Chosen Court

Chosen Court is a residential care home providing personal care to up to 11 people. The service provides support to people living with learning disabilities, autistic spectrum disorder or mental health needs. At the time of our inspection there were 9 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: We received mixed feedback from people and their relatives about the opportunities to engage in activities of interest. The registered manager told us that they were supporting people to reengage with activities after the pandemic. We have made a recommendation for the provider to review people’s activity preferences to ensure they remain current.

There was evidence of risk assessments for the building and environment. Regular health and safety audits and environmental checks were carried out to monitor the safety of the service

The environment did not meet the principles of Right support, right care, right culture as there were more than 6 people living in one communal home. However, despite the large environment, consideration had been given to the principles. The regional operational director told us, “All of the refurbishment and building work has taken place to personalise people’s environment. It has been needs based and we are making more space and a ‘break out’ area for people.”

People had not always been supported to take their medicines in accordance with their individual needs and preferences.

Agency staff had been used to ensure safe staffing levels had been maintained through a high level of staff turnover.

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.

Right Care: People's care records did not always contain the necessary detail to evidence the personalised care, support and treatment people received. A high level of staff turnover had meant the service had recently become more reliant on agency staff. Staff were not always able to explain their role in respect of individual people without having to refer to documentation. Therefore, the shortfalls we identified in relation to people’s care records meant that we could not always be assured people’s wishes and preferences would be met.

Right Culture: We received mixed feedback from people, relatives and professionals about the culture of the home. Some permanent staff told us they believed that, after a period of high staff turnover, things were now improving. The provider had put measures in place to make the necessary improvements and an agreed timeline for improvements had been implemented. More time was needed for this to be achieved.

Quality assurance processes included a variety of audits. These had been operated effectively at provider level, but internal home audits had not identified the concerns we found on inspection.

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 (published 7 May 2021).

Why we inspected

We received concerns in relation to the management of finances, diet and nutrition and people’s personal care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Chosen Court is a residential care home providing personal care to 11 people living with learning disabilities, autistic spectrum disorder or mental health needs at the time of the inspection. The service can support up to 11 people.

Chosen Court accommodates people over three floors in one adapted building. People have access to all communal areas including shared bathrooms, lounge, conservatory, dining room, kitchen and a large enclosed rear garden.

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

People felt safe and supported at Chosen Court and had chosen to live there over other alternatives. People’s health related risks had been assessed and risks to them were managed. Outcomes for people were good and two people who were new to the service had ‘thrived’ there. People looked healthy and were supported to express their individuality through their personal choices. They were supported by staff who understood them as individuals, including what they may find challenging and what may cause them anxiety. People had formed positive, trusting relationships with staff who could read their moods and respond appropriately. People rarely needed as required medicines to help them manage their behaviours.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were listened to; they were offered choices and these were respected. People were supported to maximise their independence and their ability to manage aspects of their own lives, such as their finances, had been assessed. People had regular access to others who were important to them, one person had recently got their first mobile phone.

While COVID-19 had impacted the services’ ability to involve people in community-based activities, these had been provided regularly before lockdown and would resume when possible. People had been supported to follow their personal interests through person-centred activities. This had included gardening, watching horse-racing and singing. Where restrictions were needed to manage risks to people, these were minimal and legally authorised. People experienced an inclusive culture where leaders looked for solutions, to make things happen as people wanted them to.

The registered manager’s strong, inclusive, no-nonsense leadership style had a positive impact on the culture at Chosen Court. The registered manager was supported by the provider whose systems, governance and quality work had undergone significant investment and improvement. These improvements had been embedded since our last inspection and had resulted in good outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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.

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 19 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection, to show what they would do and by when, to improve safe care and treatment, staffing, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Court on our website at www.cqc.org.uk.

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.

Chosen Court is a residential care home providing personal care to nine adults at the time of the inspection. The service supports people with physical disabilities, learning disabilities, autistic spectrum disorder and/or mental health needs. The service is registered to support up to 11 people.

The service had been developed and designed before Registering Right Support came was introduced. However, improvements to the service were being managed in line with the principles and values that underpin Registering Right Support and other best practice guidance. This ensures 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 larger than current best practice guidance, accommodating 11 people in one adapted building. However, the building design fitted into the residential area and was in keeping with other large domestic homes in the area. There were deliberately no identifying signs, intercom or cameras outside to indicate it was a care home. Staff did not wear a uniform when supporting people at home and when accessing the wider community with them.

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

People and some staff did not always feel safe due to people’s distress behaviours, which were occurring frequently at the time of the inspection. There had been a lot of changes to management and the staff team, within the six months before the inspection, which had been unsettling for people. One person was unwell and the staff team were following specialist advice to assist them to meet this person’s needs. We found improvement was needed to ensure staff received training to meet people's specialist needs. Improvement was also needed to ensure staff had regular opportunities to discuss their support and learning needs.

The service had not always (consistently) 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. We found people had not always been supported to live as full a life as possible. Although daily activities were varied and available, opportunities for day trips out and going on holiday had been minimal. People had not always been supported to spend their money on good quality, well-fitting clothing and had missed out on opportunities to enjoy what life could offer them.

Improvements were in progress to ensure outcomes for people would fully reflect the principles and values of Registering the Right Support. People’s support plans had been re-written to assist staff to support people in a person-centred way. But these still needed to be fully adhered to by staff. Health action plans and hospital passports were in place and up-to-date for each person. These supported staff to ensure people had access to appropriate health, optical and dental care. Health professionals were satisfied with how people’s health needs were managed.

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. Risks to people had been assessed and where possible people were able to access their local community independently.

Monthly meetings had been re-introduced so people could have their say on menus and social events planned for them. People had chosen a keyworker, responsible for reviewing their needs with them and their representatives (where appropriate), to increase their control and choices. We saw people had regular opportunities to spend time doing everyday activities like shopping and exercising. Managers were aware improvement was needed to improve the staff culture and plans were in place to do this which included consulting people’s relatives.

While the provider and registered manager had identified concerns and were implementing an improvement plan to address shortfalls; the service had not been monitored sufficiently following our previous inspection to ensure regulatory requirements would be met and quality sustained. Time was needed to determine whether the provider’s improvement plan would be effective in making the required improvements and ensure future monitoring of the service.

Staff treated people with respect and dignity. People were comfortable and relaxed when interacting with staff and were happy to ask them for help or support. We saw people had formed good relationships with staff, even when those staff members had not known them for a long time.

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’ (published 20 May 2017). Since this rating was awarded, ownership of the legal entity ‘Chosen Care Limited’ has changed. Chosen Care Limited (including this service) is now owned and managed by the National Care Group brand. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Responsive and Well-Led sections of this full report.

The provider has taken action to mitigate the risks we identified but time is needed for these actions to be fully effective.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, and providing personalised care 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 to at least Good. 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.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run.

At our previous inspection on 25 and 26 November 2016, the provider did not meet the legal requirement in relation to the records of people’s mental capacity assessments and consent to care. Following that inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in obtaining consent to care and mental capacity assessments for significant decisions had been completed with the assistance of external professionals.

We discussed requirements for mental capacity assessments when people when unable to consent to aspects of their everyday care needs with the registered manager. We were satisfied staff recognised when people had capacity to consent and people’s rights were upheld. People were encouraged to be independent with the aspects of the care they could manage for themselves and supported with everyday living skills, including budgeting, when they were unable to do this for themselves. During the inspection the registered manager completed a mental capacity assessment and booked themselves on further training in these assessments. We were assured that documentation of capacity assessments would be prioritised following the inspection.

People living at Chosen Court benefitted from staff who prioritised their needs and wishes and understood them well. Risks were identified and carefully managed with appropriate help from external health and social care professionals. Staff knew how to protect people from harm and were skilled in meeting people’s support needs. There were enough staff so that people could be supported flexibly and in response to their changing needs. Medicines were managed safely.

Staff felt supported in their roles and were encouraged to obtain relevant qualifications and skills. When people had specific dietary or religious needs, these were well documented and care plans were followed by staff to ensure people’s needs were met. People were supported to access community based services, activity groups, preventative and specialist healthcare.

The atmosphere at the home was open and relaxed, where everyone was valued, respected and cared for as an individual. People spoke freely about what they wanted or any issues they were experiencing and they were supported to enjoy their private family lives.

Systems were in place to monitor the quality of the service and improvements were being made to the home in response to feedback and quality audits.

As part of this inspection we spoke with five people who use the service, the registered manager, and four staff. We also observed how people were being cared for. We reviewed records relating to the management of the service which included, three care plans, daily care records, quality assurance systems and staff records. Concerns had been raised with us about the safety and wellbeing of people living in the home. We looked at how the provider had responded to these concerns as part of this inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was not safe because the service had not managed the maintenance and upkeep of records appropriately. Some records did not evidence the strategies in place to reduce risks to people. Accident and incident audits did not provide evidence of the action which had been taken to prevent accidents reoccurring. Some policies and procedures did not provide correct or sufficient information. People were not protected against the risks of inappropriate or unsafe care and support because their records and those required for the management of the service had not been kept accurately. We have asked the provider to tell us what improvements that will make in relation to ensuring an accurate record is kept in respect of each person living in the home and as required for the management of the service.

People were safe because staff used both formal and informal methods to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe. When people were anxious or upset staff understood how to support them using distraction to help them to become calm. Physical intervention was not used. Safeguarding concerns had been raised with the service and the appropriate action had been taken to keep people safe from harm. There were sufficient levels of staff supporting people with the appropriate skills, knowledge and qualifications to meet their individual needs. When unsafe practice had been identified disciplinary procedures had been followed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant staff had been trained to understand when an application should be made and how to submit one. Applications had been submitted to the relevant authorities for people restricted of their liberty. This was in response to recent developments (March 2014) in the case law around DoLS.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People's likes, dislikes and routines important to them had been discussed with them. Staff spoken with had a good understanding of people's needs. People's health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were made to health care professionals when people's needs changed. Staff received support and access to the training to make sure their skills and knowledge were maintained and kept up to date.

Is the service caring?

People received a caring service because staff had a good understanding of the people they supported which included their preferences for the care and support they received. They also knew about people's personal histories and supported them to maintain links with people important to them. We observed staff listening to people and respecting the choices and decisions they made. One person told us, 'Of course staff listen to me.' People's care and support was discussed with them. Their views were reflected in their care records and the way in which their care was provided. People were supported to be independent and make decisions about the way they wished to live. People had access to advocates to help them express their wishes and aspirations. People's end of life wishes had been discussed with them and plans put in place to reflect these.

Is the service responsive?

The service was responsive because people had their individual needs regularly assessed. Staff understood the care and support needs of people. People, their relatives and friends were encouraged to provide feedback. People and their relatives were given information about how to make a complaint. They were encouraged to discuss any issues or concerns with staff as they arose. People were observed discussing concerns with the registered manager and being listened to and offer the appropriate reassurance. We observed people being offered choice about their daily activities and staff respecting the decisions they made. People's needs were assessed and they planned annual reviews of their care with staff.

Is the service well led?

The service was well led. Feedback from people who live in the home, their relatives and staff was encouraged. Action had been taken in response to their feedback. Quality assurance processes were in place to check on the experience of people living in the home. Residents' meetings and annual surveys sent to people living in the home and their visitors gave the opportunity to feedback views on the quality of service provided. Systems were in place to monitor accidents and incidents. The necessary action had been taken to prevent these from happening again. The service had worked co-operatively with other authorities and safeguarding teams to reflect on how people were being kept safe.

The provider assessed people's capacity to make day-to-day decisions and what type of decisions may need to be made in their 'best interest'. Where people had capacity they were asked to give consent to their care and their wishes were acted upon. We saw that staff had a good understanding of people's needs and used this knowledge to enable people to make their own day-to-day decisions about their care.

Care plans were personalised to each individual's needs and detailed how staff should work with people to meet those needs. Risk assessments had been completed where necessary and all care records were reviewed monthly.

Appropriate arrangements were in place in relation to the recording and storage of medicine. There were effective recruitment and selection processes in place. The provider sought the views of people who used the service and used these comments to improve and develop the service.

The service had a new manager who we were advised would soon be submitting their applicant to become the registered manager of this location.

Everyone we spoke with told us they were happy living in the home. People were encouraged to help around the home, tidying their rooms and helping in the kitchen. One person told us 'I like cooking and cutting up the fruit' and another person told us 'I like living here'.

Staff we spoke with and observed showed that they had good knowledge of the people they supported. They were seen responding to each person respectfully, with good humour and in a manner appropriate to each individual's needs.

The home regularly asked people who used the service, their representatives and other professionals for their views about the care and support the home provided. When feedback was given by people the home acted on it and used these comments to improve the service.