharmacist audited the safety of medicines management and reported outcomes to the registered manager for noting.
Staff were knowledgeable and competent. They received appropriate levels of training, supervision and performance appraisal. Relevant subjects were used to teach staff about caring for people with learning disabilities. This included the management of challenging behaviour and dealing with people’s epilepsy.
The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decisions meant the service complied with the MCA Codes of Practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.
People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them.
We found the service was caring. People, relatives and friends and a commissioner complimented the care. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. At the time of the inspection, most people who used the service had lived there for a long period of time. This was reflected in the care that people received from staff.
Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the complaints procedure and people or others had the ability to complain.
The workplace culture at the service was good. Staff described a positive place to work and care for people. Staff told us they enjoyed their roles and found management approachable and reasonable. Sufficient audits of the service were conducted to check the safety and quality of the care. We made a recommendation regarding the scope and frequency of audits. The service had joined-up working with a community organisation to improve the quality of care.
People confirmed to us that they were involved in decisions about the care they received and that they felt confident to raise any concerns at the monthly residents meetings. One person told us 'If I have any concerns I can always talk to the manager or any of the staff on duty.'
We looked at care plans that were person centred and focussed on people's individual needs, theses were supported by risk assessments that had been written to identify and reduce the likelihood of injury or harm. People had access to health professionals and specialist support to ensure they were kept healthy and well.
We were told that a range of daily activities were provided for all who wanted to take part; we looked at activity sheets in 4 peoples care files that included details of local walks, visits to social clubs and local sports centres. One person told us 'I like going out to the social club each week to meet with my friends.'
The staff we spoke with demonstrated a good understanding of the different types of abuse and were able to provide us with a good insight into the organisations safeguarding policy and the Local Authorities reporting processes.
We found evidence that regular audit visits were carried out by the care service manager. These reports showed us that the provider was using a robust quality monitoring system to ensure safe and respectful care was received by people who used the service.
People confirmed they were involved in decisions about their care and the care planning process and were confident in raising concerns.They said they attended monthly house meetings where they could raise suggestions and discuss any issues about the service.
Care plans were in place to document people's individual needs. Risk assessments had been written to identify and reduce the likelihood of injury or harm. People had access to healthcare professionals and specialist support to ensure they kept healthy and well.
Daily activities were provided to those who wished to take part. These included trips out into the community, walks in the local area and attendance at local community colleges to pursue their chosen interests. One person told us ''I go to bingo...made lots of friends and we go bowling with staff'' and another showed us masks they had all made and told us a gentleman ''comes each week to do art and craft with us.''
The home was comfortable, clean and warm. Each person had their own bedroom which they had personalised to their own taste.
Systems were in place to regularly assess the quality of service provided.