43 Station Road

43 Station Road is a care home which accommodates up to six adults with a learning disability or autism. At the time of our inspection four people used the service. The service was a domestic home. 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 with people.

People’s experience of using this service

People were not always protected from the risk of harm. Actions taken by the provider in response to behaviours that challenged were not always robust or effective to protect people from reoccurrences of these incidents. We have made recommendations about safeguarding training. Staff did not always follow safe medicine practices and people did not always receive their medicines as prescribed. Safe and robust recruitment procedures were used when people were employed. There were systems in place for the prevention of infection.

Systems were either not always in place or failed to identify areas requiring improvement and to mitigate the risks relating to the safety of people using the service. Contemporaneous records were not always held for people or for the management of the service. Leadership of the service had been inconsistent and staff reported low morale and a lack of support with managing behaviours that challenged the service. We have made a recommendation about the service business contingency plan. Staff were committed to people using the service and were beginning to feel more supported by the new leadership team. The service worked in partnership with health and social care professionals to meet people’s needs. The service was taking action to complete comprehensive quality assurance audits to drive improvement.

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support because they did not always receive the support they needed for behaviours that challenge. For example, effective approaches to supporting people at times of crisis were not considered where this need was indicated.

Rating at last inspection

At the last inspection the service was rated Good (30 December 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s behavioural care and support needs. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the 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.

Enforcement

Please see the action we have told the provider to take at the end of this report.

Follow up

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

43 Station Road 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 the inspection.

43 Station road is registered to provide care (without nursing) for up to six people with learning disabilities. The service specialises in supporting people with autistic spectrum disorder and behaviours that challenge.

At the time of our inspection there were four people using the service, supported in the home by nine permanent staff.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

43 Station Road is a small service located close to local amenities. The home is a large detached property with a generous rear garden. The home has communal areas including a sensory room and all bedrooms have en-suite facilities.

At our last inspection on 30 December 2015 we rated the service overall as good with requires improvement for the Safe domain. This was because recruitment checks were not always completed in line with Regulations. Therefore, we made a recommendation about improving recruitment checks.

At this inspection we found the service remained good overall. We found improvements to recruitment processes and records which meant safe and suitable staff were recruited to support people. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff received safeguarding of vulnerable adults training and understood how to protect people from harm and who to alert if they had any concerns. We have made a recommendation that the provider accesses classroom safeguarding training for staff and the registered manager attends additional safeguarding training in line with the their role. Risks to individuals and general operational risks were identified and appropriate actions were taken to reduce hazards. There were enough staff on duty to meet people’s diverse, individual needs safely. Medicines were managed effectively and staff received appropriate training to administer medication safely.

People’s health and wellbeing needs were met. The service worked closely with clinicians and other professionals and followed advice and treatment plans effectively. Staff understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and the principles of gaining consent or making decisions in peoples’ best interests. 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.

The service provided a calm and friendly atmosphere and staff demonstrated kindness and commitment to people’s welfare. Staff approaches were respectful of privacy and dignity and upheld people’s rights with regards to equality and diversity. People were involved in agreeing their care plans. People’s relatives and relevant others were consulted to make decisions in people’s best interest, where people lacked capacity to consent. Care plans were person-centred and responsive to individual’s current and changing needs. People were supported to follow their interests and work towards their own goals.

Management were described as being approachable and effective. Staff we spoke to felt valued by the registered manager and said they enjoyed their work. Management emphasised a collaborative team approach and spoke respectfully about staff input to people’s care. The deputy manager demonstrated passion for improving people’s quality of life and described how they had linked-up with community services to improve access to opportunities for people. The organisation had a governance system and quality audits in place which were overseen by the Operations Manager and the quality monitoring team. We have made a recommendation that the registered manager updates governance records on file. This is to make sure there is an accurate audit trail of actions for follow-up and completion.

This inspection was undertaken on the 30 December 2015 and was unannounced.

43 Station Road had a registered manager in place. 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.

43 Station Road is a small service which is located close to local amenities. During our inspection, people were supported to access the outside community frequently as there were enough staff to assist on outings.

We found the service to have a calm, relaxed feel. We observed that people appeared settled and happy living at 43 Station Road. The home was maintained well and was kept clean. One relative told us they felt this was the best service their loved one had ever lived at.

People were supported by staff who knew their needs well. Staff were able to explain how they supported people in a person centred manner and how they promoted people’s choices. This was consistent with information we found in people’s care plans.

Staff told us they felt supported in their roles, both as a team, and by management. We found appropriate processes in place to ensure staff were supported, for example, training provision, supervision and a formal induction for new staff members.

A newly appointed deputy manager had recently commenced employment. They advised us of ways they intended to make the service better and were working closely with the registered manager to put improvements into place, for example, a new sensory room and garden.

People were protected from risk of harm as staff were aware of how to raise concerns if they suspected potential abuse. Where people received medicines, these were administered by staff who were trained and deemed competent to do so.

We have made a recommendation around ensuring robust recruitment checks are in place.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

The three people living at the home were not able to take part in detailed interviews, but we spoke with them during our inspection and observed them interacting with each other and with staff. As part of this inspection we also spoke with the registered manager, three care staff and three local authority care managers. We reviewed records relating to the management of the home which included: three care plans and daily care records. We looked at a selection of health and safety monitoring records, premises risk assessments, provider monitoring audit records and staff rotas.

Is the service safe?

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager had reviewed all people at the home that the ruling applied to and had made applications as required under the Deprivation of Liberty Safeguards.

Is the service effective?

Care managers we spoke with felt the staff were meeting the needs of the people living at the home. Staff showed skill at communicating with people and understanding their individual ways of communicating. We saw staff identified and provided care and support where needed.

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. We saw before people received any care they were asked for their consent and the staff acted in accordance with their wishes.

Is the service caring?

During our inspection we saw people were being spoken with and supported in a sensitive, respectful and professional manner. In the records we sampled and in our observations of interactions between staff and people living at the home, we saw people's diversity, values and human rights were respected.

Is the service responsive?

We found changes or newly identified needs were added to people's care plans and any actions taken in response were clearly recorded. Where changes were identified appropriate actions were taken. For example, consultation with or referral to an external health professional.

The provider took account of complaints and comments to improve the service. People we spoke with felt staff listened to what they said and changed things they didn't like.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The current service users were not able to take part in detailed interviews, but we spoke with them throughout the visit and observed them interacting with each other and with staff. The residents indicated they were happy living at 43 Station Road and we noted there were good arrangements in place to gain their consent to care.

There were satisfactory arrangements in place for managing people's meals and nutrition, and people who lived at the service were included in choosing menus. We found the home to be clean and fresh throughout with some residents taking part in some domestic duties. We checked the arrangements for making complaints and found these to be satisfactory, with a user friendly complaints procedure available for residents.

We found some minor shortfalls on the staff recruitment records we checked, and these were addressed by the manager before the draft report was completed.

The people who lived at the service indicated that they were happy living there, and observations throughout the visit showed staff treated people respectfully and took their wishes into account.

We were told people got the care they needed, and felt safe living at this service. Those who were able to comment on the staff, told us they were satisfied with the support they received from staff, and overall they were happy with the quality of the service. Residents described the home as 'Good' and 'Alright.' One person who used sign language, indicated, with help from a member of staff who was supporting them with their communication, that they were happy at this home.

There is a new manager in place at this service. The manager named on this report has yet to deregister with CQC for the Station Road location.