Brighton & Hove City Council - The Beach House

Brighton and Hove City Council – The Beach House is a residential care home providing personal care to five people at the time of the inspection. The service can support up to 14 people living with a learning disability and/or a physical disability. The service provides short breaks or respite service where people can have weekend or midweek breaks. The service also provides emergency placements for people who are in crisis in the community.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. 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 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

People and their relatives told us they felt safe being supported by staff and that staff had the skills and experience to support them appropriately.

We identified some areas of practice that need improvement. Quality assurance systems had been introduced and were continuing to be developed and improved. This included audits of medicines, infection control, and health and safety. However other systems of quality monitoring had not yet been implemented, such as the monitoring of training, supervision and appraisal of staff. Further time was needed to fully embed these into day to day practice. Staff told us they were well supported and could speak with managers about any issues or concerns they had. However, the providers formal system for staff supervision had not been maintained, and routine supervision had not gone ahead for staff for some time.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture.

Right Support: Model of care and setting maximises people’s choice, control and Independence

People were supported by staff to work towards their individual goals and objectives. During their stay at the Beach House, staff encouraged and supported people to live as independently as possible and to have control over their lives. People were encouraged to express their views using a variety of communication methods and staff actively sought feedback which was discussed with individuals.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

People who used the service and their relatives told us they felt supported kind and caring staff. Staff knew people well and ensured they were supported with their social and care needs in a person-centred way.

Right Culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The culture of the service was open, inclusive and empowered individuals to express their views on how the service was run. People and relatives told us they felt confident and were supported to manage potential risks, for example when they accessed the local community. People who used the service and their relatives were complimentary of staff and the leadership of the service.

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 was for this service was Good (report published 31 October 2019). The overall rating for the service has remained Good based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Brighton and Hove City Council – The Beach House is a residential care home providing personal care to seven people at the time of the inspection. The service can support up to 14 people living with a learning disability and/or a physical disability. The service provides short breaks or respite service where people can have weekend or midweek breaks. The service also provides emergency placements for people who are in crisis in the community.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. 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 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:

People and their relatives told us the service was safe. Risks were well managed, and the provider learned from previous accidents and incidents to reduce future risks. The registered manager and staff understood their responsibilities about safeguarding. Arrangements were in place for the safe administration of medicines.

Appropriate recruitment checks took place before staff started work. There were sufficient staff available to meet people's needs. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and supervision. Training was ongoing, and staff spoke highly about their access to training. Staff received training specific to people’s needs which included how to support people safely.

The service applied 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive 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 received support that met their needs and was in line with care plans and good practice. People's right to make their own decisions was respected. People were encouraged to maintain good diet and access health services when required.

Healthcare professionals spoke highly of the service and its ability to provide flexible and personalised care to people in crisis. Relatives praised the staff team and their adaptability in understanding and meeting people’s care needs.

People were supported to access community services and to participate in activities of their choosing that met their needs. Staff knew what was important to people and ensured people had care that met their needs and choices. People's dignity, confidentiality and privacy were respected, and their independence was promoted.

The provider had a complaints procedure and people were aware of how to make a complaint. An effective quality assurance process was in place. People, family members and staff were regularly consulted about the quality of the service.

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 was for this service was Good (report published 8 July 2016)

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.

The Beach House is registered to provide accommodation and personal care for up to 14 people. Care is provided to adults aged between 18 years and 65 years of age with a learning disability and/or a physical disability. However, two people who use the service were over 65 years of age. The registered manager told us they were now getting requests for people over 65 years of age, and has subsequently provided an updated Statement of Purpose to detail this change.This is a short breaks or respite service where people can have weekend or midweek breaks. There are two bedrooms which are used for emergency placements for people who are in crisis situations in the community. People are supported to live as independently as possible whilst alternative accommodation is sought. The purpose built accommodation is on three floors and a passenger lift gave level access to all parts of the building. Each person has their own bedroom the majority of which have an ensuite bathroom. There are lounges, dining areas, and shared bathrooms and toilets for people to use. The service is situated in a residential area with easy access to local amenities, transport links and the city centre.

At the time of the inspection there were 56 people were being supported with respite care or an emergency placement whose behaviour could be complex. Eight people were living at the service on the day of the inspection. Four people had been in the service for a period of time whilst waiting for their long term accommodation needs to be met.

The service had a registered manager, who was present throughout the inspection. They were new to the post, but they had worked in the service for a number of years and knew the service well. 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.

The service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Relatives told us people were safe in the service. One relative told us, “I have no concerns they are generally very good.“ People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were detailed, up-to-date, and had been or were in the process of being reviewed . One relative told us when they visited the service, “Staff always welcome you. When you go in they (the people) always seem happy and there is a good atmosphere.” A member of staff told us, “Everyone does a good job here. Everyone is jolly. We help each other out and are all very professional. It’s a really good group.” Care staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People were supported by kind caring staff.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. All appointments with, or visits by, health care professionals were recorded in individual care plans.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the registered manager and the management team.

People and their representatives were asked to complete a satisfaction questionnaire to help identify any improvements to the care provided. There were regular carer meetings for people’s relatives or representatives where people could receive updated information, raise any concerns or comment on the care and support provided. One relative told us, “They tell us of any staff changes. They are open about things.“ There was a detailed complaints procedures should people wish to raise any concerns. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

Below is a summary of what we have found. The summary is based on our observations during the inspection, where possible discussions with people using the service (as people had complex needs which meant they were not able to tell us about their experiences), their carers, the staff supporting them and looking at records.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they or their relative were safe. One carer told us, "100%." Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people's best interests. People had been asked for their consent for any care or treatment.

There was a system in place to make sure that the provider, manager and staff learnt from events such as incidents and accidents, complaints, and concerns.

The service was clean and hygienic. We found that shortfalls highlighted at the last inspection of the service had been addressed. Staff had been provided with training to undertake their roles in the service, systems developed and recording and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.

A staff rota was set, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs had been reviewed and where possible people and their carers had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and behavioural support needs had been identified and guidance for staff to follow was in place. People were able to move around the service freely and safely. A carer told us, 'They make sure his bedroom is safe.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and offered encouragement when supporting people. People commented,' 'They went out of their way to help him settle in,' "I am very, very happy he goes to The Beach House. I would be lost without it," "I am really pleased the staff there love him. They are wonderful," and 'I like it here.'

We saw people using the service, their relatives and carers had been involved with the service and had completed an annual satisfaction survey in 2013.

People's preferences, interests, aspirations and diverse needs had been recorded. People told us care and support had been provided in accordance with people's wishes. One carer told us,"They ring me up to find out if there are any changes in his care needs. They ask about his likes and dislikes."

Is the service responsive?

People completed a range of activities in and outside of the service regularly. Weekly meetings had been held with people to discuss what activities they would like to participate in during their stay in the service.

There was a complaints policy and procedure in place if people were unhappy, which was monitored by the provider. No complaints had been received since the last inspection. The carers told us they aware who to speak with if they had any concerns. One carer told us, "I would complain if necessary. I would know who to speak to if necessary." People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

The service had quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

This told us people or their carers had been able to express their views about the care provided, and where possible had been involved in making decisions about their care and treatment. People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Care workers had a good understanding of people's care needs. Comments from carers included, 'They all seem to enjoy themselves here,' 'They are life savers,' "She is so at home here,' 'I can't praise them enough,' 'It's 100% here,' and 'Very satisfied with the care.'

People were provided with a choice of suitable and nutritious food and drink.

All feedback received confirmed that the service was clean However, infection control policies and procedures were not in place to fully protect people.

Robust recruitment procedures were in place to protect people.

We found that the processes in place to respond to complaints had ensured information provided was used to improve the service.

People or their representatives had been able to express their views about the care provided if they wished to, and where possible people who used the service had been involved in making decisions about their care and treatment.

People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Care workers had a good understanding of people's care needs.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

The records needed for the management of the home had not always been maintained to ensure they were accurate and complete.