Champions Place

Champions Place is a residential care home providing accommodation and person care for up to 14 people with a learning disability, such as autism. At the time of our inspection 12 people were living at the service.

The service was working towards the principles and values that underpin Registering the Right Support and other best practice guidance. This was to ensure 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 that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. As 12 people were using the service this is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. 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 and what we found

We identified some shortfalls at the service in relation to medicines checks, audits, people’s feedback and their care plans. We have issued recommendations to the registered provider in relation to these.

People told us they liked living at Champions Place and staff treated them with kindness. People had the support required to enable them to make their own decisions and learn skills new to them. People said they had the medicines they needed and we read where people were at risk of harm staff followed guidance to reduce that risk.

People said they felt safe living at the service and had the ability to access a wide range of activities of their liking. They told us they did not have to wait to be supported by staff and that they liked the food that was provided for them. 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.

People could access healthcare professional involvement when needed and where people had accidents and incidents staff responded to these to reduce reoccurrence. People were supported by staff who had access to training, were competent in their role and worked well together as a team.

Improvements had been made since our last inspection and this was evident through people’s interaction with each other and us. People were relaxed and happy and clearly comfortable in staff’s company.

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 (report published 20 December 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. This was because we had identified breaches of Regulation in relation to medicines and the Mental Capacity Act 2005.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

However, the service remains rated requires improvement. Therefore, this service has been rated requires improvement for the last two consecutive inspections.

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.

This service was set up and registered prior to Building the Right Support and Registering the Right Support and it is not the type or size of service we would be registering if the application to register was made to CQC today. This is because it does not conform to the guidance as it is very difficult for large services for people with autism to meet the standards.

There was a registered manager in post. A registered manager is a person who has registered with 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. The registered manager assisted us with our inspection.

We last inspected Champions Place in May 2018 when we rated the service Inadequate. This was because we found restrictive, institutionalised practices taking place and a lack of respect being shown to people. There were insufficient staff to care for people and a failure to recognise incidents of abuse. Poor medicines management practices were taking place and there was a lack of information about potential risks to people. People’s care plans did not demonstrate person-centred care planning and the management oversight of the service was not robust. In addition, we found the registered manager was not meeting the requirements of registration as they had failed to notify us of significant incidents.

Following this inspection, we placed the service into Special Measures and we asked the registered provider to send us an action plan to demonstrate how they planned to address the shortfalls. We carried out this inspection to check that they had taken the appropriate steps to follow their action plan. We found significant improvements in the service overall and it was clear from people’s behaviours that they were more relaxed and happy living at Champions Place.

Processes in relation to medicines management had improved, however we identified some shortfalls that required further work. Although improvement was seen in following the principles of the Mental Capacity Act 2005, further work was needed to ensure that legal guidelines were being adhered to.

People were cared for by staff who showed a kind, caring, attentive and respectful approach towards them. People were encouraged in their independence, making their own decisions and supported to maintain relationships that were important to them.

People were being cared for by a sufficient number of staff who had been recruited through an appropriate process. People were protected from the potential risk of harm or abuse as staff were aware of their responsibilities in this respect and there was guidance in place for staff. In the event people had an accident or incident, this was recorded and appropriate action taken in response.

People lived in an environment that was checked for its safety and was clean and suitable for people’s needs. People’s needs were assessed and reviewed and where they required the input of a healthcare professional, this was provided for them.

Staff were competent in their role and worked well together as a team. They had access to training and supervision.

People could choose their favourite foods and they were encouraged to be more independent during mealtimes. Where people had specific dietary requirements, these were recognised and appropriate action taken.

Person-centred care planning had improved. There was a new care plan format in place which was a work in progress and information around people’s end of life wishes needed to be included.

People had the opportunity to access more activities in line with their individual wishes. Due to the change in staffing levels this included opportunities to go out in the evening and at weekends.

The registered manager was aware of the need for the service to move forward and continue to improve. They had worked hard to make positive changes to Champions Place since our last inspection, listening and taking guidance and support from external agencies. The registered manager remained open and transparent and was keen to learn from others’ experience to consider new ways of introducing good practice.

Since our inspection in May 2018, the registered manager had introduced a complaints process, notified us of significant incidents, introduced audit and governance processes and worked closely with the local authority and quality assurance team.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

During our inspection we found two continued breaches of Regulation and made two recommendations to the registered provider. You can see what action we told the provider to take at the back of this report.

Champions Place is a residential care home that provides accommodation and support for a maximum of 14 adults with a learning disability. People who live at the home have mild to moderate learning disabilities, Down’s Syndrome or autism. At the time of this inspection there were nine people living at the home whose age ranged from 35 to 86.

People had varied communication needs and abilities. Some people were able to hold conversations, others could express themselves verbally using one or two words; others used body language and gestures to communicate their needs. Everyone who lived at the home required support from staff for all aspects of their life including emotional and physical support.

During our inspection the registered manager was present. 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 and associated Regulations about how the service is run.

Quality assurance audits and checks were completed but had not ensured quality standards were maintained and legislation complied with. Aspects of the provider’s quality assurance policy were not being followed. You can see what action we told the provider to take at the back of the full version of the report.

There were infection control policies and procedures in place but these had not ensured all aspects of the service promoted effective infection control. You can see what action we told the provider to take at the back of the full version of the report.

People’s legal rights to consent were not upheld. Mental capacity assessments and DoLS applications had not been made when required. You can see what action we told the provider to take at the back of the full version of the report.

People’s rights to privacy and dignity were not always promoted as a shower used by one person was located in a store room. Everyone’s medicines were stored the same person’s bedroom and they were unable to consent to this. You can see what action we told the provider to take at the back of the full version of the report.

Formal processes for actively involving people in making decisions about their care and treatment were either not in place or used inconsistently. Information was not routinely provided to people in formats they could understand. You can see what action we told the provider to take at the back of the full version of the report.

Care records gave descriptions of people’s needs and the support staff should give to meet these. However, recommendations from a professional were not acted upon for one person when their needs changed. You can see what action we told the provider to take at the back of the full version of the report.

Staff were available for people when they needed support in the home and when they wanted to participate in activities outside of the home. However, a formal dependency assessment was not used to decide staffing levels. We have made a recommendation about this in the main body of our report. Robust recruitment procedures were followed to ensure staff were safe to work with people.

A monitored dosage system (MDS) was used to help ensure people received the correct amount of medicine at the right time. Some information about medicines was located in different parts of the home and meant that staff might not be able to access this quickly if needed. We have made a recommendation about this in the main body of our report.

People were supported to access healthcare services and to maintain good health. People had enough to eat and drink throughout the day to help them stay healthy.

There was a stable staff group employed at the home and this helped build positive relationships with people. People appeared very happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

People on the whole expressed satisfaction with the activities they could participate in. People were supported with their relationships and supported to maintain their independence based on their individual capabilities.

Systems were in place for responding to incidents and accidents that happened within the home in order that actions were taken to reduce, where possible reoccurrence.

Staff were skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis. Staff received a high degree of support that enabled them to carry out their roles and responsibilities.

Staff understood the importance of supporting people to raise concerns. Information of what to do in the event of needing to make a complaint was available to people.

People spoke highly of the registered manager. Staff were motivated and told us that management of the home was good. The registered manager was aware of the attitudes, values and behaviours of staff.

This inspection was carried out to review the quality and standard of care provided at Champions Place and to follow-up on the findings from our previous inspection of 15 March 2013 to assess if action had been taken with regards to the concerns we highlighted.

People who used the service spoke positively about the care they received. We spoke with five of the eleven people who lived at Champions Place. Comments included 'I am well looked after', 'The girls (staff) are lovely' and 'I wouldn't like to live anywhere else'.

We also spoke with Care Managers who are Social Care Professionals responsible for placing and supporting people in social care settings. One Care Manager said "I could only best describe the care as very good. They (the service) meet the needs of my client' and 'I have no concerns about this service".

Where people's health or care needs had changed, the service had responded by re-assessing their needs to ensure the caredelivered was effective.

We found the home was in a good state of repair and the patio to the rear of the property had been improved.

Windows on the first floor had been fitted with restrictors which meant windows could not be fully opened therefore safeguarding people from the risks of falling.

We found that recruitment processes were in place and staff files contained the relevant information as required by the Health and Social Care Act.

There were systems in place for staff to seek consent from people before care or treatment was carried out. Where people lacked the capacity to make decisions, we found that the manager took steps to organise best interest meetings to ensure that appropriate decisions were made for individuals.

The service had their own internal adult safeguarding policy and staff also had access to the Surrey Multi-Agency Adult Protection document. Staff had a good understanding of adult protection and could identify the various types of abuse. Staff knew how to escalate their concerns to the appropriate authorities.

We found that whilst the inside of the home was in a good state of repair, the patio to the rear of the property was in a poor condition and presented a trip hazard to people. We also found that windows on the first floor did not have restrictors which meant windows could be fully opened. We have asked the provider to make improvements.

We found that recruitment processes were in place but staff files had missing information. We have asked the provider to make improvements.