High View Care Services Limited - 9 High View Road

High View Care Services Limited - 9 High View Road is a care home providing personal care to up to 5 people. The service provides support to people with mental health conditions, some with a history of substance abuse. At the time of our inspection there were 4 people living at the service but only 1 was receiving personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People received the right support in relation to risks, such as those relating to mental health conditions and substance abuse. However, the provider had not always assessed these risks in line with best practice. People were not always supported to have maximum choice and control of their lives so staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Health and safety checks were carried out of the premises to make sure they were safe. However, a risk assessment relating to water borne infections had not been carried out in line with best practice, and we found the same concern at our last inspection. The provider checked staff were suitable to work with people through recruitment checks although gaps in employment histories were not always explored. All these issues meant the provider’s oversight of the service required improvement.

The premises were clean, tidy and hygienic and staff followed current infection control and hygiene practice to reduce the risk of infections. Staff received training in infection control practices, including the safe use of personal protective equipment (PPE). Staff were trained in safeguarding to keep their knowledge of their responsibilities up to date. There were enough staff to support people safely and staff knew people well. People received the right support in relation to their medicines.

The registered manager communicated with people and staff to gather their feedback as part of improving the service. Staff felt well supported. Care was provided in a person-centred way. The provider had a team of psychologists and occupational therapists who worked with people to improve their lives. The provider also worked with local health and social care services to ensure people received the care they needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated good (report published September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

Enforcement

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in July and August 2016 our Mental Health Inspection Team inspected the service but we did not rate independent substance misuse services at that time. However, we found areas of good practice and a few areas for improvement including ensuring safeguarding concerns were referred to the local authority and that complaints were responded to promptly. At this inspection we found the provider had taken sufficient action to improve in these areas and we rated the provider Good overall. However, we rated the provider Requires improvement in relation to the key question ‘Is the service effective’ as there was lack of training for staff to protect themselves from physical aggression despite this being a known risk. People were not exposed to the same risk at the time of our inspection.

There was no registered manager in post at the time of our inspection. 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. A manager had been in post since November 2017 and there had been unavoidable delays in the process of registering with us.

Risks relating to people’s care were well managed and staff were trained to understand people’s behaviours and how to deescalate situations where possible. Staff received training in a range of topics to help them understand people’s needs, including acquired brain injury, mental health issues and substance abuse.

The provider had an in-house psychological therapies team and an occupational therapy team who provided people with individual support and worked with staff to help them understand people’s needs.

People were supported by staff who the provider checked were suitable to work with them. There were sufficient numbers of staff deployed to support people safely and to spend time interacting with people in a meaningful way.

People’s medicines were managed safely, and the provider had robust processes to check people received their medicines as prescribed.

Systems were in place to safeguard people from abuse as the provider trained staff to understand the signs of abuse and the action to take if they had concerns.

The premises were maintained safely with a range of health and safety checks. The premises met people’s support needs as there was sufficient space for people to occupy themselves in their own company or the company of others.

The provider assessed people’s needs and developed care plans to meet their needs and preferences, involving people in the process. People’s care plans reflected their physical, mental, emotional and social needs, their personal history, individual preferences and interests.

The provider was meeting their responsibilities in relation to the Mental Capacity Act 2005 and people received care in line with the Act. The provider followed legal authorisation to deprive some people of their liberty as part of keeping them safe.

People received choice of food and food was provided to meet people’s cultural preferences. Staff supported people with their day to day health and people had access to the healthcare professionals they needed.

Staff knew the people they supported and developed positive relationships with them. People were treated with dignity and respect. Some people were supported to build their daily living skills, so they could live independently in the future. Other people who would require a high level of care through their life were supported to maintain their independent living skills.

People were provided with activities they were interested in and the provider told us they were developing the activities provision further. People were supported to maintain and develop relationships to reduce social isolation.

A suitable complaints process was in place and complaints were responded to appropriately and clearly recorded.

Leadership was visible across the service and the provider received close support from the director of care, psychological therapies team, occupation therapy team, team leader and senior care workers. Staff understood their roles and responsibilities.

Good governance systems were in place to check the quality of the service and to gather feedback from people, staff and professionals.

One person said 'The food is okay. I cook what I like to eat'. Another person said 'I don't cook meals for myself but I make sandwiches and tea sometimes'. People said they went shopping with staff and got to choose what food they wanted to eat.

Two people told us staff supported them to take their medications and one person told us staff reminded them when they needed to attend health care appointments.

All of the people using the service we spoke to said if they had any concerns they would tell staff or the manager and they would do something about it.

We spoke with four of the people who were using the service. Three of them said it was a good place to live. Only one person told us that they did not want to live there anymore. They all said that staff were 'very kind', 'nice and friendly' and 'quite good to them'. One person remained in bed while we were there, preferring to get up later in the day.

People all had their own bedroom and they had been able to help choose how it was furnished and decorated. They were able to decide what they wanted to eat and they discussed what they wanted before the weekly shopping trip. We saw that this included items for people who liked Caribbean food. Some people helped to prepare meals and they were all able to make their breakfast or a snack.

There was a programme of activities arranged to suit people's preferences and they were all able to go out every day with staff. The home has its own minibus. People also had an annual holiday, this year it was to The Isle of Wight.