351 Maidstone Road

Updated 11 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 24 October 2018 and was announced. We gave the service 18 hours’ notice of the inspection visit so that the risks of people with complex needs becoming anxious when we arrived was minimised. The inspection visit was carried out by one inspector, one assistant inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. This inspection was in response to concerning information we had received about safeguarding incidents involving challenging behaviours that exposed people to potential harm. Due to these concerns, we brought the inspection date forward.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. Before the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service, which the provider is required to tell us by law.

People who lived at the service had complex communication needs. We spoke in depth to one person who used the service about their experiences. Other people did not engage verbally, however, we gathered information about the care received by observing how people responded to staff when care was delivered. We met and spoke with a relative. We spoke with six staff members which included the registered manager, deputy manager, the providers area manager, two senior support workers and one support worker. We asked three external health and social care professionals for feedback about the service.

We looked at two people’s records to see how their care and treatment was planned and delivered. We reviewed four staff files to check staff were recruited safely and were trained to deliver the care and support people required. We also looked at records relating to the running of the service including staff training records, quality assurance audits, complaints, accidents and incident records.

Updated 11 December 2018

The inspection took place on 24 October 2018 and was announced.

351 Maidstone Road is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

351 Maidstone Road provides accommodation and or personal care for up to five people with a learning disability and/or autistic spectrum disorder. The accommodation is provided in a house with access to garden areas. At the time of our inspection four people were living at the service. People had complex care and communication needs and may present with challenging behaviours.

The care service has been developed and designed 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. The service ethos is to enable people with learning disabilities and autism to live as ordinary a life as any citizen.

At our last inspection on 20 September 2017, we rated the service Good. We re-inspected this service earlier than planned due to concerns that had been raised about people’s safety. At this inspection we found that the evidence continued to support the rating of Good.

There had been substantial disruption to the service from people displaying behaviours that challenged the service, staff and other people. The disruption had reduced from the beginning of October 2018 after a change in the number of people living at the service. At this inspection we found that people continued to receive safe care. Risks associated with people's care and support were managed safely. People’s care needs were fully assessed and people were involved in the day to day planning of their care and making choices about their lives and routines.

Before this inspection allegations of abuse had been made about the service. We found that the registered manager and the provider had responded to these allegations by working with the local safeguarding team so that they were thoroughly investigated. At the time of this inspection there was no evidence or information that people in the service were at risks of harm.

The environment had been badly damaged by people displaying challenging behaviours. The decoration had suffered from damage and dilapidation. At this inspection the risks of continued damage had stopped. A maintenance team were in the process of repairing and redecorating the service.

Staff continued to minimise cross infection risks by following infection control guidance.

Behavioural management plans and interventions were based on the use of Positive Behavioural Support (PBS). PBS is recognised as one of the best way of supporting people who display, or are at risk of displaying, behaviour which challenges care services. Staff recognised that harmful behaviours were also a form of communication. Staff received specialist training to enable them to respond appropriately to potentially harmful behaviours. This work was supported by a behaviours specialist employed by the provider.

Staff understand people’s communication styles, using objects of reference, people’s moods, facial expressions and body language. The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

There was a learning culture from incidents and accidents. These were recorded, investigated and checked by the registered manager and the provider to see what steps could be taken to prevent them happening again.

There were policies and procedures in place, based on nationally recognised good practice for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. People had sufficient amounts to eat and drink. People had access to GPs and other health care professionals such as the learning disability team. People’s health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

End of life choices formed part of the care planning process, but end of life care was not being provided at the time of this inspection.

A policy about how to make complaints about the service was in place.

There were sufficient numbers of staff, who had been recruited safely, to support people’s needs. Safe recruitment practices had been followed before staff started working at the service. New staff and existing staff were given extensive induction and on-going training which included information specific to learning disability services. Agency staff were not being used at the time of this inspection. However, appropriate agency staff checking systems were in place should they need to be used.

We observed a service that was welcoming and friendly. Staff provided friendly compassionate care and support. Staff we spoke with and observed were kind and calm at all times. We observed staff giving people choices about what activities or routines they wanted to follow. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people's experiences. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. Good practice information was shared by managers meeting and networking with management colleagues. Business development plans were based on improving people’s experiences of the service.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The registered manager understood the requirements of their registration with CQC. The registered manager had sent statutory notifications to CQC when required. The CQC rating from our last inspection had been displayed.

Further information is in the detailed findings below.