Adult Pathways 1

Updated 18 November 2020

The inspection

We carried out this focussed inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors, a specialist advisor and two Experts by Experience who contacted people’s relatives by telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor was a nurse.

Service and service type

Adult Pathways 1 is a ‘care home’, comprising of eight separate accommodations. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection. Due to the impact of the COVID-19 pandemic we were mindful of the amount of time inspectors were on site. Therefore, records and documentation were requested before the site visit and reviewed remotely.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection-

We spoke with 4 people who used the service. We contacted 20 relatives by telephone about their experience of the care provided and spoke with 18 staff including the registered manager, a residential manager, a team leader and care officers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included multiple care and medication records, two recruitment records and a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at additional records and contacted 11 professionals who regularly work with service. We spoke with two professionals directly and received six written responses.

Updated 18 November 2020

About the service

Adult Pathways 1 is a residential care home providing personal and accommodation for 83 people at the time of the inspection. The service can support up to 126 people. Adult Pathways 1 provides care and support in eight ‘houses’ of varying size and occupancy situated within the main David Lewis Centre site located in rural Cheshire.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice, however had not always been followed.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service had developed over a period of time. Adult Pathways 1 comprised of eight ‘houses’ of different size within a large campus which included a further eight ‘houses’ under a different registration. In total, the main campus facility provided regulated activity for a maximum of 172 people with a learning disability and/or autism, along with day services and medical facilities.

The fact that the accommodations varied considerably in size resulted in a differing experience for people living there, whilst we saw in smaller accommodations a more homely atmosphere, the larger properties evidenced a somewhat institutionalised approach. The registered manager provided details of refurbishment plans and we have made a recommendation that Right support, right care, right culture guidance is used to inform improvements and future plans.

Regular fire drills had not been carried out and risk assessments were not always up to date. Staff received training and were aware of the procedures to follow to protect people from abuse, however, they had not questioned restrictive practice which we observed.

People told us they felt safe and relatives also felt their family member was safe. Medicines were administered by trained and competent staff. We identified some areas for improvement which were discussed with the registered manager and have made a recommendation that the registered provider carries out a review of medicines practice to ensure compliance with best practice guidance. Staff were using personal protective equipment effectively and safely to prevent and control the spread of infection.

People were supported by trained and skilled staff. Safe recruitment procedures were followed to ensure only suitable staff were employed. People’s dietary needs were assessed by the provider’s multi-disciplinary team. One person told us the food was “good.” People were generally supported with their meals in a caring and dignified manner. People felt well supported to maintain their health and well-being. We received positive feedback about this from people using the service, relatives and visiting professionals.

The COVID-19 pandemic had impacted upon quality assurance processes and we found they had not always been effective. Staff and people using the service told us the registered manager was fair and approachable.

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 Good (published 02/11/2018.

Why we inspected

We received concerns in relation to culture, staff practice and safety of people within the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and well-led only.

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 Good to Requires Improvement. 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 Adult Pathways 1 on our website at www.cqc.org.uk.

During this inspection we did not see people were at risk of harm directly related to the concerns received. However, we have found evidence that the provider needs to make some improvements. Please see the Safe, Effective and Well-led sections of this report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent 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 for 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.