Archived: Integra Care Homes Limited - 105 Water Lane

105 Water Lane is a residential care home providing accommodation and personal care to older and younger adults with a learning disability or autism. At the time of the inspection there were four people living at 105 Water Lane, some with complex needs. The service can support up to eight people.

The service had not 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 did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Four people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were not safe from potential harm because known risks to people were not effectively being monitored by the management and staff team. People who had known risks of ingestion, and where incidents had already occurred, still had access to items that could cause them potential harm.

There were inadequate numbers of permanent staff and the service was reliant on agency staff.

There were not sufficient staff with suitable skills, knowledge and experience deployed to meet the needs of the people.

Relevant recruitment checks were conducted before staff started working at the service to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.

Environmental risks were not managed effectively; fire alarm tests were not up to date as recommend by fire safety regulations. People did not have regular fire evacuations to keep them safe. The home was dirty and in need of cleaning and the service needed redecoration.

People were not supported to eat a balanced diet. There were not meaningful activities and access to the community for people to reduce the risk of social isolation. People were not always treated with dignity and respect.

Medicines were not always safe, and people did not have pain relief available to them when needed.

Staff did not receive regular support and one to one sessions or supervision to discuss areas of development and to enable them to carry out their roles effectively. Training had fallen behind, and we could not be assured staff had appropriate training in place to keep people safe.

People’s rights were not always protected because staff did not always understand and work within the principles of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. These were in the process of being reviewed.

Each person had care plans in place although there was not always sufficient detail to guide staff and plans were not always up to date. We found staff did not always follow the guidance and some plans contained inaccuracies and missing information. There were concerns with missing entries and gaps in charts to monitor people’s food and fluid and bowel movement.

During our inspection we found there was a lack of effective management and leadership in the home. Staff felt unsupported and let down by management and morale was low amongst staff.

The provider had failed to ensure effective oversight of service provision. Care plans were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way.

People were not supported to have maximum choice and control of their lives and staff did not 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.

The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 23 February 2019).

Why we inspected

The inspection was prompted due to concerns received about staffing, accidents and incidents, management oversight, medicines, support plans, records and the maintenance of the building. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see information in the report.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, person centred care, dignity and respect, meeting nutritional and hydration needs, premises and equipment and good governance at this inspection.

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 would normally follow up as per the guidance below but the provider following receipt of the report has decided to close the service.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

105 Water Lane is a residential care home for up to eight people with a range of needs including learning disabilities and autism spectrum disorder. The property is arranged into three separate living spaces across two floors with an activities space in an outbuilding. At the time of the inspection there were six people living in the home.

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 a learning disability and autism using the service can live as ordinary a life as any citizen.

The service did not have registered manager in post at the time of the inspection, however there was an interim manager in place and the provider was recruiting. 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.

Rating at last inspection

At our last inspection on 03 August 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report was written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service was rated Good

Staff were knowledgeable about the signs of abuse and neglect and felt confident to report any concerns.

People’s risks were assessed and risks were managed in the least restrictive way. There were suitable numbers of staff to keep people safe.

Medicines were managed safely, people received their medicines as needed. The home was clean and tidy. The building was maintained safely and risks of fire were managed appropriately. Incidents were reported, staff were confident to report and appropriate actions were taken in response.

People’s needs and preferences were fully assessed and support plans were in place to meet their needs. Staff had the appropriate skills, knowledge and experience to deliver effective care.

People were supported to eat and drink enough and to maintain a healthy diet. Professional guidance was sought where needed and support plans were written in line with this guidance.

People had access to healthcare services. The service had made improvements to the building since the last inspection, which now met people’s needs, though superficial works were required around décor and furniture to make spaces more personalised, which were underway.

Staff had a good understanding mental capacity. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness and compassion. People were supported to express their views and wishes. People’s privacy and dignity was respected. People were encouraged to be independent where possible.

People’s support was provided in line with their needs and wishes. People were supported to participate in activities which engage them. People were supported to develop life skills. There was a “final wishes” document which helped people to express their views around end of life care or wishes after death.

There was a clear set of values within the home with a person-centred approach. There was a robust governance framework in place to review the quality of the support provided and ensure the safety of the service. Change was viewed positively and as an opportunity to improve and try new things.

Further information is in the detailed findings below.

Integra Care Homes Limited are part of the Lifeways Care Group. Lifeways Care Group provide support services for people with diverse and often complex needs in community settings. Throughout this report, Lifeways Care Group will be referred to as the provider. 105 Water Lane is a residential care home for up to eight persons and is situated within a residential area close to local shops and amenities. The home consists of four self-contained flats. Until recently two people lived in each flat where they had their own bedroom with ensuite facilities and shared a lounge and kitchen. The first floor flats are accessed either by their own external front door or by walking through the ground floor flats and using the internal stairs. The service has a large garden which appeared to be well used by people. The home had two vehicles to assist people to access leisure, recreational and educational activities in the community. At the time of the inspection there were six people living at the service who had a range of complex needs including learning disabilities and autism. At times, some of the people who used the service could behave in a way that was challenging or harmful to themselves or to others.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. One type of significant event is when the local authority approve an application to restrict a person’s liberty to protect them from harm. Applications for a DoLS had been approved by the local authority for each of the six people living at 105 Water Lane but the provider had not notified the Commission.

Staff needed specialist training to help ensure they were suitably skilled in the use of physical interventions which the provider required staff to undertake on an annual basis. This training was out of date for the majority of staff.

Policies and procedures were in place to ensure the safe handling and administration of medicines. However, the information available for “as required” (PRN) medicines, could be more detailed to ensure people receive their medicines consistently.

Improvements were needed to ensure that all aspects of the environment enhanced people’s quality of life and supported staff to deliver effective care.

Staff had received training in the Mental Capacity Act 2005 and they were able to demonstrate an understanding of the key principles of the Act. However staff had not always completed an assessment of people’s capacity to consent to some aspects of their care and support.

New staff had access to a comprehensive induction. Staff received regular supervision and arrangements were underway to ensure that all staff had an annual appraisal.

Although some people could display behaviours which challenged others, staff had taken steps to understand the potential triggers and had implemented methods to manage and de-escalate these behaviours in the least restrictive way possible. Risks were appropriately assessed and planned for and staff demonstrated a good understanding of these. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. There were suitable numbers of staff deployed to meet people’s needs safely.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs. Where necessary a range of healthcare professionals had been involved in planning peoples support to ensure their health care needs were met.

Our observations indicated that people were supported by staff who were kind and caring. Staff had a good knowledge and understanding of the people they were supporting.

People were supported to take part in a range of activities and make choices about how they spent their time.

Complaints policies and procedures were in place and were available in easy read formats. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

Relatives and staff spoke positively about the manager. There were systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The needs of the people living at the home were very complex and consequently made talking with them difficult. We used a number of different methods to help us understand the experiences of people living at the home.

We observed how people were supported by staff at a mealtime and at other times during the day.

We telephoned the relatives of three people hear their views about the support the home provided.

We spoke with six members of staff and also a manager from another service operated by the provider. The latter was supporting the home's new proposed manager and we also spoke with them.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

One relative we spoke with told us they thought the home did an, 'Amazing Job'. They said, 'The staff do their jobs because they care, it is not just a job to them'.

The home's staff arranged for people to see their GPs when they were unwell and also arranged for them to have regular heath checks with dentists and opticians. The staff were also supported by healthcare specialists who visited the home such as a podiatrist, speech and language therapist and a clinical psychologist to ensure people's healthcare was promoted.

Is the service responsive?

The provider had a complaints policy and procedures in place. We saw that it was available in a picture/symbol format to help people who lived at the home understand how they could raise concerns.

Records we looked at showed complaints made to the home had been listened to and acted on.

Is the service safe?

Potential risks to people's welfare arising from daily activities had been identified and people's support plans set out measures that had been put in place to prevent people being harmed by them.

People were protected from risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

Is the service effective?

The support people received was planned and delivered in a way intended to promote their safety, welfare and rights.

The home's staff were supported to provide a safe service to people and to an appropriate standard.

Is the service well led?

The provider had systems in place to regularly check and monitor the quality of the service and identify, assess and manage risks to the health, safety and welfare of people using it and others.

We spoke with three members of staff and the manager. Care and support provided to people using the service was observed to be respectful and responsive to individuals' needs.

Staff ensured people were enabled to give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

People were supported to be able to eat and drink sufficient amounts to meet their needs, and were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

The provider's recruitment and selection processes ensured staff were suitable and sufficiently skilled to provide effective care and support to vulnerable people.

We found that people were involved in the planning of their care, treatment and support with the help and assistance of staff and family members. People were treated with dignity and respect and were given choices about the care they received. Pictures and symbols were used to assist some people to make those choices. We noticed information was conveyed to people using these communication tools, for example, who was on duty and what activities were available on the day.

Care plans were detailed and individual in presentation and contained medical, personal, social and family information. They were reviewed and updated regularly.

People were encouraged to maintain their independence wherever possible. There was a calm and relaxed atmosphere in the home.

People were protected from risk of abuse or harm by safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team who were well supported and trained.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review. Records showed us that people using the service, families and professionals involved in people's care were consulted.