9 Victoria Street Care Centre

9 Victoria Street is a residential care home providing personal care for up to 16 adults or children aged 13 to 17 years who may be living with a physical disability, sensory impairment, learning disability or on the autistic spectrum. At this inspection there were six adults receiving care at the service.

This is a large service which was registered before the development and publication of Registering the Right Support and other best practice guidance. This states that people who use the service should be supported to 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. This means that people using the service should live as ordinary a life as any citizen.

The service a large home for the support of up to 16 people, which is larger than current best practice guidance for this service type. However, there were only 6 people using the service and the size of the service having a negative impact on people was mitigated to some extent, by the building design fitting into the residential area. There were deliberately no overt identifying signs externally, to indicate it was a care home.

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

The service continued to be safe. The provider’s safeguarding, staffing, medicines and risk management arrangements for people’s care, helped to protect them from the risk of harm or abuse. The provider took action for people’s safety when things went wrong at the service and to prevent any reoccurrence.

The service was now effective. Enough improvement was made to fully ensure this. People’s capacity to consent to their care was now consistently considered in line with the law. People were supported to make their own decisions and have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People’s care needs were effectively accounted for. Staff supported people to maintain or improve their health and nutrition, through consultation with relevant external health professionals when needed. This included timely support and relevant information sharing, if they people needed to move between services for care and treatment. People’s needs were largely met by the adaptation of the premises. Work was in progress to further ensure this through the use of additional signage for people’s orientation.

The service continued to be caring. People received care from kind, caring staff, who treated them with respect and ensured their dignity, equality and rights in their care. Staff knew people well; how to communicate with them and understood what was important to people for their care. People were actively informed, involved and supported to understand, agree and make ongoing decisions about their care and future living arrangements.

The service was now personalised. Enough improvement was made to fully ensure this. People received planned, co-ordinated care, that was now consistently inclusive and person centred. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Outcomes for people therefore reflected the principles and values of Registering the right Support and other best practice guidance.

Complaints were now managed in line with the provider’s policy. Concerns and complaints were listened to and used to inform service improvements when needed for people’s care. The service does not provide end of life care. However, staff took account of people’s preferences and choices relating to end of life care as appropriate. People received the right support to enable them to cope with grief and loss when needed.

The service was now well led. Enough improvement was made to fully ensure this. The provider now sought regular opportunities to engage with and seek the views of people, staff and relevant parties, to effectively inform and ensure the quality and safety of people’s care and to drive service improvement.

Management and staff understood their role and responsibilities for people’s care. Operational management arrangements helped to ensure effective communication, record keeping, safe information handling and excellent partnership working for people’s care.

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 June 2018) with two breaches of 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. The provider was therefore no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

9 Victoria Street is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is a care home registered to support 18 people with learning disabilities. This is a large service which was registered with us prior to the development and publication of Registering the Right Support and other best practice guidance. These state that the service should be designed and developed in line with the values of choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should live as ordinary a life as any citizen.

We found that the planning of the service did not always meet these principles. There were not always enough opportunities for people to plan and achieve their goals. They were not always included in the planning and managing of their home; for example, choosing when and what to eat. When they raised concerns they were not always satisfied with the outcome. Complaints were also not always managed in line with the provider’s policy. Some staff felt that the service was not as person centred as it could be and that when they raised those concerns they were not always listened to.

When people could not make some decisions for themselves these were not always assessed or legal safeguards applied for. This meant that 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.

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. The registered manager understood their responsibilities to ensure that we were informed of events in line with their registration. They ensured that audits and quality checks were completed so that people received safe care and treatment.

Risk was assessed, reviewed and managed to keep people safe. They received their medicines as prescribed and they were stored and managed well. There were enough staff to meet people’s needs safely and they had been recruited to ensure they were safe to work with people. The risk of infection was also controlled.

People had enough to eat and drink and any specialist dietary needs were catered for. They were supported to attend health appointments and to monitor their health. When specialist support was needed this was sought so that staff provided care in line with national best practice guidelines. Staff knew people well and had caring relationships with them. They respected their privacy and encouraged their independence. Relationships with families and friends were encouraged and developed.

Staff received training and support to do their job well. They maintained care records on a daily basis which highlighted any changes to people’s support and this was communicated clearly.

The environment was being reviewed and modernised to meet people’s needs. Information was displayed in the home in an accessible way for people to understand. There was no one receiving end of life care and so we did not inspect this.

You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with were generally satisfied with the service. One person said, 'It's alright here. They do their best for us, the staff. We go out sometimes. We've been to the pub and to a nightclub.' Another person said they usually liked being at 9 Victoria Street, though did not like the behaviour of some other people using the service: 'I don't like it when they start kicking off. I don't like all the noise and swearing.'

We found that the provider had taken action since our previous inspection to ensure that people were asked for their consent to care and treatment. Where people were unable to give consent, the provider acted in accordance with legal requirements. This ensured that decisions taken were in the best interests of people using the service.

We found that the provider had taken some action to increase the number of staff employed at the service. However, the staffing issues identified at our previous inspection had not yet been fully addressed. There were occasions when staffing had fallen below the planned levels. This meant that the safety of people may have been compromised and they may not have had the support planned for them.

The people we spoke with said that their privacy and dignity was respected at 9 Victoria Street. One person told us, '[Staff] treat me with respect.' They also told us that staff encouraged them to be as independent as possible.

People told us that staff talked things over with them before carrying out their care. However, from reading people's care records, we found that where people were unable to make informed choices about important life decisions their best interests were not always being fully considered.

The people we spoke with told us that staff respected their personal preferences and they thought that their needs, apart from their social needs, were being met. People told us that the food provided was, 'Lovely', and, 'We can get our drinks if we want.'

People gave us mixed views on whether staffing levels were adequate to meet their needs. However, the consistent message from staff was that staffing levels were not adequate.

People were asked for their views. One person told us, 'Staff ask if I'm all right'they help me'I like it here.'

People told us they were involved in making decisions about their care and they understood the choices available to them. One person said, 'I can make choices what I like to do'. A relative we spoke with told us they were 'fully involved' in making decisions about the person's care. People said their privacy and dignity were respected and we saw evidence of this. We found that people did not always have appropriate support and opportunities to promote their independence and community involvement.

People's needs were assessed and their care was planned and delivered to meet their individual needs. One person said, "I have a care plan in the office. I sit with staff to help".

People using the service told us they felt safe. We found that people were protected from the risk of abuse by staff awareness and the policies in place.

People told us they were asked for their views about the service and we saw evidence of this. However, we found that there was no formal system for gathering and evaluating the views of people using the service, their representatives and staff.