United Response - 9 Beverley Road North

About the service

Beverley Road a residential care home providing personal care to five people at the time of the inspection. The service can support up to five people. The home is an extended Dorma bungalow, all bedrooms are on the ground floor as well as a kitchen and dining area and a lounge leading on to a paved patio and outside seating area. The upper floor holds a dedicated sleeping area for staff and office and storage space.

People’s experience of using this service and what we found

Right Support

Medicines management was not consistent with best practice and some staff’s knowledge in this area was a concern. Management took action to address immediate areas of risk.

Areas identified as concerning in fire safety practice and monitoring were not addressed in a timely way. Management were aware more action was required to address this area and we were told steps would be taken. Staff supported people to have the maximum possible choice, control and independence and control over their own lives. People were supported by staff to pursue their interests. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support.

Right Care

Staff promoted equality and diversity in their support for people. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity and they understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people’s needs and keep them safe and there was an ongoing recruitment and training programme to ensure staff were appropriately skilled. Staff, people supported, and their advocates cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staffing was becoming more stable led by an appointed manager who was registering with the commission. Management were working to ensure everyone in the home received consistent care from staff who knew them well. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 (18 March 2018 )

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support Right care Right culture.

We received concerns in relation to risk management including safe care and the administration of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. During the inspection the provider took action to address concerns where required and plans were in place to address other issues already identified by the provider.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response - 9 Beverley Road North on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe management of medicines and have made two recommendations to ensure oversight of risks to both the environment and the people supported is maintained at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection visit took place on 30 January 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the service was a small care home for younger adults who are often out during the day, we needed to be sure someone would be in.

At our last inspection we rated the service overall Good. It was outstanding in caring and good in the other four domains. At this inspection we found the evidence continued to support the rating of overall good and remained outstanding in the caring domain. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of our inspection visit five people lived at United Response – 9 Beverley Road North.

There was a registered manager in place. 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 supported in Beverley Rd had complex care needs and not all were able to speak with us or communicate in a way we understood. However we observed interactions between staff and people who lived at Beverley Rd, spoke with people able to communicate verbally and with families. They told us they felt they or their family member were safe and cared for, happy and well supported by staff.

Procedures were in place to minimise the risk of unsafe care or abuse and staff understood their responsibilities to report unsafe care or abusive practices. They had received training on safeguarding vulnerable people and knew how to do this.

Care plans were focused on each person’s individual needs and preferences. Staff involved people and where appropriate, their relatives and records were informative about the care people received. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with complex care needs. There were sufficient staffing levels in place to provide the support people required and staff responded promptly when people needed assistance.

Medicines were managed safely. They had been ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. People received their medicines when needed and appropriate records had been completed.

People indicated they liked the choice and variety of meals. We saw people received adequate nutrition and hydration. One person said, “I enjoy cooking with the staff. We choose healthy food.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The design of the building and facilities provided were appropriate for the care and support provided. We found equipment had been serviced and maintained as required. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of infection.

People had been 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.

We saw people had access to healthcare professionals. One person told us “[Name] sorts out for the doctor or nurse to see me and stays with me so I don’t get too anxious.” People’s healthcare needs were met promptly. Staff provided care in a way that respected peoples’ dignity, privacy and independence. People and their relatives told us staff cared for them in the way they wanted.

People indicated they enjoyed a variety of meaningful leisure activities in the home and in the local community. These gave people the opportunity to try new activities as well as ones they already enjoyed.

People and their relatives were given information about how to complain. People we spoke with told us they felt able to complain and express any concerns. No-one we spoke with had any complaints. People also had information about support from an external advocate should this be required.

The registered manager assessed and monitored the quality of the service. These included regular audits and ways to seek people’s views about the service provided. People who lived at Beverley Rd and relatives told us the management team and staff were approachable and willing to listen.

Further information is in the detailed findings below.

We observed the care staff provided to people during the inspection. We saw staff supporting people quietly, calmly and sensitively. Records showed that people went out and about on most days, involved in a variety of activities. Relatives felt that staff supported their family member well with social, educational and leisure activities.

We observed staff communicating with people. We saw that they were able to communicate effectively together. We observed people being treated with respect and dignity.

Person centred care records were in place providing information about people. These were informative and updated frequently. They showed that people living in the home and their relatives were involved in decisions. Senior staff monitored the home effectively and sought the views of those involved in the home.

9 Beverley Road was maintained and decorated for the comfort of the people living there. Bedrooms were personalised according to people's wishes.

We saw people being treated with respect and encouraged to carry out tasks in the way they wanted to. We observed that routines in the home were flexible and people were supported to get involved in activities they enjoyed.

Relatives said that their family member was treated with respect and that they were involved in decisions about care. They told us they felt that people were safe and well looked after. They said staff were approachable and they would tell the staff if something was wrong and it would be dealt with.

Person centred care records were in place, which provided up to date information about people. This helped staff to provide the right care for people.

There were satisfactory numbers of staff and staff worked flexibly to support people in the way they needed. All staff had access to a structured training and development programme, to give them the skills they needed. Managers regularly checked that the home was running well and took action if they felt improvements were needed.