10 High Street

10 High Street is a care home providing accommodation and personal care for up to eight people with learning disabilities. At the time of our inspection five people were living in the home.

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

At our last inspection in June 2019 we found aspects of the service that were not safe and increased the risk that people may be harmed. Staff had not kept accurate records of the medicines they supported people to take. Risk assessments had not always been reviewed regularly and some contained contradictory information. The systems for checking how the service was operating did not always identify shortfalls.

At this inspection we found the necessary improvements had been made. People received their medicines as prescribed. The registered manager had developed a robust new process and management system to ensure medicines were administered safely.

Risks to people's safety had been assessed and appropriate plans developed to manage them. Risk assessments had been reviewed regularly and when there were any changes.

There was a new electronic quality monitoring system in place, which had improved the overall monitoring and effectiveness of the service. Regular audits were carried out which were scrutinised by the senior management team. Any shortfalls were identified quickly, and actions taken to rectify them.

Staff treated people in ways that maintained their dignity and privacy. Staff were well trained and there were sufficient numbers to meet the needs of the people they supported.

The service worked well with health and social care professionals to meet people's needs effectively and appropriately.

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 people with autism.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture.

Right support:

• The model of care and setting maximises people’s choice, control and independence.

Right care:

• The care provided at 10 High Street is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 (published 17 July 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out an announced comprehensive inspection of this service on 11 and 17 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve regulation 12 Safe care and treatment and regulation 17 Good governance..

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 10 High Street on our website at www.cqc.org.uk.

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.

10 High Street is a care home providing accommodation and personal for up to eight people with learning disabilities. At the time of the inspection five people were living in the home.

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 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.

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

Some aspects of the service were not safe and increased the risk that people may be harmed. Staff did not keep accurate records of the medicines they supported people to take. Risk assessments had been completed, but had not always been reviewed regularly and sometimes contained contradictory information.

The systems for checking how the service was operating did not always identify shortfalls. Checks had been completed but did not identify poor medicines records or gaps in risk assessments.

Staff treated people in ways that maintained their dignity and privacy.

Staff were well trained and there were enough of them to provide the support people needed. Thorough checks were completed before staff worked at the service.

The service worked well with other health and social care professionals to ensure they could meet people’s needs.

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.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 (published 24 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 19 November 2016. At a previous inspection which took place in May 2014 we found the provider was meeting all of the requirements of the regulations we looked at.

There was a registered manager in post who was present throughout our inspection. 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.

Due people’s complex needs people were limited in what they could tell us verbally about their experiences of living at 10 High Street. From our observations we saw staff members’ approach to people who use the service was kind and caring. We saw that positive praise and choices were offered and that communication was calm and respectful. People were encouraged to make their rooms at the home their own personal space.

People were protected from harm and abuse by staff who had received training in how to recognise, respond to and report poor practice and abuse. Relatives knew how to report any concerns they had about people’s safety and wellbeing and told us they felt comfortable doing so. The risks associated with individual’s care and support had been assessed and plans but in place to manage these. The registered manager had organised their staffing requirements to ensure people had their care and support needs met safely.

The provider had systems in place to ensure that medicines were administered and disposed of safely. Staff completed training in the safe administration of medicines and had their competency assessed All medicines were stored securely.

People were supported by staff who had the necessary skills and knowledge to meet their individual needs. Staff received effective training and supervision to support them in their roles. There were sufficient numbers of staff available to meet people’s care and support needs.

Staff were recruited safely. The provider and registered manager carried out all the required pre-employment checks to protect people from the employment of unsuitable staff.

People’s rights under the Mental Capacity Act 2005 were protected by the provider and staff team. People’s care plans evidenced specific decisions had been made in their best interest when they lacked the capacity to make these. Staff asked people’s permission before care was provided and gave people choices about their support.

People received care and support which was tailored to their individual needs and preferences. Staff knew people living in the home well and treated them with dignity and respect. People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest others they would like to try. People were supported to maintain relationships which were important to them.

People were provided with support to maintain good health and nutrition. We saw people had their preferred food and drink. Snacks and drinks were available in between meals throughout our inspection.

The registered manager demonstrated good management and leadership skills. The quality of the service was audited and action was taken where improvements were needed. There was good communication between the registered manager, relatives and staff. Relatives and staff said they were comfortable in making suggestions for improving people’s individual care and felt listened to.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

People were treated with respect and dignity by staff. We observed people were happy living at the home and that staff treated them well. People were cared for by staff that knew and understood how to support people in a consistent and safe way.

People's safety was protected and promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

Improvements had been made in the maintenance of the home so that people were protected against the risks of unsafe or unsuitable premises. Further work was being planned to make improvements to the environment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no applications had needed to be submitted relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were kept safe from harm.

Is the service effective?

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and person centred.

Through our observations we saw that staff had built good relationships with people and that people were comfortable in the company of staff. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. Staff were knowledgeable about people's preferences and interests and encouraged people to be involved in meaningful activities.

There was a constant interaction between staff and people in the home; people were involved in conversations with the staff. We observed staff paid attention to people who needed additional support ensuring they were understood. People's communication was understood by staff and responded to in a timely way.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people's records which indicated they had been consulted over the care they received. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. 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 ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

The provider sent us an action plan which described how they planned to meet the compliance action. At this visit we saw improvements had been made. New systems had been developed to ensure the service was regularly monitored, detailing actions to be undertaken and when completed.

Where issues and concerns had been identified, measures had been put in place to enable them to be addressed.

There was evidence in people's care plans of people's needs being assessed, plans being drawn up, implemented and reviewed. We found that individual risks were assessed and plans drawn up to support people.

Staff told us of action they would take if abuse was suspected, witnessed or alleged. We saw staff were trained in safeguarding people. We saw that the provider had submitted one safeguarding referral. We reviewed the records of this referral and found it had been managed appropriately.

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by staff that "staff care" and that "continuity is important".

We found the provider did not have a system in place to regularly assess and monitor the quality of service provided. We saw evidence and were told of views not being acted upon by the provider.