Holt Road

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 Care Quality Commission (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.

About the service

Holt Road is a residential care home providing accommodation for persons who require nursing or personal care for up to five people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were four people using the service.

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

The service demonstrated how they were meeting the underpinning principles of Right support, Right care, Right culture.

Right support:

Staff were aware of and followed best practice and the principles of Right support. People received person centred support. Positive behaviour support plans promoted strategies to enhance independence and demonstrated evidence of planning and consideration of the longer-term aspirations of each person. The service provided care and support in a safe, clean, well-furnished and well-maintained environment that met people’s sensory and physical needs. The service was similar to the other houses in the area. People’s rooms were clean and personalised with their belongings and family photographs.

Right care:

The service had enough appropriately skilled staff to meet people’s needs. Staff received support in the form of continual supervision, appraisal and recognition of good practice. They also benefitted from a system of monitoring, which ensured they received timely feedback from managers. People could take part in activities and pursue interests that were tailored to them. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. There were visual structures, including picture aids and use of gestures.

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives. Leaders had the skills, knowledge and experience to perform their roles and had a clear understanding of people’s needs and oversight of the services they managed. This was demonstrated by the behaviour technician, service manager and the regional manager throughout the inspection. We found them to have the competencies associated with actions necessary for the delivery of positive behaviour support.

There were effective systems and processes in place to minimise risks to people. The assessments provided information about how to support people to ensure risks were reduced.

Positive behaviour support plans included risk assessments that detailed known triggers, early warning signs and de-escalation methods to be used. This insured people received timely intervention if their mental health deteriorated. There were enough staff deployed to keep people safe. Pre-employment checks had been carried out.

There were systems in place to ensure proper and safe use of medicines. We observed from records people received their medicines on time.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

There was a process in place to report, monitor and learn from accidents and incidents. Accidents were documented timely in line with the service’s policy and guidance.

There was an effective training system in place. Care staff demonstrated good knowledge and skills necessary for their role.

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.

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 the service was good, published on 21 March 2018.

Why we inspected

We received concerns in relation to the management of risk relating to hot water temperature, poor management of medicines and staff demonstrating lack of understanding in the management of behaviours people may display when in distress. A decision was made for us to inspect and examine those risks. We found that the service had acted on the concerns.

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.

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.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Holt Road is a care home providing personal care support and accommodation for up to five people with autistic spectrum conditions, complex communication needs and behaviours that challenged the service. At the time of our inspection, five people lived in the home.

At our last inspection on 31 March 2016 we rated the service 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.

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Holt Road had robust system, processes and practices to safeguard people from abuse and avoidable harm. Potential risk to people was assessed and their safety was monitored and managed to ensure people stayed safe and their freedom was respected. Sufficient staff were deployed to meet people’s needs and safe recruitment practices ensured only staff suitable to work people was employed. Medicines were managed safely and people can be confident that they received their medicines as prescribed. Appropriate infection control prevention ensured people lived in a clean home. Lessons were learned from incidences and accidents to minimise the risk of these happening again.

People’s needs were assessed to ensure Holt Road was able to meet their complex needs. Care staff had access to a wide range of training, which also included training specific to people’s needs. People had a choice of a nutritious and well balanced diet, which was freshly prepared by care staff. Holt Road accessed specialist support if needed. People lived in a well maintained and decorated home, which provided space to relax and socialise. 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 did support this practice.

Relatives told us that people were treated with respect and kindness and care staff demonstrated compassion and understanding for people’s complex needs. People who used the service were encouraged and supported to express their views. People’s privacy, dignity and independence was respected and promoted.

Peoples care was personalised and responsive to their needs. Complaints and concerns were taken seriously and responded to appropriately. The service does not provide end of life care.

Relatives and staff spoke positively of the changes in management and practice. Staff were motivated and felt supported by in their role and were on board with the registered manager's vision for the service. Relatives, people and staff were provided with the opportunity to give feedback on the service, which was then acted upon. A variety of audits were in place to assist the registered manager in driving improvement across the service. The registered manager and staff group worked alongside other agencies in order to obtain the appropriate care and support for people.

Further information is in the detailed findings below.

Holt Road is a care home providing personal care support and accommodation for up to five people with autistic spectrum conditions, complex communication needs and behaviours that challenged the service. At the time of our inspection, five people lived in the home.

There was a manager registered with the Care Quality Commission (CQC), however the registered manager was currently on sick leave and an experienced senior support worker was acting on her behalf. 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.

We found people were cared for by suitably qualified, skilled and experienced staff who knew their needs well. People were supported to follow their own chosen routines and to take part in activities they liked, such as trampolining, swimming, going to the gym, walking, and baking cakes and household chores.

People’s care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Staff followed the care plans and had good relationships with the people living at the home.

Risk assessments and care plans for people using the service were effective, individual and autism specific in capturing the required information. People’s individual care needs were recorded in a timely manner which demonstrated that their needs had been met. There was a strong focus on supporting people in becoming more independent by working together with the family, the person and the day service to achieve the best possible outcome.

People received their medicines in a safe manner and staff recorded and completed Medicine Administration Record (MAR) charts correctly.

The service showed good practice in supporting people with their physical and mental health needs and in making decisions for themselves.

The house was safe and improvements to the environment had been made since our last inspection.

The home was well managed and the registered manager was supported by an experienced senior care worker as well as the Head of Care who was available as and when needed. Care workers were supervised monthly and supported by senior members of staff to ensure they did their job well.

Where things had gone wrong, appropriate action was taken to make sure the same mistakes were not made again. For example, where a mistake had been made in giving somebody the wrong medicines, staff were suspended from giving medicines until they had further training and the manager had assessed their competence.

The manager notified relevant people of any incidents as required.

SS4AL undertook frequent audits to ensure the home was operating to a good standard.