Matthew Residential Care Limited - 1 Milton Avenue

Matthew Residential Care Limited – 1 Milton Avenue is a residential care home providing personal care and accommodation to 4 people at the time of the inspection. The service can support up to 5 people.

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 (RSRCRC) 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.

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

During our last inspection we found the provider had made improvements to ensure that the underpinning principles of RCRSRC were addressed. However, we were not fully assured that the changes the service had made were fully embedded. At this inspection we found further improvements had been made.

Right Support: People were supported by staff who understood their needs and had received training to support them in their roles. We observed good communication between people and staff, and noted the provider was developing picture assisted and easy read information to enhance people’s understanding of the care and support they received. There were sufficient staff on duty to meet people’s identified needs and additional staffing was provided as required to support activities outside the home. The provider’s staffing rotas had not always been updated to accurately reflect staff members working at the home at any given time.

Right Care: People's care plans were regularly reviewed and updated to include important information and guidance for staff on supporting their identified needs. Staff understood people’s wishes and preferences and were observed to support people in a friendly and respectful manner. Where appropriate, staff encouraged people to take positive risks, such as participation in new activities. Staff had engaged with people, family members, health care professionals and other relevant individuals to ensure people’s care and support met their needs.

Right Culture: People and those important to them, such as family members, had been involved in planning their care and support. People were regularly asked about their needs and preferences and staff developed activities and support to ensure their individual choices were addressed. Staff training reflected current best practice in supporting people with learning disabilities and autistic people. Staff were supported to discuss best practice for the people they supported in supervisions and team meetings. People were provided with the support they required to use the home and the local community as they wished. There was no evidence of restrictive 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 31 October 2022). We made one recommendation regarding accessible information. At this inspection we found improvements had been made and further improvements were in progress.

Why we inspected

We carried out this inspection following concerns we had received from a local authority in relation to safeguarding of people living at the home.

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 one recommendation regarding ensuring the accuracy of staff rotas.

Follow up

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

Matthew Residential Care Limited – 1 Milton 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 five people.

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.

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 we found the provider had made improvements to ensure that the underpinning principles of RCRSRC were addressed. However, we were not fully assured that the changes the service had made were fully embedded.

Right Support: The service had made improvements to the support they provided to people in relation to recognised models of care for people with a learning disability, autism and behaviours that challenge, such as the development of positive behaviour support plans (PBS) and PBS training for staff and managers. Staff demonstrated they understood the support people required. However, although staff were observed to communicate well with people, the provider had not yet developed accessible information tools to support their communication needs.

Right Care: People's care plans had been updated to include important information and guidance for staff on supporting their needs. Staff understood people’s wishes and preferences and were observed to support people in a friendly and respectful manner. Where appropriate, staff encouraged people to take positive risks, such as participation in new activities. Staff had engaged with people, health care professionals and other relevant individuals to support people’s care and support.

Right Culture: People and those important to them, such as family members had been involved in planning their care and support. People were asked about their needs and preferences and staff developed activities and support to ensure their requests and preferences were met. Staff and managers had received training in supporting people. The training reflected current best practice in supporting people with learning disabilities and people with autism. Staff were supported to discuss best practice for the people they supported in supervisions and team meetings. People were provided with the support they required to use the home and the local community as they wished. There was no evidence of restrictive 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 8 March 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 one recommendation regarding accessible information.

Follow up

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

Matthew Residential Care – 1 Milton Avenue is a residential care home providing care to five people with learning disabilities at the time of our inspection. The service can support up to five people.

Summary

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.

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 in relation to recognised models of care for people with a learning disability, autism and behaviours that challenge, such as positive behaviour support approaches (PBS) and supports to engage people in relation to their communication needs. As a result, whilst we saw features of positive support, including choice, participation, and inclusion, these were not consistent.

Right care:

People’s care plans failed to include important information in relation to needs such as epilepsy, diabetes and behaviours considered challenging. Behaviours that challenge are a product of an interaction between the individual and their environment. Functional assessments and evaluations had not been carried out to understand the reasons for people’s behaviours. Therefore, without a comprehensive understanding of people’s needs, care was not always person-centred.

Right culture:

Staff and managers had not received training in managing behaviours that challenge and how to support and reduce anxieties and triggers for behaviours. Staff and managers had not explored the use of communication tools to fully engage people in making decisions. 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.

People’s medicines were safely stored and generally well recorded. However, there were no protocols for medicines prescribed ‘as required’ in relation to reduction of behaviours and anxieties. People’s records did not show if alternative methods of behaviour management had been explored before medicines were given to people.

Some staff had not received regular supervision. Staff training records showed that required mandatory training had not always been recorded as having taken place. Managers and staff had not received training in people’s specific needs, such as positive behavioural supports, epilepsy and diabetes.

People’s care plans, risk assessments and care records did not include information relating to their current needs, for example, in relation to epilepsy and diabetes. Monthly reviews of care plans had not taken place since September 2021.

Activities provided to people were limited, and we did not observe choices being offered by staff. There was no evidence that accessible communication tools such as visual communication methods had been explored and used. Staff had not received Makaton training to support a person who used this as a means of communication.

The service’s quality assurance monitoring had failed to identify failures in relation to a fire door closure and access through a padlocked gate to the fire assembly point should there be a need for an urgent evacuation. Fire drills had not been carried out. Hot water temperature checks had not been carried out to reduce risk of scalding. Further failures in relation to care plan reviews, care records, including behavioural monitoring and staff supervision and training had not been identified through the quality assurance procedures.

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 22 March 2018)

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 – 1 Milton 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, staffing, person centred care and good 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 noted an improvement plan had been developed which broadly mapped ways to address identified risks.

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.

1 Milton Avenue is a care home registered for five people with a learning disability situated in Kenton. At the time of our inspection there were no vacancies at the home. The people who used the service had significant support needs because of their learning disabilities. The majority of people had additional needs such as autistic spectrum conditions, mental health conditions, and communication impairments.

There was a registered manager in post. 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 2008and associated Regulations about how the service is run.

Family members told us that they thought that their relatives were cared for safely. We saw that people were comfortable and familiar with the staff supporting them and were treated respectfully.

People who lived at the home were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported immediately.

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Medicines at the home were well managed. However we found that there were gaps in the medicines administration record for one person. This had been identified by a pharmacist’s audit on the day before our visit and the home was taking action to address this.

Although people had up to date risk assessments, the most recent versions were not contained within their care files and staff did not have access to these. Personal emergency evacuation plans for people were also not available to staff should there be a need to evacuate the home. The registered manager assured us that paper copies of this information would be made immediately accessible to staff.

We saw that staff at the home supported people in a caring way, and responded promptly to meet their needs and requests. There were enough staff members on duty to ensure that people had the support that they required. Staff members interacted well with people who were unable to communicate verbally, and we saw that people responded well.

The staff who worked at the home received regular training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about capacity was included in people’s care plans. Up to date Deprivation of Liberty Safeguards (DoLS) authorisations from the relevant local authority were in place to ensure that people who were unable to make decisions were not inappropriately restricted. Staff members had received training in MCA and DoLS.

People’s nutritional needs were well met. Meals provided were varied and met guidance provided in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

Care plans were person centred and provided detailed guidance for staff around meeting people’s needs. Daily records of care were well written and easy to understand. However, we noted that staff members had failed to record the actions that they had taken to manage behaviours that were considered challenging. Where a person had been given medicines to reduce their behaviours, there was no record showing that staff members had followed the guidance in their care file to alleviate the need for such medication.

The home supported people to participate in activities throughout the week. People’s cultural and religious needs were supported by the service and detailed information about these was contained in people’s care plans.

There was a complaints procedure and family members that we spoke with told us that they knew how to make a complaint. The home’s complaint’s log showed that complaints were dealt with quickly and appropriately.

The care documentation that we saw showed that people’s health needs were regularly reviewed. Staff members liaised with health professionals to ensure that people received the support that they needed.

We saw that there were systems in place to review and monitor the quality of the support provided by the home, and action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date. To ensure that the home had opportunities to further develop the quality of service, we recommend that the provider seeks advice from a reputable source regarding current best practice in quality monitoring.

The registered manager engaged positively with people and staff members. Staff and family members spoke positively about the management of the home.

One staff member said that where verbal communications were limited, they studied the person's care plan which detailed what the person liked and disliked. They also said that they used this information when giving choices to the person and obtaining consent to deliver care.

People had an individual care plan completed by the provider. This detailed peoples' needs and the care and support that would be given.

Staff we spoke with were able to identify the various types of abuse and the what they would look for to identify if this was taking place. We saw the company safeguarding policy and that staff had completed safeguarding training.

We saw evidence that staff had completed training on first aid, manual handling, fire safety and food hygiene. We saw evidence that staff had attained or were enrolled to undertake qualifications in health and social care.

The provider had systems in place to monitor the quality of the service provided. We saw that the provider sent out surveys asking for feedback on the service they had delivered.

People using the service told us that they felt "safe".

Care plans were detailed and reviewed by and with people using the service, comments included "I had my review last week".

Staff were available in sufficient numbers, which ensured people's complex needs were met and responded to. Staff told us that they felt supported by the manager and regular team-meetings enabled them to discuss people using the service, which led to their needs being met better.

Regular quality checks and surveys ensured that the quality of care was monitored and improvements were implemented if shortfalls were found.