60 Cobham Road

60 Cobham Road is a residential care home providing accommodation for up to 6 people requiring personal care. The service provides support to people with a learning disability, sensory impairments and/or autistic people in one residential property. At the time of our inspection, there were 5 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Staff supported people to live as independently as possible and have a level of control over their lives. People were provided with a choice in their day-to-day decision-making and families were involved in people’s care. People's risks in relation to their care were generally managed and staff understood how to maintain and encourage people's independence. We observed there were sufficient staff to meet people’s needs. We were assured that the service were following good infection prevention and control procedures to keep people safe. Whilst there had been previous instances of delays in accessing healthcare professionals, staff were now working well with them to achieve positive outcomes for people. The provider had recently employed staff to support people with their activities in the local community.

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:

People told us they felt supported by staff in a kind, caring and dignified way and we observed this. People's differences were respected by staff and they had undertaken relevant training to support people. This included training for learning disabilities and autism awareness. Feedback from relatives was mixed as some felt that there had been delays in seeking medical attention and that the activities provisions offered were not enough. People's right to privacy was respected and staff encouraged people to provide feedback about the quality of care in a format they could understand. Care plans were personalised and included information on people's healthcare needs, communication needs, preferences and social history. Care plans included steps to take to ensure people had regular access to a dentist and were following good oral care guidelines, however this had not always been followed. People were supported to enjoy the diet of their choice and staff encouraged them to have a nutritionally balanced diet. The service was located in a residential street with minimal information to indicate that it was a care home. The service was of a similar size as neighbouring properties.

Right Culture:

The provider’s monitoring systems were not always effective in identifying and acting on shortfalls we found during the inspection. For example, we identified areas for improvement in relation to medicines documentation, some of which had not been identified by the provider’s governance systems. Other areas of improvement had been identified by the provider’s systems and there was an action plan to address these. Where we highlighted shortfalls, the registered manager took immediate action and implemented processes to ensure this would not happen again. People and their relatives told us they felt able to share concerns with the provider and that these would be addressed by the operations manager who was overseeing the service. Staff were complimentary about the registered manager and told us they were able to raise concerns.

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 (report published 14 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to concerns received about medicines, staff failing to seek medical advice in a timely manner and staffing. A decision was made for us to inspect and examine those risks. Please see the effective and well-led sections 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.

Follow up

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

We found the following examples of good practice.

Staff were aware how to balance the health risks with people’s individual wellbeing needs and human rights. People could safely access outdoor exercises such as walks in the local area with staff who supported them to adhere to the COVID-19 national guidance. People continued to access healthcare services or other essential community outings where it was crucial to meet their physical health or other support needs and to minimise the impact of the COVID-19 pandemic. The registered manager reviewed the changes to the national guidance so appropriate support could be provided to ensure people’s and staff’s safety.

Staff felt supported by the provider and well-informed throughout the pandemic. The provider effectively used technology and implemented additional ways of communicating with the registered manager and the staff to keep them up to date and to ensure swift implementation of any required changes. This included broadcasts available to staff and regular online meetings for registered managers. Staff we spoke to were also confident the provider would support them during any periods of required self-isolation.

The home environment and cleaning regimes were re-assessed to enable increased infection prevention and control. The changes were made in a way which did not adversely impact the homeliness of the environment or people’s safety. For example, the antiviral cleaning products and personal protective equipment (PPE) supplies were stored in key points of the house in clean and locked containers or cabinets. The supplies were always available for staff, but storage did not create an institutional feel or safety risks to people, some of whom had behavioural support needs. The service had effective plans on good ventilation which were consistently implemented on the day of the inspection.

There was a spacious garden available for people in good weather which was used as a safe space for home events, individual celebrations and to support people’s sensory needs. Although the pandemic impacted on people’s ability to access their local community and meet with friends, people were supported to participate in different indoor activities or to learn new daily living skills such as baking or making a cup of tea independently. The provider had an organisation wide online platform sharing ideas on activities and organising virtual events. People who lived at the home won an award in an arts competition. The registered manager supported one person to maintain contact and to host essential visits from their advocate. The registered manager also continued to explore how technology could be used to support people’s wellbeing.

The registered manager received ongoing support from the provider, for example to outsource and monitor stock of required PPE. The senior management team provided rapid support to deliver certain items of PPE within short timescales when required. Staff confirmed PPE was always available to them throughout the pandemic. The provider’s guidance for staff included additional topics supporting staff to safely use PPE and take care of their own health and wellbeing. This included guidance on skin care, allergies, possible fire safety precautions needed when using certain products or support for maintaining good mental health.

60 Cobham Road is a house located in the village of Fetcham, in Surrey. The home provides accommodation and personal care for up to six people living with learning and physical disabilities. The care provider is a national care organisation with locations of care homes across England.

People’s experience of using this service:

People living at 60 Cobham Road were safe and supported by staff who were kind and caring. Staff provided a calm and respectful approach and understood individual needs and personalities. Most people who lived at the home were non verbal in their communication. Staff knew how to communicate with each person and people were involved in day to day decision making as much as possible.

The house was suitable for people at this time and some adaptations had been made to accommodate people with mobility needs. However, there was some outstanding work to be done to make the home look well cared for and to take account of people’s needs as they aged. We made a recommendation that this work should be acted on as soon as possible.

People were supported to take part in suitable activities they enjoyed each day. People were engaged with the local community life, and participated in everyday tasks such as doing the shopping. Staff enabled people to take part in tasks at home and in their own care and promoted their independence.

Relationships with healthcare services had been strengthened to meet the needs of people as they aged. People received regular health checks, their medicines were reviewed and any individual health issues were being addressed. People took part in choosing meals and they ate healthily. Staff were aware of the risks some people faced with their nutrition and this was well monitored.

The registered manager had a good awareness of the priorities for the service, staffing and the people they supported. Improvements had been made over the last six months to ensure the service provided was good. The provider had a continuous quality monitoring cycle in place. Statutory requirements were being met. Recruitment and development of staff was an important aspect to ensure standards were maintained.

Rating at last inspection:

Our last comprehensive inspection report was published on 28 August 2016 when we rated the service as good overall. The service was rated as requires improvement in the Effective domain because they had not always followed the legal requirements of the Mental Capacity Act 2005.

A focused inspection took place and a report was published on 5 April 2017 which demonstrated that the service had made improvements in this area and was rated as good.

Why we inspected:

This was a planned comprehensive inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our scheduling guidance.

60 Cobham Road provides accommodation and personal care for up to six people with learning disabilities. There were five people using the service at the time of our visit. The people are supported with a full range of tasks, including maintaining their health and well-being, personal care, support with nutrition and social activities.

This was a focused inspection following the last inspection in June 2016. Despite being awarded an overall rating of ‘Good’ during the last inspection we found a breach in Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This follow up inspection on 2 March was a focused inspection to check if the service was effective.

On the day of inspection we met the registered manager. 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.

During this inspection we found 60 Cobham Road to be working in line with the principles of the Mental Capacity Act 2005 (MCA). People were involved in the decision making process and when people lacked capacity best interest meetings had taken place.

People were being supported by staff who had a good knowledge of their support needs. Staff felt supported and felt they had adequate training to meet people’s needs.

People were supported effectively when it came to their nutritional needs and a varied diet was offered to people. Alternative meals were offered if and when requested by people.

People were supported to maintain good health and had access to healthcare services to meet their needs.

Cobham Road is registered to provide accommodation and personal care for up to six people with a learning disability and who are neurodiverse. The home is located in the village of Fetcham, between Cobham and Leatherhead in Surrey, with convenient access to local shops. On the day of the inspection there were four people living in the home.

The service had a registered manager. 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.

Information about the home was accessible and understood by people who used the service. People had communication plans in place and staff followed these. People were listened to and their rights were respected and staff provided person-centred care.

Recruitment checks were completed to assess the suitability of the staff employed. Staff received suitable training and good support from the registered manager to enable them to carry out their roles. There was a suitable number of staff to meet the needs of the people who used the service.

The provider ensured the administration, storage and disposal of medicines were managed safely.

Systems were in place to effectively improve the quality of care delivered. However impartial feedback was not sought from people to obtain their views and comments regarding the service.

Suitable arrangements were in place to ensure people received good nutrition and hydration. Good food hygiene practices were followed by staff working in the home.

Staff had a good understanding of safeguarding procedures and followed protection plans to minimise the risk of harm to people. Prevention measures had been put in place to minimise future re-occurrences of any incidents.

People were supported by staff to attend health care appointments when there were changes to their health care needs or associated risks to their health. Staff did not always follow the legal requirements in relation to the Mental Capacity Act 2005. Staff understood the MCA and presumed people had the capacity to make decisions first. However, where someone lacked capacity, best interests decisions about whom else could make the decision or how to support the person to be able to make the decision was not sought.

People were supported to maintain positive relationships with their relatives and friends. Relatives were complimentary regarding the care and support provided by staff. People had access to activities that were important to them and were encouraged to be active in the community.

Relatives knew how to make a complaint and were confident any concerns would be resolved. There was an easy read complaints policy available for people.

We found one breach of regulation relating to consent. We have also made a recommendation about obtaining the views of people who use the service. You can see what action we asked the provider to take at the back of the full version of this report.

We were unable to speak to the people who used the service during our visit because of their complex needs. This meant they were not able to tell us of their experiences. Instead we used a range of methods to gather information about this service which included observation, speaking to relatives and staff.

We were told by the people that we spoke with that the staff were good and knew the needs of people who lived in the home well. We were told 'Yes. They know him well.' and 'He responds to them.'

We were told the home was kept clean and tidy and people were always in clean clothes.

The people that we spoke with told us that they had not felt the need to complain but would know who to speak to if they wished to.

We spoke to two relatives of the people using the service. One person told us that they believed that their relative was happy at the service. They also told us that the service was always 'Willing to share information.'

We found that most of the people who used the service had activies planned for them however one person who was new to the service did not have any.

All the staff we spoke to had a good understanding of most people's needs. We noted that in once instance however there were no up to date risk assessments in one person's care plan.