Background to this inspection
Updated
27 February 2021
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.
As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.
This inspection took place on 4 February 2021 and was announced.
Updated
27 February 2021
This was an unannounced inspection that took place on 21, 26 and 28 September 2018.
1a Upper Brighton Road is a ‘care home’. 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 home provides care for up to nine young people including people with learning disabilities or autistic spectrum disorder. It is located in the Surbiton area of Surrey.
The service had a registered manager. 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.
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.
This was the first inspection since the service was registered.
The home provided a service for younger adults with learning disabilities or an autistic spectrum disorder. They had moved from residential schools, other care home placements or parental homes where their support needs were no longer being fully met. Their lives were massively impacted in a positive way by the move which was reflected in their progress, personal achievements and opportunities to try new experiences.
The young people benefited from a wide and varied range of activities, in the community, at home and further afield. They selected them with patient, painstaking support by staff that enabled them to do things that were focussed on their individual interests and likes. Whilst people could not comment verbally on the activities their body language showed us they were enjoying them with lots of smiling, laughter and enthusiasm. The impact of this was that people thoroughly enjoyed their activities and developed bonds and friendships, through them, with staff, each other and others.
The positive impact the home had on the young people was also demonstrated by a
substantial reduction of incidents and situations where people may display behaviour that others could interpret as challenging. Where people displayed anxiety or anger through aggressive behaviour, staff were on hand and knew how to defuse situations. They understood that this was an expression of people's needs, emotions, feelings and an attempt to communicate them. Staff turned people’s negative behaviour and frustrations into positives by calming the situation, finding out what was wrong or what people wanted and addressing their needs. They achieved this by having a thorough knowledge of each person and their likes and dislikes based on trial and error and growing positive relationships and bonds with them.
Due to people having limited verbal communication relatives generally spoke on their behalf. Relatives felt the home provided a warm, welcoming and friendly atmosphere and that staff treated the young people's safety as paramount. This was whilst still acknowledging that people must be enabled to try new experiences and take opportunities by taking acceptable risks. Staff weighed up the benefits of the activity with the young person in relation to the risks involved. This was reflected in the number of new experiences and activities people safely had whilst continuing with those that they previously enjoyed. It meant people received a service that was individual to them. The service and activities were flexible and changed with them as their needs changed and skills and confidence developed, resulting in more fulfilling and enjoyable lives. Staff also thought the home provided a safe place for people to live and them to work.
Relatives told us people were very happy and enjoyed living at the home and we saw how much people enjoyed the care and support provided by staff. This was reflected in their positive body language and interactions with staff and each other during our visit. Staff enabled people to make progress by adopting a very person-centred approach. They recognised people’s achievements, highlighted them and supported the young people to also recognise and celebrate them. They achieved this by having a thorough knowledge of people's individual communication and sensory needs and meeting them in a patient and measured way.
People’s support plans were comprehensive and individualised to them. They encompassed all aspects of people’s lives that included their social, leisure, educational and life skill development needs. These were mirrored and met by the structured and spontaneous activities that people chose which enabled them to live their lives the way they wished. Staff paid great attention to people's health, emotional needs and people were encouraged by staff to discuss and meet any health and appropriate sexual needs they may have. The depth of planning and cooperation and its impact was demonstrated in each support plan and files we looked at. People’s care plans were regularly reviewed and updated. This enabled staff to support people in an efficient, professional way. The records kept were up to date and covered all aspects of the care and support people received. The home worked in tandem with health care professionals in the community.
People were protected from nutrition and hydration associated risks by staff encouraging and supporting them to have balanced diets that also met their likes, dislikes and preferences. Staff also used meal selection to develop people’s life style and decision-making skills in a very effective way.
The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) required the provider to submit applications to a ‘Supervisory body’ for authority. Appropriate applications had been submitted by the provider and applications under DoLS been authorised, and the provider was complying with the conditions applied to the authorisation.
The home was very well-maintained, furnished, clean and adapted to meet people’s individual requirements, to a high standard.
Staff received excellent structured training that was organisation, service and person-specific. The quality of the training was reflected in the exceptional care practices staff demonstrated and followed throughout our visit. They were very knowledgeable about the field they worked in, had appropriate skills, knew people and their relatives well and understood people's needs in great detail. Their knowledge was used to provide care and support in a professional, friendly and supportive way, focussed on the needs and wishes of the individual. People knew and trusted the staff that supported them.
Relatives told us that the registered manager and staff were accessible to them, very communicative, worked well as a team and provided them with updated information as needed. The registered manager was responsive, encouraged feedback and consistently monitored and assessed the quality of the service.
Staff told us that the organisation was a great one to work for and they really enjoyed working in the service. They received excellent support and there were opportunities for career advancement. They felt enabled and supported to develop their skills and progress their careers. Individual skills were acknowledged, harnessed to further practice development and incorporated within the way the service worked. The service and organisation enabled staff to contribute effectively in developing people's individual support as well as developing new ways of working and procedures. They felt their ideas were listened to and implemented.
The organisation’s quality assurance and monitoring systems were geared for continuous improvement and required staff to constantly monitor individual care and support and feedback from people. They also supported staff to reflect on how their actions impacted on people and how people’s lives could be made better and more enjoyable. The records system was well thought through, clear and useable. Staff also recognised the importance of these records as a source of quality improvement and whilst they were very detailed this was not allowed to detract from the care and support people received.
The culture of the service, staff and organisation was open, progressive and transparent. There was a commitment to continuous improvement with care and support being person centred. Relatives felt people and themselves were valued as did staff who considered themselves integral members of the organisation. The National Autistic Society had accredited the organisation and recognised the high quality of the person-centred care and individualised support provided. The organisation worked well with other stakeholders, seeking their opinions and checking if they were satisfied with the service provided.