We carried out a review of the data available to us about 54a on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about 54a, you can give feedback on this service.
54a is a residential care home providing a regulated activity to up to 3 people. The service provides personal care support to adults with learning disabilities and/or autism. At the time of our inspection there were 3 people using the service.
People's experience of using this service and what we found
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 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.
Right Support: Staff supported people to be as independent as possible, staff knew people well and how to meet their needs. People, staff and professionals were involved with decision making where appropriate. 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.
Right Care: People received person-centred care; we observed staff acting in a person-centred way and care plans reflected people's wishes and preferences. People's privacy and dignity was respected and people were involved with decisions about their care.
Right Culture: We received positive comments from people about staff and the management team. We observed staff working with people respectfully and measures were in place to protect people from avoidable harm. There was an inclusive approach to care provision and staff levels were reviewed and amended in response to people's care needs.
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 this service was requires improvement (published 14 November 2019) and there was a breach in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 26 September 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the need for consent and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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, which will help inform when we next inspect.
54a provides accommodation and personal care for up to three people with a learning disability. People using the service are supported to live as independently as possible. The service was split between a self-contained flat for one person, and shared facilities including separate bedrooms for two others.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The documentation in place to support people to make decisions when they lacked capacity to do so required improvement. This was because it was not always clear which specific decisions had been assessed or how best interest decisions had been made on their behalf. 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 did not support this practice.
Risks were assessed and minimised wherever possible, and there were good systems in place to ensure lessons were learnt after any incidents. We made a recommendation about reviewing some information used in risk assessments because it was not always up to date.
People were protected from the risks of abuse, and there were good systems in place to ensure concerns were reported.
There were enough staff at all times, and we saw people were happy and relaxed in the presence of staff. Recruitment and training practices remained safe and effective. People got their medicines when they needed them.
When people needed to see other health professionals they were able to do so. There were very good plans in place to ensure people would get the support they wanted at the end of their lives.
The care provided was person-centred and free of discrimination, however we made a recommendation about improving some of the phrases used in care plans to ensure documents reflected this good practice. Information was available to people in adapted formats where this was useful to them.
People’s needs and preferences were understood and acted on, and we saw people could make and challenge decisions about their care. People shopped for and prepared their own meals, and were able to access the community whenever they wished to.
There were systems in place to monitor the quality of care provided, however these had not identified issues with the documentation of people’s capacity to make decisions. People were consulted about the running of the home and their feedback was welcomed.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; best interest decisions were referred to in care plans, however there was no evidence to show what process had been followed in making these.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
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 this service was good (report published 24 March 2017). We did not identify any breaches of regulations. At this inspection we have identified one breach of regulations relating to people’s capacity to make decisions, and the rating has deteriorated to requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
54a provides accommodation and personal care for up to three people who had a learning disability. People using the service are supported to live as independently as possible. The service has a self-contained flat for one person and two bedrooms in the main house. The home is close to local amenities.
The service had a registered manager in post at the time of our inspection. 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 service had procedures in place to ensure people’s medicines were managed in a safe way. We looked at the storage of medicines and found they were kept in each person’s room in a locked cabinet which was accessible by staff. Some medicines, prescribed on an ‘as and when’ required basis were recorded but a record was not always kept of the effect the medicine had on the person.
Risks associated with people’s care had been identified. However, the service did not have any Personal Emergency Evacuation Plan’s (PEEP) in place for people who may not be able to evacuate the service quickly in an emergency. We spoke with the registered manager who told us they would address this and devise a personal plan if required.
Through our observations and by talking to people who used the service, their relatives and staff, we found there was enough staff available to support people.
Staff we spoke with were knowledgeable about safeguarding people from abuse. They knew how to recognise and respond to abuse. All staff we spoke with were confident the registered manager would address any situation brought to their attention.
We looked at records in relation to staff training and saw that staff had certificates in their personal file. We also saw a training matrix, which was a record of training received, due and overdue. This was completed by the deputy manager. Some training was out of date in relation to what the company expected. However, training was sought and booked during our inspection.
People were supported to eat healthy meals based on their likes and dislikes. People discussed the menu on a weekly basis and devised a shopping list, helped to buy the food and where appropriate assisted in the preparation of meals.
The service was meeting the requirements of the Mental Capacity Act 2005. Staff were knowledgeable about this subject and supported people well.
People were referred to healthcare professionals when required. Staff took on board advice given and updated support plans to reflect this.
During our inspection we observed staff interacting with people who used the service. We saw that staff had developed positive, caring relationships with people based on their individual preferences and choices. It was evident that staff knew people very well. We saw that staff maintained people’s privacy and dignity.
We looked at care records belonging to people and found they reflected the support people required and the support staff were offering. An initial assessment was carried out to ensure the service was able to meet people’s needs.
People were involved in community activities and events within the service. People had an activity planner which they had devised. This included events people took part in and identified where they would need support.
The service had a complaints procedure in place and people felt they could raise concerns if they needed to. People told us they were happy with the service and did not have any worries.
We spoke with people who used the service and staff and they told us the registered manager was supportive and approachable. Staff knew their roles and responsibilities well and worked as a team.
We saw audits were in place to ensure the quality of service provision was being maintained. We saw audits for areas such as finance, medication, health and safety, fire safety and infection control. Areas for improvement were identified and addresses appropriately.
We saw evidence that people had a voice and used several forums to raise suggestions and ideas. These were listened to and appropriately actioned.
Some policies and procedures required updating. Work was currently taking place to address this.
This inspection took place on 10 July 2015 and 13 July 2015 and was unannounced. We previously inspected the service on 3 December 2013. The service was not in breach of health and social care regulations at that time.
54a is a home registered to provide care for a maximum of three people. The home specialises in providing care for people with learning disabilities or autistic spectrum disorders. The home aims to promote people towards independent living. The accommodation comprises of a one-bedroomed self contained annex and two further bedrooms in the house with a shared lounge, kitchen/dining area and bathroom. There is a garden to the rear of the property.
The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us they felt safe living at 54a and the family members we spoke with also said they felt their relatives were safe.
Staff were able to demonstrate they understood different types of abuse and what to do if they had any concerns that someone was being abused. However, some staff did not have up to date training regarding safeguarding adults.
Medication was not managed appropriately. Some medication was received and not recorded and other medication was administered and not recorded.
We found that safe recruitment procedures were followed and safe numbers of staff were employed at the home.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. We found that staff had a thorough understanding of these safeguards. Authorisation had been appropriately sought when people’s freedom or liberty was being restricted.
Staff at 54a were caring and attentive to people’s needs. We saw evidence of this in the way that staff and the people who lived at the home interacted with each other. Staff knew the people who used the service well.
People received personalised care and there was a variety of activities for people to participate in, taking into account people’s likes and dislikes. People were empowered to be as independent as possible.
There was a clear vision and ethos within the organisation as a whole, which included working ‘with, not for’ people. The staff we spoke with were aware of this and this was embedded into their day to day practise.
People’s views were not always appropriately sought and there were mixed views regarding whether the service was well led.
You can see what action we told the provider to take at the back of the full version of the report.
We spoke to two people who lived in the home. One person said 'I like living here. I go out to more places than I did before. I have a girlfriend and sometimes she comes here and sometimes we go bowling. I go to the youth club every week'.
We looked at a range of records. These contained information about the persons preferred name and identified the person's usual routine. One member of staff said people do have a regular routine but if they want to change it they can, otherwise the service could become very regimented and it should not be like that, people should have choice.
People who used the service said they were consulted about the care they received and were able to give their views about the care and treatment.
We saw that health and social care professionals were involved in the care planning process and that people had access to primary healthcare services such as GPs.
We saw that training records had information on staff attending training in areas such as medication, food hygiene, first aid, moving and handling and restraint techniques.
We saw information on staff having regular supervision and yearly appraisals this helped ensure staff were competent and/or highlighted when further training or support was needed to ensure high standards of care were met.
We asked how the provider monitored the quality of the care they delivered. The manager said that the provider normally carried out staff, service users, family and healthcare professionals surveys on the quality of the service provision but because the home had been opened for less than a year this had not yet been carried out. The manager did say however, that an informal opening day had been held in April where family and friends had been invited to have a look around and talk to staff.
We saw that a monthly report was recorded which gave information on the general overview of each service user, monitored all incident reporting including safeguarding referrals and complaints. It was noted that there had been no complaints recorded.