Real Life Options - 2-4 Bethecar Road

About the service

Real Life Options 2-4 Bethecar Road is a care home providing accommodation and personal care for up to 6 people who live with learning disabilities, and may have mental health needs, sensory impairments and /or physical disabilities. At the time of the inspection there were 4 people living in the care home.

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

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

Right Support

People received a service that was safe for them to live and staff to work in. The quality of the service was regularly reviewed, and improvements made to ensure people's care and support needs were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

Staff were appropriately recruited, trained, and in sufficient numbers to support people to live safely, whilst enjoying their lives. Identified risks to people and staff were assessed, monitored, and reviewed. Complaints, concerns, accidents, incidents, and safeguarding issues were appropriately reported, investigated, and recorded. Trained staff safely administered people's medicines.

Right Culture

The ethos, values, attitudes and behaviours of the registered manager and staff ensured people using services led confident, inclusive and empowered lives. The provider engaged people in the running of the service and had effective systems of audit in place. The provider understood their obligation to be open and honest and promoted a positive culture that achieved good outcomes for people. The provider worked in partnership with other multi- disciplinary professionals.

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 12 April 2022) 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 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, Effective and Well-Led.

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 based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Real Life Options 2-4 Bethecar Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Real Life Options–2-4 Bethecar Road is a care home providing accommodation and personal care for up to six people who live with learning disabilities, and may have mental health needs, sensory impairments and/or physical disabilities. At the time of the inspection there were four people living in the care home.

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

The service was not able to consistently demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture.

Right Support

The service people received was provided in a house, which was similar to the other houses in the area, and people living with physical needs had their bedroom on the ground floor. However, the décor of the interior of the home was very tired looking, some areas were not clean, and there were maintenance issues that had not been addressed. The lack of an attractive well maintained environment could impact negatively on people’s well-being, safety and comfort. Staff supported and encouraged people to make choices in all aspects of their lives. People’s independence was supported. Staff supported people to take part in activities they enjoyed, within and outside of the home. People were supported to safely access facilities and amenities within the local area. People’s care plans set out person centred meaningful goals that had been discussed and agreed with them.

Right Care

People received care and support that was person-centred and promoted their dignity, and human rights. Staff knew people very well. They had knowledge and understanding of each person’s individual needs, and involved them in all decisions about their health, care and day to day lives. Staff received the training they needed to provide people with the right care. During the inspection people’s privacy was respected. However, on the first day of our inspection, we found that one bathroom did not have a blind on the window, so people’s privacy was not protected. The manager promptly ensured that a blind was put in place.

Right culture

Staff engaged with people in a respectful and positive way. People spoke of the good relationship they had with their keyworkers, who met with them regularly to discuss a range of matters to do with their lives. Staff supported people to achieve their goals and aspirations. They recognised the importance of empowering people to live their lives in the way they wanted, and provided people with the support they needed to lead confident and inclusive lives. Staff understood how to protect people from poor care and abuse. They had training on how to recognise and report abuse and knew how to apply it. Staff told us that they would report without hesitation poor practise from staff.

Suitable and robust infection, prevention and control systems were not in place to ensure that all areas of the environment were clean to minimise the spread of infection.

Governance systems and processes had not identified the shortfalls in the service that we found.

There was positive and respectful engagement between staff and people using the service. People were treated with dignity and respect. People told us that staff were kind to them and provided them with the support and assistance they needed.

Relatives spoke highly about the staff and told us people's care and support needs were met by the service. They told us they were fully involved in all areas of people’s care. People’s care and support plans were personalised and regularly reviewed with them. They set out people’s needs and preferences and detailed how they were met. Support focused on people's wishes and their quality of life.

Staff understood their responsibilities in relation to safeguarding people, whistleblowing and reporting all concerns to do with people's safety.

People were supported with their medicines safely and to access healthcare.

Appropriate recruitment procedures were in place to help protect people from the risks of being cared for by unsuitable staff. Staff received the induction, training and support to enable them to competently carry out their roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 6 September 2019).

Why we inspected

The inspection was prompted in part due to concerns found during an infection, prevention and control inspection carried out by us. A decision was made for us to inspect and examine those risks. As a result, we returned to the service and undertook a focused inspection to review the key questions of Safe and Well-led only.

We have found evidence that the provider needs to make improvements. Please see all the key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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. The overall rating for the service has changed from good to requires improvement.

This is based on findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Real Life Options – 2-4 Bethecar Road on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in regulation in relation to premises, infection prevention and control and 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Real Life Options–2-4 Bethecar Road is a care home providing personal care for up to six people who live with learning disabilities, and may have mental health needs, sensory impairments and/or physical disabilities.

The service was provided in a house, which was similar to the other houses in the area. People living with physical needs had bedrooms on the ground floor. At the time of the inspection there were four people using the service.

The care home had been registered before Registering the Right Support and other best practice guidance had been developed. Registering the Right Support guidance focuses on values that include choice, inclusion and the promotion of people’s independence so that people living with learning disabilities and/or autism can live a life as ordinary as any other citizen. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People using the service received planned and co-ordinated person-centred support to live their life as independent as possible in the way they wanted.

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

People received kind and compassionate care and staff respected people's privacy, dignity and independence. Staff engaged with people in a respectful and friendly way. People’s relatives spoke in a positive way about the service people received from staff.

People were fully involved in their care. People and those important to them participated in reviews of their care. People’s care and support plans were up to date and personalised. They included guidance for staff to follow to ensure people received the care they needed and wanted.

Staff understood and valued people’s differences. Staff we spoke with were knowledgeable about people's likes and dislikes, how they preferred to be supported, and their personal histories.

People told us they felt safe. People were protected from the risks of harm, abuse and discrimination. Staff knew what their responsibilities were in relation to keeping people safe. We observed people to be relaxed around staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the services supported this practice.

Systems were in place to ensure that people received their prescribed medicines safely.

Staff followed appropriate infection prevention and control procedures to ensure the environment was clean and people were safe.

Staff received a range of training and the support they required to enable them to carry out their roles and responsibilities effectively. Appropriate recruitment procedures helped ensure only suitable staff were employed.

Staff supported people to lead healthy lives and to access treatment, care and advice from a range of healthcare services.

People were supported to take part in activities they enjoyed and to maintain relationships with the people who mattered to them.

Systems to monitor how well the service was running were carried out. Improvements were made when needed.

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 5 September 2018). There were three 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

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.

Real Life Options 2-4 Bethecar Road is care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and personal care for up to six adults who have learning disabilities, some of whom may have mental health needs, sensory impairments and/or physical disabilities. The accommodation is a terraced house located in Harrow close to a range of local shops and other community facilities. People have access to safe outdoor space. They have their own bedroom and share the lounge, kitchen and other communal areas. There were four people using the service at the time of the inspection.

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 using the service were supported to live as ordinary a life as any citizen.

There was a registered manager in post at the service. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

There were systems in place to help keep people safe and protect them from the risk of harm but we found shortfalls in arrangements for safe access to the home by wheelchair users. Risk assessments and risk management plans to minimise potential risks to people were not always in place.

Staff received relevant training to carry out their roles, but refresher training was not always completed and staff had not received training or learning about a person’s medical condition.

Checks were carried out to monitor the quality and safety of the service, but these did not identify shortfalls that we found, or indicate that action was taken to make improvements and develop the service.

Staff knew people well and had a caring and supportive approach to their work. Staff understood the importance of treating people with dignity, protecting people's privacy and respecting their differences. We saw and heard many positive interactions between people using the service and staff. People told us the staff were kind to them.

People's care plans included details about people’s individual preferences and information staff required to provide people with the care and support they needed in the way that they wanted. Care plans were reviewed regularly and updated when people's needs changed. They contained guidance on how to keep people safe whilst maximising their independence.

Medicines were stored and managed safely. People received their medicines as prescribed.

People received the support they needed to access community and hospital healthcare services to ensure that their healthcare needs were met.

People's nutritional needs were met and people were involved in meal planning and preparation. The service encouraged healthy eating and regular exercise. People had the opportunity to take part in a range of activities that met their individual preferences.

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. Staff gained people's consent before providing them with assistance with personal care.

Appropriate recruitment procedures were in place so that only suitable staff were employed to provide people with the care and support that they needed. Staffing levels and skill mix provided people with the assistance and care that they needed.

There was a complaints procedure in place, which was in a format that could be easily understood by people using the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to safe care and treatment, staff training and good governance. You can see what action we told the registered manager to take at the back of the full version of this report.

Real Life Options – 2-4 Bethecar is registered to provide accommodation and personal care for six people. The home provides care and support for people who have a learning disability, some of whom have mental health needs. The home is owned and managed by Real Life Options who provide a similar service in two other care homes in North West London and a range of services in other areas. On the day of our visit there were four people living in the home. Public transport and a range of shops are located within walking distance.

The service currently does not have a registered manager. However, a manager was in post managing this service and two other registered locations. He has managed the services for several months first as acting manager and recently as permanent manager, and has commenced the initial process of applying to register with us. 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 2008 and associated Regulations about how the service is run.

People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People told us staff were kind to them. Staff respected people’s privacy and dignity.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm.

Care plans reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People were supported to choose and take part in a range of activities of their choice.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was upheld and promoted. People were provided with the support they needed to maintain links with their family and friends.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People chose what they wanted to eat and people were involved in the preparation of their own meals.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities. Further training in some specific areas was in the process being arranged. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

People had opportunities to feedback about the service. There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We met and spoke with five people who were staying in the home and spoke with three relatives and four members of staff, including the deputy manager. The registered manager was not on site at the time of our inspection.

Is the service safe?

We found people had been involved in making decisions about their care and treatment. The care plans were person-centred and reflected people's wishes and preferences as to how they wanted their care to be delivered.

Staff had the skills and experience to care for people with learning disability and had knowledge of each person's behaviour patterns and assisted them appropriately, while ensuring their care needs were met. Medicines had been handled, stored and administered appropriately.

The provider had an effective recruitment and selection process in place. This had ensured people were safely cared for and were supported by skilled and experienced staff.

People were cared for in a clean and comfortable environment, which was well maintained and secure.

Equipment had been appropriately checked and serviced, including the fire equipment. Each person who used the service had a personal evacuation plan, which had been regularly reviewed and updated as their needs had changed.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. Staff had received training on the Mental Capacity Act 2005 (MCA) and DoLS and had an understanding of when an application under DoLS should be made and how to submit one to be authorised by the local authority. There had been no DoLS applications since the last inspection.

Is the service effective?

People's personal, healthcare and social needs had been closely monitored and provided for. Their needs had been reviewed regularly and risk assessments had been carried out where appropriate. The service had worked closely with the local authority, other healthcare professionals and the relatives to ensure people received appropriate care and treatment.

One person's relative said, 'The staff are doing a fantastic job. My (relative) has been living here for several years now and we are very happy (our relative) is well cared for.'

We observed staff interacted well with people and were patient and respectful. The staff we spoke with had a good knowledge of people's needs, daily routine and behaviour patterns. This had ensured people received appropriate care, support and treatment.

Staff said people had been encouraged and supported to lead independent lives. A member of staff said, 'People are encouraged to have an independent lifestyle.' Staff had received appropriate training to enable them to meet people's personal, health and social care needs.

Is the service caring?

All five people who used the service had a learning disability and communicated with us with limited words. We observed their facial expressions, sounds and gestures which indicated they were happy and content with the staff and the care they received.

We observed people being treated with respect and dignity and being encouraged to get involved in making decisions. A relative said, 'The staff are always very polite and respectful.' Another relative said, 'My (relative) is very happy living here. Our (relative) comes home to us every weekend. The staff are wonderful and they support our (relative) very well.'

One member of staff stated, 'This is their home and we try to make it as homely as possible.' We were shown the notice board with people's own photographs and pictures of outings and activities they had taken part in. The pictures were chosen and arranged in the way they preferred. This showed people's wishes and preferences had been respected and staff had been caring.

Is the service responsive?

People had access to a choice of community activities and holidays organised by staff. The weekly activity records were detailed and reflected each person's preferences and lifestyle.

The care records showed people's needs had been assessed and regularly reviewed. This enabled staff to provide appropriate care and treatment. A relative said, 'We were invited to a meeting about three months ago to discuss our (relative's) care needs. Staff take notice of what we say and respond satisfactorily.' We all work together like a big family to help our (relative), you know. Yes, we are very happy with the care.'

Is the service well-led?

Staff had a good understanding of the provider's ethos in providing a care service. They were clear about their roles and responsibilities and staff had been consulted before any changes were implemented.

Staff told us the service had improved under the new manager and they had been given support through regular supervision and staff meetings and issues had been discussed to improve the service.

People and relatives had been listened to and suggestions had been taken on board to improve the menu and the activities. Relatives confirmed surveys had been conducted regularly to assess how satisfied people were with the service and improvements had been made as a result. One person's relative said, 'We would talk to the staff or the manager if we had any concerns, but we are very satisfied with the way staff care for our (relative), so we have not needed to make a complaint.'

Another relative commented, 'Communication between the staff and us is very good. They keep us informed if there is anything needing to be discussed or if there have been any changes in our (relative's) condition.'

The provider had an effective monitoring system in place to ensure people lived in a safe environment where staff provided safe and appropriate care and treatment.

Each person who used the service had a plan of care that had been regularly reviewed and included information and guidance about the individual support and care that the person needed. People were supported to be involved in decisions about their lives and best interest decisions were made when people were unable to consent about matters to do with their care and treatment.

Numbers and skill mix of staff were flexible to ensure people's varied needs were met by the service. Staff knew people well and were aware of their roles and responsibilities in meeting the needs of the people who they supported. People who used the service approached staff without hesitation and staff interacted with people in a sensitive and positive manner. People accessed their bedrooms and the communal areas of the home freely.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

Records were up to date and kept securely.

During this follow up inspection we spoke to five people using the service and to two relatives of a person living in the home but on this occasion the focus was on talking to staff and checking records to make a judgement as to whether the provider had met the compliance actions Outcome 4 Care and welfare of people who use services, Regulation 9 (HSCA 2008 Regulated Activities) Regulations 2010, and Outcome 16 Assessing and monitoring the quality of service provision, Regulation 10 (HSCA 2008 Regulated Activities) Regulations 2010.

At this inspection we found that the provider had taken proper steps to ensure that appropriate information and records were in place so people were protected against the risks of inappropriate or unsafe care and treatment, and to ensure that a quality service was provided to people.

We saw that staff talked to people and explained things to them so they were involved in their care. People were supported in maintaining independent living skills and to be involved in the local community. People cleaned their rooms, did their own laundry and helped in the kitchen. They also went for trips and holidays according to their wishes and preferences.

We saw care plans and risk assessments were not always in place to address how people needs were being met and how their safety was being maintained. People's conditions were also not monitored regularly so action could be taken when necessary to ensure their safety and welfare. For example people were not weighed regularly and a person who needed blood tests quarterly to monitor the level of a medicine was not having these regularly.

The service had some initiatives to monitor the quality of the services provided but these were not always effective to ensure that people were not placed at risk of unsafe or inappropriate care. For example checks were not adequate to ensure that care plans and all safety certificates were in place as required.

Mr. Michael Piekarczyk is listed as a registered manager but he is no longer in post at this location.