Adult Pathways 1

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.

Pathways and Community - Warford is a ‘care home’ operated by The David Lewis Centre. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Pathways and Community - Warford accommodates people in 16 separate buildings, each of which has separate adapted facilities.

Pathways and Communities Warford is made up of 16 separate homes across a single private site in a rural area of Cheshire. The homes are mixed gender and mixed ability. The homes are varied from minimum occupancies of two to a maximum of 18. The service supports people with complex needs in a residential village setting. The homes are registered to care for people living with dementia, learning disabilities or autistic spectrum disorder, older people, young adults and people with a physical disability. The service specialises in supporting people with epilepsy. At the time of inspection there were 123 people living at the site.

The service followed a multi-disciplinary approach with socially registered homes and on-site clinical facilities including a GP surgery, physiotherapists, occupational therapists, speech and language therapists, specialist nurses, pharmacy and psychologists. The service had a working farm, leisure facilities including a swimming pool and community based day services on site. All of which were accessible to the people living there.

The service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service is unique in size, it spans 50 acres, people had access to wide open spaces and were kept safe within this community. The entrance to the site is secured with a barrier, the site is not accessible to the general public. Because of this the site felt safe, people and staff walked or drove around the large site.

The service had a registered manager in post. 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.

The registered manager had overall responsibility of the 16 homes. Each home had a manager, team leaders and care officers. Each home completed quality audits and presented these at management meetings. People and staff spoke positively about the management team.

At the last inspection which was published in June 2015 the service was rated good. At this inspection we found the evidence continued to support the rating of good and 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.

People were supported to receive safe care from staff who received a high level of safeguarding training. Safeguarding policies and procedures were robust. Recruitment was completed safely and thoroughly with appropriate pre-employment checks. Medicines were well managed and people were protected from the risk of infection. People were protected from the risk of discrimination.

People were 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. There was a multi-disciplinary approach to care and a proa-active approach at supporting people who displayed behaviour that challenged. There were a variety of different types of home within the service and people were supported to choose the most effective setting for their care. People and their relatives were included in care planning.

Staff were kind and caring. The people we spoke to told us they were cared for by staff who knew them well and respected their preferences. Many people received one to one support from staff. Staff were not task orientated, their role was to care and support, there were extra domiciliary staff to complete other tasks.

People were treated as individuals. Many people had jobs on the site and within the community and were supported with this by staff who understood their needs and preferences. There was a wide variety of activities both on and off site. There was a working farm and leisure facility which people had full access to.

Further information is in the detailed findings below

During the inspection, we looked at four care plans and in each of them we saw evidence that the provider had followed guidance and legislation relating to capacity assessments and best interests meetings.

People we met were happy with the care and support they received. One person said; 'It's good here I like it.' Another person said; 'They're alright' they then laughed and smiled at the staff and said; 'Yep, really nice.'

We were told that the Director of Clinical Services was the Centre lead for infection control and that a comprehensive infection control policy was in place.

We checked a number of pieces of equipment, including fire alarms, fridges, freezers and electrical equipment and saw that it had been checked and maintained within applicable timescales.

It was clear that the provider sought people's views. We saw that there were residents meetings held weekly where people could make suggestions and raise concerns.

We spoke with four people who used the service. One person told us about their daily life at the service and said they were happy living there. Another person said 'they help me to look after myself.'

We saw that the service had implemented regular audits as well as consulted with people who used the service and family members to monitor the quality of service provision.

We saw that systems were in place that ensured people were protected from the risk of harm and abuse. We were provided with a copy the staff training records. This showed that staff received training and were supported to access courses that enabled them to deliver safe and effective care to people who used the service.