Foresight Residential Limited - 14 Otley Road

About the service

Foresight Residential Limited - 14 Otley Road is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 13 people.

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

The home is bigger than most domestic style properties. Yet the size did not have a negative impact on people. We believed that this was because the building design fitted into the local residential area. There were deliberately no identifying signs to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going out with people. The home was very spacious and made best use of larger communal areas.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximised people's choice, control and independence.

People were supported to make choices about where to live and with whom.

Staff were creative with supporting people to live their best lives, as independently as possible. Support was provided which promoted people to develop their daily living skills and access a range of activities and events.

People and their relatives told us they received care and support from staff who they knew and had their preferences respected.

Right care: Care was person-centred and promoted people's dignity, privacy and human rights.

Records were up to date and decisions made on behalf of people under the Mental Capacity Act 2005 were consistently applied or reviewed to ensure they continued to be the least restrictive option and in the persons best interest.

People and their relatives were involved in planning their care.

Care records included person-centred information for staff to follow.

People told us staff were respectful, caring and understanding around their emotional and physical needs.

The service worked closely with a range of health professionals to ensure people received the most up to date care which promoted their health and wellbeing; enabling them to live as normal lives as anyone else.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

The culture of the service was open and empowered individuals to express their views.

People spoke positively about the service they received and the way the service was managed. The registered manager and staff team were passionate about providing people with a personalised service which promoted their independence.

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 29 November 2019) and there were 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 and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in good governance and safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe, Responsive and Well led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Foresight Residential Limited - 14 Otley Road on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about management oversight of medicines under Well led.

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.

Otley Road is a residential care home providing accommodation and personal care. The home accommodates up to13 people in one individual adapted building. At the time of our inspection 10 people with learning disabilities were living at the home.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always consistently applied them.

Otley Road is one large house, bigger than most domestic style properties. It is registered for the support of up to 13 people. 10 people were using the service. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. 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 out with people.

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

We received positive feedback from people and their relatives. People were happy living at Otley Road. They told us they felt safe, were kept busy doing the things they liked, and we observed positive interactions between people and staff.

People were not always protected from potential risks, a fire exit was used to store broken equipment, keys to cupboards containing cleaning materials that could be hazardous were in easy reach and a blocked off balcony was open.

Audits and monitoring systems were not always used effectively to manage the service and make the improvements required. Health and safety checks were in place, however they failed to address the safety issues found on inspection.

Care plans were in place but were not always person centred. People did receive personalised support and staff knew people well, but this wasn’t reflected in their care plans, especially around communication.

People had ‘pen portraits’ (a profile of the person) that listed all people’s problems and background. People didn’t have any personal goals or outcomes in place. We have made a recommendation that these needed to be improved.

Medicines were managed well, safely administered and recorded accurately. Liquid medicines were not always labelled with opening dates. Medicines that were ‘as and when required’ had clear instructions in place but no records to show if they had been effective. We have made a recommendation that these issues need to be improved.

The environment lacked homely features with a staff office space in the hallway. A staff announcement information board and personal protective equipment were on display in the dining room, primarily for staff convenience as opposed to people’s preferences. We have made a recommendation that this needs to be improved.

There were enough staff to support people and staff were always visible.

People and staff spoke positively about the registered managers.

Staff received support and a variety of appropriate training to meet people’s needs.

Individualised risk assessments were in place. Staff were confident to raise concerns appropriately to safeguard people.

Robust recruitment and selection procedures ensured suitable staff were employed.

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 supported to have enough to eat and drink.

Appropriate healthcare professionals were included in people’s care and support as and when this was needed.

There were systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings and emails.

People had good links to the local community through regular access to local services.

People were supported to be independent where they could, their rights were respected and access to advocacy was available.

Support was provided in a way that put the people and their preferences first. Information was provided for people in the correct format for them.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; the premises didn’t meet everyone's needs and peoples care plans were not completed to ensure they were person centred. Also, the environment lacked homely features.

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 20 June 2017) The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found some improvements had been made in some areas. However, not enough improvement had not been sustained and the provider was still in breach of some regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to health and safety, records and oversight from management.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in February 2017 we found the provider had breached two regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to evidence that people’s capacity had been assessed and the oversight of the home. The provider submitted an action plan and has met with us on three occasions since the last inspection. A continuing breach of Regulation 17 Good Governance was found at this inspection. You can see what action we have told the provider to take at the end of this report.

The rating remains unchanged at Requires Improvement. This is the second time the service has been rated Requires Improvement. We will meet with the provider outside of the inspection process to understand what action they will take to improve their overall rating to Good.

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Up to 13 people can be accommodated. Ten people lived at the service when we inspected. People between the ages of 18 and 64 live in the service who have a sensory impairment and or a learning disability/ autism. Some people also have mobility needs.

The service is developing 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.

Two registered managers were new in post since the last inspection who shared responsibility for the service. 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 and staff felt the support from the registered managers, deputy and senior care workers was positive. People and staff were more confident and told us they felt able to speak up about concerns or ideas they may have to improve the service they received. We observed people looking relaxed and fully involved in their own care and support.

The provider had not ensured that systems were properly established which are required to keep people safe and to enable them to receive a quality service. For example, health and safety systems, risk assessment tools, records relating to the Mental Capacity Act, and accident, incident procedures. The registered managers did not have the resources, skills and support to implement all that was delegated from the provider to sufficiently improve the service and demonstrate sustained improvements. The provider has confirmed following the inspection they will take appropriate action to address these concerns.

People and their families told us they felt safe using the service and we saw day to day checks and servicing of the building and equipment had occurred to support this. All staff understood how to protect people from avoidable harm and knew how to raise concerns if they saw signs of abuse.

Appropriate systems were in place for the management of medicines so people received their medicines safely.

People told us there were enough staff on duty to meet people’s needs. We found safe recruitment and selection procedures were in place which the provider needed to ensure were followed consistently.

Staff felt confident they had the skills to deliver safe and effective support. We saw the training they required was not always up to date. The registered managers had a plan in place to ensure this was rectified.

We saw improvements had been made around the culture of the service. Focus had been to support and recruit the right members of staff who understood what person centred care looked like. And who were willing to ensure people received a person centred service. This had been successful and people told us they received support in the way they preferred and that they enjoyed feeling relaxed in their own home. People had better access to community activities and staff had enabled people to develop and maintain their independence. People received support from staff who treat them with dignity and respect and who displayed a caring, compassionate attitude.

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 supported to maintain their health including their nutritional needs with the support of healthcare professionals. Better records were needed to evidence the support provided to monitor progress of specific health needs.

The service continues to make improvements and the registered managers were keen to listen to feedback from people and their relatives to influence how continuous improvements could be achieved.

Situated over three floors, 14 Otley Road is registered to provide residential, personal and social care for 13 adults with learning disabilities who may have other sensory impairments and physical difficulties. At the time of our visit there were 12 people living at the service.

The home’s previous registered manager had left in early 2017 and the registered provider's two other registered managers from nearby services were jointly applying to the Care Quality Commission to manage the service. 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. We met with one of the joint managers during the course of our inspection visits.

The registered provider did not always have systems and processes in place to assess, monitor and mitigate any risks relating to the health, safety and welfare of people who used the service.

The provider’s fire risk assessment had not been reviewed since 2006. We had some concerns such as the regularity of fire drills outlined did not correspond with the registered provider’s current regime. The management team told us they would ensure the fire risk assessment was appropriately reviewed as soon as possible.

We saw that risk assessments were in place which detailed some measures to keep people safe. However these required further development.

Following day one of our visit we asked the NHS infection prevention control team to visit because we found areas of concern. The provider has since submitted an action plan in response to issues found by the infection control team.

Staff members were not all aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. We saw that assessments to check whether people had capacity to make their own decisions were not in place where required.

We found that records to evidence safe recruitment and selection procedures were in place. The registered provider did not ensure they recorded their decision to proceed with recruitment where one of the members of staff had been disciplined at their previous employment. We saw that the managers had produced an action plan to ensure appropriate records of checks were carried out in future to ensure staff members had been assessed to work safely.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. The service did not have “as and when required” medicine protocols in place for people although this had been addressed by day two of our visit.

The registered provider needed to develop effective systems to monitor and improve the quality of the service provided. There was no robust audit programme in place to ensure the safe and effective management of the service.

Staff members had been trained and had the skills and knowledge to provide support to the people they cared for. We received feedback that staff felt there should be a review of night-time arrangements as staff sleeping over at the service were sometimes awoken by people using the service.

Staff told us the culture of the service needed to change to ensure people were supported and empowered to lead fulfilling lives and to ensure they were at the centre of the service being provided. Staff we spoke with were positive about the changes being made at the service to ensure people led an active community life.

Staff told us that they felt supported. By day two there was a programme of regular staff supervision and appraisal in place, which had not been in place on day one of our visit.

Support plans required work to ensure they captured all people’s assessed needs. Where reviews of support were completed evidence that the person and their advocate were involved was not recorded. People’s independence was encouraged and staff supported them to access activities within the community. The manager recognised that further improvement was required in this area to demonstrate people were supported to develop skills in activities of daily living.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff members were attentive, showed compassion, were patient and gave encouragement to people.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted. Staff told us that they monitored people’s weight and nutrition and would contact the dietician if needed. However, staff did not complete nutritional assessment documentation using a recognised tool such as the Malnutrition Universal Screening Tool (MUST).

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff would respond and take action to support them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to consent, and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People's needs were assessed and their rights were respected by the staff. We saw that people were encouraged to make decisions for themselves or were supported, by the staff, to make decisions about their daily routines. We observed staff treating people in a kind way and with dignity. We saw that people were supported to maintain their independence and observed a warm and friendly rapport between those living and working at the home.

People had care plans and risk assessments in place, which helped staff to understand and meet their needs.

We saw that there were sufficient staff on duty and staff received training to ensure that they had the skills they needed to be able to look after people safely. Staff told us the training was very good. One member of staff told us, "It is a very good organisation to work for; we are kept up to date with our training." Another member of staff told us, 'I have the skills and abilities I need to feel confident about my work.'

The complaints procedure was displayed in the home, this meant that people had access to the information they needed should they wish to make a complaint. People also had access to other methods of complaining should they need support to raise issues.

We had previously found that while some medication records were up to date and completed properly, the home did not have an adequate system for the recording of medicines, or for the auditing of their stocks. The numbers of some medicines in stock did not tally with how many the home thought they should have. In addition, the home was not able to evidence whether the numbers of medicines in stock were correct, or whether some medication had been lost or misappropriated. This meant that errors, such as missed doses or overdoses, would have been less likely to be discovered.

On this visit we found that the home had improved procedures and introduced new practices for medication recording. They were able to demonstrate that numbers of medicines were being recorded correctly. This meant that people who use the service were protected against the risks associated with the unsafe management of medicines.

We looked at the care plans for three people who live at the home. Although in some cases risk assessments required updating and review, in general records kept for each person showed that the home had carried out sufficient assessment of the needs of each person, to enable appropriate care and support to be given.

Staff told us they felt settled and happy in their jobs, and had been well trained and supported by their manager. Comments included 'I never feel like I can't ask a question.' Training and staff records showed that staff had suitable qualifications and skills, and appropriate character checks had been carried out prior to employment.

We had received a concern from a Local Authority that they had not been kept fully informed by the home about a resident. We found that the home had in place appropriate review procedures and had for the most part been working appropriately with other professionals.

We looked at medication administration records and systems. While some records were up to date and completed properly, the home did not have an adequate system for the recording of medicines, and for the auditing of their stocks. We have asked the manager to take action to improve the recording procedures and to carry out a full audit and stock check of the system.