45 Hall Green Road

45 Hall Green Road provides accommodation and or personal care for up to eight people living with a learning disability, autistic spectrum disorder or acquired brain injury. At the time of this inspection eight people were living there.

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

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives. However, people were not always supported to have maximum choice and control of their lives and the provider did not always support them in the least restrictive way possible or in their best interests; the application of the policies and systems was inconsistent and did not always support good practice. Voyage Care published people’s private and personal information on their website without the consent of the person or identifying if it was in their best interests.

People were not always safe as the systems and procedures at 45 Hall Green road were ineffective in identifying improvements needed in safety.

People did not always receive their medicines safely. When people had prescribed medicated creams for pain control the information provided was inconsistent and unclear for staff members to consistently and safely follow. Staff members did not date topical medicines when they commenced their use.

The infection prevention and control measures and checks were ineffective in identifying and correcting defective equipment.

The providers quality monitoring procedures were ineffective in identifying the improvements which were needed to drive good care and support.

People were protected from harm and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do. People had information on how to raise concerns and were confident any issues would be addressed correctly.

People had individual assessments of risk associated with their care and support.

Staff members were aware of the necessary action they should take in the event of an emergency.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision.

People had access to additional healthcare services when required.

People were supported to maintain a healthy diet by a staff team which knew their individual likes and dislikes.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships.

People were supported by staff members who were aware of their individual protected characteristics like age, gender, disability and religion.

People were provided with information in a way they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider, and management team, had good links with the local communities within which people lived.

Rating at last inspection

The last rating for this service was ‘Good’ overall with requires improvement for the safe domain (published 27 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the need for consent and the overall governance at 45 Hall Green Road.

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

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 45 Hall Green Road on our website at www.cqc.org.uk

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider is registered to accommodate and deliver personal care to eight people who experienced a learning disability or associated need. Seven people lived there at the time of our inspection.

The manager was registered with us as is required by law. 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 our last inspection in September 2016 although there was not sufficient evidence to warrant a breach of regulation we found that the ‘safe’ domain required improvement. This was because where people had received support from staff with taking prescribed medicines this had not always been done in a safe way.

At this, our most recent inspection we found some improvement but identified that the issue of the security of one medicine cupboard remained and the requirement to date label ‘short life’ medicines had not always been complied with. We found that where health conditions had been declared by staff these had not always been explored further or risk assessed to ensure potential staffs fitness. Staff knew the procedures they should follow to ensure the risk of harm and/or abuse to people was reduced. Staff were available to meet people’s individual needs. Staff received induction training and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff felt supported on a day to day basis and had received the training they required. Staff knew of the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This should ensure that people received care in line with their best interests and would not be unlawfully restricted. Staff supported and enabled people to have the food and drink that they liked. People had access to a range of healthcare professionals to meet their healthcare needs.

People were enabled and encouraged to make decisions about their care and were involved in how their care was planned and delivered. The provider ensured a happy, friendly atmosphere. Staff were caring and helpful towards people. Staff promoted people’s privacy, dignity and independence. Staff encouraged and enabled people to have contact with their family.

People’s care and support requirements had been assessed and reviewed to ensure that their needs could be met. People were encouraged and supported to participate in in-house and community based activities that they enjoyed. A complaints procedure was available for people and their relatives to use if they had the need. Complaints were documented and dealt with in a thorough way.

People, their relatives and staff told us that the service was good and well organised. There was a management structure that relatives and staff understood. The registered manager and provider carried out monitoring and audits of the service and took action where changes were needed.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. People we asked told us that they had not seen anything of concern. One person told us, 'The staff do not shout or anything. They are nice'. Staff we spoke with knew of the Deprivation of Liberty Safeguard (DOLs) processes. DOLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. All staff we spoke with told us that there was no need at that time to impose any restrictions on the people who lived at the home. This showed that systems were in place to keep people safe.

We found that people's health and other needs had been assessed and were generally met. We found that the management of day to day risks and safety was adequate which prevented people having falls, accidents, or suffering from untoward incidents.

We determined that staffing levels were adequate and flexible to ensure that people were not being placed at risk of harm through inadequate supervision and care provision.

Overall we found that the provider had processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

People's health and care needs were assessed and they were included in their care plans. For example, care plans highlighted what action staff should take to reduce risks to people who had specific health conditions. This meant that care plans supported staff to meet people's needs. One person told us, 'I am happy with my care'.

We found that people's needs had been assessed by a range of health professionals including; specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met.

We saw that staff gave people their full attention throughout our inspection. We also saw that staff attended to people's needs as they should have. We saw that staff had time to chat and undertake activities with people and to give them support. People told us that they were happy with the care that was delivered and that their needs were being met.

We saw that staff had a good understanding of people's care and support needs and risks. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people who lived there.

Overall we found that the provider had processes and systems in place to meet the requirements of the law in relation to ensuring that the service was effective.

Is the service caring?

Overall we determined that staff showed people respect and promoted their dignity. We observed good interactions between the staff and people who lived at the home and we saw that people were given choices. We saw that people were at ease and comfortable when they were in the company of staff. One person said, 'The staff are very nice'.

People's preferences and interests had been recorded so that care and support could be provided in accordance their wishes. We found that day to day activity provision was appropriate and met people's needs. One person told us, 'I go out a lot. I also do things here like bingo. I like that'. This meant that people were fulfilled and did not experience boredom.

People who lived there were given the opportunity to give their views on the care and service provided. By listening to the views of the people who lived at the home the provider would know when improvement was needed.

We found that the provider had processes and systems in place to meet the requirements of the law in relation to ensuring that the service was caring.

Is the service responsive?

We saw that systems had been put into place to promote learning from events such as a recent unforeseen incident that had occurred. This reduced potential harm to the people who lived there.

People who lived there confirmed that staff were responsive their needs and acted to meet them. One person said, 'If I want something I tell the staff and they do it'.

Overall we found that the provider had processes and systems in place to meet the requirements of the law in relation to ensuring that the service was responsive.

Is the service well-led?

We found that the provider monitored the service delivery which included safety aspects. One staff member told us that new systems were continually being implemented to enhance the service provided.

Records we saw during our inspection confirmed that generally they were all completed adequately. Staff told us that they had received training and that care records were audited on a regular basis. This showed that staff had undertaken tasks as they should have been which gave assurance that the service was well led.

Staff told us that they were happy at work. We found that staff of late had greater opportunities to receive supervision regularly and get support when it was needed. One staff member said, 'I really like it here. All staff are well supported'.

Overall we found that the provider had processes and systems in place to meet the requirements of the law in relation to ensuring that the service was well led.

Because some of the people living at the home had complex needs, not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people which included observation. We spent time sitting in communal areas to observe the care that people received. We saw good interactions between the staff and people who lived at the home and we saw that people were given choices. We saw that people were at ease with the staff.

We found that people were offered varied and nutritious food. Where concerns had been identified referrals had been made to health care professionals to prevent malnutrition.

We saw that people's needs had been assessed by a range of health professionals including, specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met.

We found that systems were in place for staff to raise and report concerns that they may have to prevent abuse and harm to the people who lived there.

We found that staffing numbers were adequate which ensured that there would be enough staff to care for the people living there and keep them safe.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.