Pathways

We found the following examples of good practice.

The registered manager was following the government’s guidance on whole home testing for people and staff. This included weekly testing and rapid testing for staff. Consent was gained from people each time prior to testing. Where consent was not gained from people using the service, they were not tested. This only occurred with one person and alternative arrangements were put in place to reduce risk.

Staff had received training on the use of personal protective equipment (PPE) and infection control practices and processes were in place to minimise the spread of infection. There was an adequate supply of PPE.

Arrangements were in place to enable people's families to visit them. Risks were assessed and vacant facilities were used to reduce risk.

Increased cleaning regimes had been introduced including hard surface contact cleaning hourly.

Contingency plans were in place to ensure effective management of an outbreak, including use of a vacant bungalow for staff to stay over, staff working in teams and changed shift patterns to reduce footfall.

All people using the service had received their first Covid-19 vaccination.

People living at the service were in receipt of the Department of Health free winter supply of vitamin D. This is particularly important as individuals had been indoors for unusual extended periods due to measures introduced to stop the spread of Covid-19. The supplement supports people's general health.

Arrangements were in place to ensure fire prevention measures, systems and equipment were in place and working properly. Staff had received training in fire safety evacuation procedures.

Rating at last inspection

The last rating for this service was requires improvement (published 6 July 2019).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The last comprehensive inspection found risks around fire safety and a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. As part of this targeted inspection we checked they had followed their action plan and to confirm they now met legal requirements. We found concerns under safe regarding fire safety had been resolved. We found no evidence people were at risk of harm and the service was no longer in breach of Regulation 12.

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.

Pathways is a residential care home providing personal care to 10 people aged 65 and over at the time of the inspection. The service can support up to 12 people. It is a service for people who have a learning disability and/or autistic spectrum disorder, physical disabilities and sensory disabilities. Some people had complex needs.

The service is split into two bungalows. There were six people living in bungalow 56a and four people living in bungalow 56b.

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 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 service was not well led. The provider and management lacked oversight of the service.

Systems were in place to monitor the quality of the service; however, these were not effective and failed to highlight concerns raised during the inspection. Where issues had been raised, no action was taken to rectify this.

The service did not always manage and mitigate fire safety. We referred the service to the local fire authority.

Risks to people had no always been assessed according to need. Environmental checks were not completed in line with national guidelines. We found no evidence that people had been harmed however, systems were not robust enough to demonstrate safety was effectively managed. This placed people at risk of harm.

People received effective care from staff who understood how to recognise potential abuse. However not all concerns were appropriately raised through safeguarding procedures.

Staff and relatives told us there was not always enough staff in the service to support people.

Relatives told us the service did not provide meaningful activities for people. We recommend the service review their process for providing meaningful activities for people

End of life care plans were not always in place for people. We have recommended end of life care planning for people is developed.

The service did not always maintain and develop staff knowledge and skills, however knew people and their needs well.

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. However, capacity assessments had not always been completed in line with guidance.

Relatives told us the environment was dated and required improvement. We have made a recommendation about the environment of the service.

Information was not always available in other formats to aid people’s understanding where required.

Staff respected people's privacy and dignity and interacted with people in a caring and compassionate way.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 (published 21 December 2016).

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 service is split into two bungalows. There were six people living in bungalow 56a and four people living in bungalow 56b when we inspected on 19 September 2016. This was an unannounced inspection.

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 2008 and associated Regulations about how the service is run.

People received care that was personalised to them and met their individual needs and wishes. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred. Staff had developed good relationships with people who used the service and understood the need to obtain consent when providing care.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care and there were procedures and processes which guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being and people’s nutritional needs were assessed and met.

There was an open and transparent culture in the service and staff were very motivated. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. An effective quality assurance system was in place and as a result the service continued to develop and improve.

People told us they were well supported by staff they trusted. They told us that they felt safe and knew how to pursue concerns and complaints. People said they felt listened to and involved in determining how their care was planned and delivered. We saw that care and treatment was planned and delivered according to individually assessed need. We observed that interactions between staff and people who used the service were positive and warm and that people using the service were confident to share jokes and display affection to members of the care team. One person told us, 'I have lived here for many years and I love it.' A relative told us, 'I have no concerns about the service. Staff are superb.'

We discussed with people using the service what they thought about their meals. We sat with people as they ate their evening meal and saw that everyone had a meal that they enjoyed. Everyone ate well.. The service supported people to access health eating choices.

We saw that staff recruitment and training provision helped ensure the delivery of safe and effective care and treatment. We reviewed care plans, staffing records and management records and saw that these were fit for purpose.

We found that staff were aware of the needs and preferences of people using the service. Staff told us it was important for them to support people to make independent choices. Care plans were detailed and person specific. People were supported to make healthy lifestyle options and to maintain contact with people who were important to them. Quality assurance measures were in place to ensure people's safety.