United Response - 26 Tennyson Road

26 Tennyson Road provides care and support for up to five people with a learning disability. At the time of this inspection there were five people living at the home. The home is a detached residential property located in a suburban area of Bognor Regis. Each person had their own bedroom which was decorated in the way they had chosen. There was a communal lounge and a dining room. Bathroom and toilet facilities were provided on both floors of the home.

At the last inspection of 31 May 2017, we found the provider was in breach of three regulations. The provider had failed to notify us of incidents which they were required to do as set out in regulations. The provider had not taken sufficient action to ensure people were always protected from harm, which had placed people at risk of abuse. We found the provider had not operated a system of adequate monitoring of the quality and safety of the service to ensure people were always protected from harm, which had placed people at risk of abuse. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection improvements had been and all three breaches had been met.

The service did not have a registered manager, but there was a manager who had applied to the Commission to become the registered manager. 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.

At this inspection we identified some of the safety checks regarding risks to people and staff regarding the premises were not properly assessed in line with health and safety guidance. We have made a recommendation about this.

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

Staff were trained in safeguarding people in their care. Relatives said staff had a good awareness of their responsibilities to protect people.

Risks to people were assessed and care plans included details of action staff needed to take to keep people safe.

Sufficient numbers of staff were employed to meet people’s needs and to ensure people had access to community facilities.

Medicines were safely managed.

The home is a converted residential dwelling. People were able to choose the décor for their rooms which were personalised with their own belongings.

People’s health and social care needs were comprehensively assessed and arrangements made to monitor and treat health care needs.

Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

People chose the meals they had and people had nutritious meals.

Staff supported people to make their own decisions and to have as much control about their lives as possible. Staff were trained in the Mental Capacity Act 2005 (MCA) and in the Deprivation of Liberty Safeguards (DoLS).

People received care from staff who were caring and compassionate. People were involved in decisions about their care. Relatives described the home as being like a family. People were supported to develop their independence and their privacy was promoted.

People received person centred care which was responsive to their needs. Care plans reflected people’s needs and preferences, although the manager acknowledged these needed to be reviewed and updated. People were supported to attend a range of social and recreational and occupational activities. People’s communication needs were assessed and staff were skilled when interacting with people. Information was provided to people in a format they could more easily understand.

People and their relatives were able to contribute to decision making in the home. Relatives and staff said the manager was supportive and approachable. Staff said they were supported. The provider promoted an ethos of person centred care where people’s rights to care were upheld. There were a number of audits and quality assurance checks regarding the safety and quality of the services.

A new manager was appointed in May 2017. They had submitted an application form to the Care Quality Commission to be registered as a manager. 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 last inspection took place on 4 April 2016. As a result of this inspection, we found that care plans did not always include guidance to reflect people’s preferences on their care, treatment and support. This was a breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made recommendations for the provider to refer to the Mental Capacity Act 2005 (MCA) and its codes of practice as we found consent to care and treatment had not always been sought in line with the MCA. In addition, for the provider to review their complaints system to ensure it is effective and accessible for identifying, receiving, recording, handling and responding to complaints. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider had now met those legal requirements.

At this inspection we found further improvements were still needed and therefore the service remains rated “requires improvement” overall. Staff had received safeguarding training, demonstrated an understanding of key types of abuse and explained the action they would take if they identified any concerns. However, whilst some incidents had been reported, other incidents, such as verbal abuse, intimidation and physical abuse between people, had not been identified as safeguarding concerns and had not been reported to the local authority safeguarding agency or to the Care Quality Commission as required by law. Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. Overall, there were effective systems to check the safety and quality of the service, however they had not always been properly utilised and as a result, opportunities to identify and address areas for improvement had been missed. We found that the lack of audits and gaps in records had impacted on the safety of the service people received.

We found that recruitment processes ensured staff were safe to work with people and although the provider had ensured staffing levels was adequate to meet people’s needs, we observed the way staff were deployed could be improved. We made a recommendation about this at the time of the inspection. Following the inspection the manager provided evidence of this recommendation being met.

Identified risks associated with people's care were assessed and plans developed to mitigate them. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. There were also risk assessments in place to help keep people safe in the event of an unforeseen emergency such as a fire.

Medicines were managed safely. People were supported to take their medicines as directed by their GP. Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines.

People's capacity to consent to care was considered and the home worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards. This included training for all staff on both subjects.

Care plans reflected information relevant to each individual and their abilities, including people's communication and health needs. Staff were vigilant to changes in people's health needs and their support was reviewed when required. The service had good links with health care professionals to ensure people kept healthy and well.

People were supported to have enough to eat and drink and were provided with a balanced, healthy diet. Mealtimes were often viewed as a social occasion, but equally any choice to dine alone was fully respected.

People looked happy and were relaxed and comfortable with staff. They were supported by staff that understood their needs and abilities and knew them well. Staff were kind and caring towards people and upheld their privacy and dignity at all times.

People were involved as much as possible in planning their care. People had monthly meetings with their keyworkers to discuss all aspects of their care. The manager and staff were flexible and responsive to people's individual preferences and ensured people were supported in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them.

There were processes in place for people to express their views and opinions about the service provided. The complaints procedure was displayed and people said they knew what to do if they were not satisfied with the service. Complaints were logged and records showed the provider looked into complaints and responded to complainants.

During this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Tennyson Road provides accommodation for persons who require personal care for up to five people with a learning disability or autism. At the time of our inspection there were three people living at the service.

The provider had a registered manager in place as required by the conditions of their registration 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.

Care plans needed improvement. They contained information on people's preferred routines, likes, dislikes and medical histories but this was minimal. They had not always been updated to identify how care and support should be provided when people's care needs had changed. This meant that people were at risk of not receiving the care and support they needed. You can see what action we told the provider to take at the back of the full version of this report.

People did not always benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. Information about the person's life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. The programme of activities was morning and early afternoon based on one staff member being rotored on in the afternoon and evenings. It was not clear how people had been involved in choosing their activities. Staff supported people in their own time if anyone had vocalised they wanted to go cinema in the afternoon or evenings.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA); however this was not always demonstrated when best interest decisions had been made for people who were deemed to lack capacity. We made a recommendation to refer to the Mental Capacity Act 2005 and its codes of practice. Staff demonstrated a good understanding of the Deprivation of Liberty Safeguards (DoLS) and how to put this into practice.

There was no evidence which demonstrated that people knew how to make a complaint. There was no evidence that the provider had developed a robust system for dealing with complaints that had been received. We made a recommendation that the provider reviews their complaints system to ensure it is effective and accessible for identifying, receiving, recording, handling and responding to complaints.

People received care and support from staff who knew them well. Staff showed concern for people's wellbeing in a caring and meaningful way and responded promptly to requests for assistance. Throughout our visit we saw people were treated in a kind and caring way and staff were friendly, polite and respectful.

People were protected from harm and potential abuse. Staff we spoke with knew what to do if they were concerned about the well-being of any of the people using the service. Risk assessments were in place to support people to be as independent as possible.

Staff were supported to carry out their role through supervisions, team meetings and training. People received individualised care from staff who had the skills, knowledge and understanding needed.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers to make safer recruitment decisions by providing information about a person's criminal record and whether they are barred from working with vulnerable adults.

People had access to food and drink throughout the day and were encouraged to eat healthily and to maintain a balanced diet.

Medicines were managed safely and administered by appropriately trained staff. People received their medicines as prescribed and in their preferred manner. People were supported to access health care services and to maintain good health.

The registered manager had systems in place to regularly monitor the quality of the service. Where internal audits had identified shortfalls, the registered manager had put in place an action plan to address these areas. The registered manager had notified the Care Quality Commission (CQC) about significant events which had occurred in the service.

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

We found that people were supported to make decisions about their day to day care and treatment that took into account their communication needs. Where people's decisions conflicted with their health and wellbeing the provider followed a best interest decision making process.

A relative said "I think the home has a warm, friendly, family atmosphere - my relative comes home regularly and is always happy to go back". We found that people were engaged in activities and work placements and were supported through person centred planning to identify their needs and plan their support.

We found that people's medicines were managed safely and appropriately and people's records were maintained and accurate.

We found that there were sufficient staff to meet people's needs and that staff knew and understood people well. A person told us "the staff are lovely". Staff were appropriately qualified and trained to meet people's needs and we saw that people had a good rapport with staff who understood and promoted people's communication needs.

We found that people were supported by staff to make decisions and choices relating to their care and treatment. We saw that people were treated with dignity and respect and their communication needs were understood and acted on by staff.

We saw that the provider used person centred planning to ensure that people's care and treatment was centred on them as an individual and their diversity and preferences were considered. We found that care was planned and delivered so that people were safe and enabled and supported to take positive risks.

We spoke to staff and reviewed records which showed us that suitable arrangements were in place to protect people from abuse.

Staff we spoke to and records we reviewed, demonstrated that staff were supported, trained and competent to meet people's needs. A staff member told us "there is a good rapport between staff and residents - people are happy here".

The Provider had systems in place to monitor and assess the quality of the service.