Matthew Residential Care Limited - 59 Woodgrange Avenue

About the service

Matthew Residential Care Limited - 59 Woodgrange Avenue is a residential care home providing personal care and accommodation to 2 people at the time of the inspection. The service can support up to 3 people.

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

During our last inspection we found the service was meeting the underpinning principles of Right support, right care and right culture (RCRSRC). However, we were not fully assured that the changes the service had made were fully embedded and quality standards would be maintained. At this inspection we found the provider had maintained the required standards.

Right Support: People were involved in the planning of their care and told us that they received support which met their individual needs and preferences. People who used the service were supported in the least restrictive way and staff demonstrated understanding of people’s needs. People were supported to live the life they wanted by staff who knew them well and put them at the centre of decision making. Staff enabled people to access specialist health and social care support in the community. People had a choice about their living environment.

Right Care: Staff understood how ensure people were protected from harm or abuse. Staff worked with people to identify and reduce the likelihood of risks to their wellbeing and activities. Staff understood people’s care and support needs.

Right Culture: People were involved in planning their care. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. 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 and update - The last rating for this service was requires improvement (published 24 August 2022). We made a recommendation that the provider sought further guidance on managing behaviours that challenge the service and another on recording and acting on lessons learnt following incidents. At this inspection we found the provider had taken action and improvements had been made.

Why we inspected

This inspection was carried out following concerns we had received from a local authority in relation to service quality. At this inspection we found these concerns had been addressed.

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.

Recommendations

Follow up

We will continue to monitor information we receive about the service, which will help inform us when we next inspect.

About the service

Matthew Residential Care Limited - 59 Woodgrange Avenue is a residential care home providing personal care and accommodation to three people at the time of the inspection. The service can support up to three people.

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

During our last inspection we found that the service did not demonstrate how they were meeting the underpinning principles of right support, right care and right culture (RCRSRC). During this inspection the service had made a number of improvements to ensure that the underpinning principles of RCRSRC were addressed. However, we were still not fully assured that the changes the service had made were fully embedded and the quality standards will be maintained.

Right Support: During our last inspection, the service did not effectively support people through recognised models of care and treatment for people with a learning disability, autism and behaviours that challenge the service, such as positive behaviour support approaches (PBS). During this inspection we saw that PBS’s had been updated and implemented. The registered manager told us that PBS’S needed further development by involving external behaviour specialist in the process. People were involved in the planning of their care and told us that they received support which met their individual needs and cultural preferences. People who used the service were supported in the least restrictive way and staff demonstrated understanding of people’s PBS’s. People were supported to live the life they wanted by staff who knew them well and put them at the centre of decision making. Staff enabled people to access specialist health and social care support in the community. People had a choice about their living environment and were able to personalise their rooms

Right Care: Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People's care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture: People and those important to them, including advocates, were involved in planning their care. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. 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 and update - The last rating for this service was requires improvement (published 17 February 2022) and there were breaches of regulations. 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

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Recommendations

We made two recommendation in regard to responding to people expressing distress and the analysis of accidents and incidents.

Follow up

We will continue to monitor information we receive about the service, which will help inform us when we next inspect.

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.

About the service

Matthew Residential Care Ltd – 59 Woodgrange Avenue is a small care home which is registered to provide care and support to three people with learning disabilities autism or who have complex needs associated with their mental health. At the time of the inspection there were three people living at the service.

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

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The service did not effectively support people through recognised models of care and treatment for people with a learning disability, autism and behaviours that challenge, such as positive behaviour support approaches (PBS). As a result, whilst we saw features of positive support, including choice, participation, and inclusion, these were not firmly embedded. People did not have maximum choice and control of their lives because the service did not embrace a PBS approach in its entirety.

Right care:

People’s behaviour indicated that they found the environment challenging. However, we observed the environment was not fully adapted to match people’s needs. Functional assessments had not been carried out to understand the function of people’s behaviours. Therefore, without a comprehensive understanding of people’s needs, care was not always person-centred.

Right culture:

There were signs that suggested the service was at risk of developing a closed culture. Staff and managers had not received training in managing behaviours that challenge or PBS. There were limited interventions designed to help people cope with challenging environments. The absence of communication plans and strategies to ensure the environment was predictable to people increased people’s dependence on staff for their basic needs.

The failure to fully meet the underpinning principles of Right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

We made recommendations on the management of people’s finances, building people’s skill, promoting equal opportunities, and partnership work.

People were not always supported to have maximum choice and control of their lives and staff did not always supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Although people told us they were safe, we were not satisfied the service was set up to respond to their needs appropriately. The service did not support people through recognised models of care and treatment for people with a learning disability or autistic people.

When restrictive practices were used, the service did not have a reporting system in place to ensure reviews were carried out to try and reduce the use of these practices.

The environment was not fully adapted to respond to people’s needs. Several environmental factors, including opportunities for meaningful activities had not been adapted to meet people’s needs. People did not always take part in activities as planned.

People were not always protected from financial abuse. The service did not demonstrate sound financial management practice. Whilst we did not see evidence of financial dishonesty, people were not supported with their finances in ways that reduced the potential for abuse.

There was lack of input from a multi-disciplinary team to build core skills and competencies, including designing and implementing behavioural support plans. Staff did not have necessary skills and resources to implement behavioural support, even low-level interventions. Managers did not always ensure staff had relevant training, supervision and appraisal.

The governance processes did not help the service to always keep people safe, protect their human rights and provide good care, support and treatment. Whilst there were a range of factors as identified in the report, the lack of resources including specialist input to support a recognised model of care for people with a learning disability who displayed behaviours that challenged was significant.

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 on 11 April 2019)

Why we inspected

We received concerns in relation to the management of risk, staffing levels, staff training, the management and leadership within the service and people’s personal care needs. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Matthew Residential Care Ltd – 59 Woodgrange Avenue on our website at www.cqc.org.uk.

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 regulation in relation to safe care and treatment, safeguarding people from abuse, staffing, consent, dignity and respect, person centred care and governance. Please see the action we have told the provider to take at the end of this report.

At the time of the inspection the service had enlisted input from a consultancy company, and we saw that an improvement plan had been developed, which broadly mapped ways to address identified risks. On the second day of the inspection, there was evidence improvement work had commenced.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

About the service:

Matthew Residential Care Ltd – 59 Woodgrange Avenue is a small care home which is registered to provide care and support to three people with learning disabilities. When we inspected the home on 11 and 16 April 2019 three people with learning disabilities were living there.

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 choice, control and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

People’s care plans included guidance for staff on supporting people effectively and managing risk. However, although we found that risks to people were well managed, there were no records showing that formal risk assessments had taken place.

People told us they were happy with the care and support that they received from staff. They spoke positively about their care workers and the home’s registered manager.

Care and support was person centred and reflected people’s individual needs. People’s care plans and risk assessments had been reviewed regularly and updated where there were changes in their needs.

Staff communicated well with people and supported them to participate in their preferred activities.

Staff were knowledgeable about people’s needs and how these should be supported. They understood their roles and responsibilities in ensuring that people were kept safe from harm or abuse. They had received regular supervision and training to help them to care for people safely and effectively.

Staff supported people to make decisions about their care and support where they were able to do so. Information about people’s capacity to make decisions had been recorded in their care files. Applications for authorisations under the Deprivation of Liberty Safeguards (DoLS) had been made to ensure that people were not unduly restricted in any way.

Staff supported people to take their prescribed medicines. Accurate records of medicines administration had been completed.

People enjoyed their meals and their dietary needs had been catered for. They were offered choices at meal times and people were supported to enjoy the cultural foods that they liked.

We observed that people participated in a wide range of community activities. People told us that they had chosen and enjoyed these activities.

Regular quality assurance monitoring had been carried out in relation to people's care and support. Actions had been taken to address any concerns arising from monitoring.

People had good healthcare support. When people were unwell staff had immediately contacted healthcare professionals to meet their needs.

We made one recommendation in relation to ensuring that risk assessments were developed for people.

Rating at last inspection:

Good (report published 19 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to inspect as part of our re-inspection programme.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

During this inspection we found that the provider had provided medicines administration training to staff and procedures for the administration of medicines had been updated and improved.

Matthew Residential Care Limited – 59 Woodgrange Avenue is a care home providing accommodation and personal care for the maximum of three people who have learning disabilities and mental health needs. The home has currently one vacancy.

The inspection was carried out by one inspector.

59 Woodgrange Avenue has a manager who is registered with the Care Quality Commission (CQC). 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.

People were safe in the home. Staff understood the safeguarding processes and knew what constituted abuse. Staff knew how to keep people safe and reported any issues of concern appropriately. Risk assessments were clear and detailed and reviewed regularly. Staff followed guidance and protocols that were in place to help reduce the risks for people. People received their medication on time and in the manner the prescriber intended.

There were enough staff to meet people's needs properly and the staff on duty had the skills and knowledge to support people effectively and meet their needs in a timely manner. Appropriate and safe recruitment practices were followed, to help make sure staff were suitable to work with people in a care environment.

Staff received good support from each other and the registered manager. Staff were regularly supervised and the management team was hands on and approachable. The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The registered manager ensured the service operated in accordance with the MCA and DoLS procedures and staff demonstrated a clear understanding of the MCA, DoLS, capacity and consent.

People were supported to make their own decisions and choices as much as possible. People received enough food and drink to meet their individual needs and staff had a good understanding and knowledge of people's dietary needs. Referrals to healthcare professionals were made promptly as needed and any advice or guidance given was followed appropriately by staff.

People were fully involved, where possible, in planning and reviewing their own care and staff appropriately supported people, when necessary, to make informed choices for themselves. Staff were kind, caring and compassionate. People were treated with dignity and respect and their privacy was upheld. People were also supported and encouraged to do as much for themselves as possible, in order to enhance and maintain their independence.

People took part in activities of their choosing and followed their own hobbies and interests, inside and outside of the home. Visitors were always welcomed without unnecessary restrictions and people's personal relationships were valued and respected. People were listened to and comments or complaints were welcome. Any complaints were fully investigated and actions taken to improve the quality of care provided.

There were effective systems in place to monitor the quality of the service and these were used to develop the service further. Staff and people living in the home were regularly involved in making decisions on how the home was run. Record keeping and management systems were up to date, with effective auditing and follow up procedures in place. An open and inclusive culture was demonstrated at 59 Woodgrange Avenue, with clear and positive leadership evident.

We spoke with the registered manager, a manager from another home within the same organisation, and one staff member. We reviewed the care plans of two people.

This is a summary of what we found:

Is the service safe?

Systems were in place to ensure that staff learnt from events such as accidents and incidents. This reduced the likelihood of people being at risk. We saw systems were not in place to protect people against the risks associated with medicines. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the administration and recording of medicines.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have the capacity to give consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw one person was unable to leave the home without the assistance of staff. This may mean a deprivation of liberty authorisation was required.

Is the service effective?

We found from speaking with staff and watching how they communicated with people, they had an understanding of people's care and support needs and knew them well.

Staff assessed people's health and care needs with the person. Staff told us care plans assisted them to meet people's needs through the provision of information on people's care needs.

Staff received supervision and appraisals and were provided with feedback on their performance. This meant staff were given support to deliver the care and support to people.

Is the service caring?

Both people told us they felt safe in the care of staff. One person said, 'Staff are nice,' the other person said, 'Staff are O.K, I get on with them.'

People told us they could speak with staff if they had concerns or were unhappy about their care. One person said, 'I would like to stay here for life, it's my favourite home.'

Is the service responsive?

People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with the wishes of people using the service. For example, care plans recorded activities people enjoyed.

People we spoke with knew how to make a complaint. We saw there was a process in place to respond to any issues of concern.

Is the service well-led?

This small service was introducing quality assurance systems to identify and address issues.

One person who used the service told us "I like it here." Another said "The staff are nice."

Records showed that people's needs were assessed and a care plan was developed detailing how a person's needs would be met.

Records showed that the provider worked along with other agencies to deliver the care and support to people who used the service

We found that the provider had systems in place to monitor the cleanliness of the service. Staff we spoke with were able to detail the protective equipment they used when supporting people.

Records showed that the provider completed the necessary checks when recruiting staff.

People told us that they were involved in their care plans, comments included "I have a care plan and I meet with my key worker to discuss it regularly.' They said, that they felt 'safe' at the home. Staff received adult protection training and demonstrated that they were able to transfer learned skills. Staff told us that they would contact the provider or the appropriate authorities if witnessed or were told of any adult protection issue.

People using the service lived in an environment suitable to their needs. We observed people clean the communal areas and a person told us that they "tidy my room.' People appeared very comfortable within the presence of staff and told us "I like the carers, they are nice." People were aware of the complaints procedure and told us "I would talk to my key worker or the manager if I have a problem.'