Homewards Limited - 48 Leonard Road

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 guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and/or autistic people.

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

The service could show how they met the principles of Right support, right care, right culture. The provider had made significant improvements to the service since the last inspection.

Right support:

The model of care and setting maximised people’s choice, control and independence. People lived in a small homely environment where they felt safe and comfortable. The provider had made improvements to the health and safety of the service in relation to the maintenance of the property and ensuring risk assessments were more detailed. Staff supported people to live up to their goals and aspirations. People were encouraged to make choices and decisions in accordance with their level of understanding.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights. The provider had made improvements around staffing of the service in relation to recruitment checks, numbers of staff and their deployment. People were supported to maintain their privacy and dignity by a staff team who knew them very well. Staff demonstrated they provided kind and compassionate care to people and relatives. People were supported to maintain links with their culture and family. Staff engaged people in a variety of indoor and outdoor activities in accordance with individual care plans.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. People’s representatives and staff spoke positively of the new registered manager and the positive changes they had made to the care provided. The provider had made improvements since the last inspection and now had a regular system of quality checks. People and their representatives were asked by the provider about their opinions of the service.

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’s care and support was provided in a safe, clean, and well-maintained environment which met people’s sensory and physical needs.

• People were protected from abuse and poor care. The service now had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People had their communication needs met and information was shared in a way that could be understood.

• People’s risks were assessed regularly in a person-centred way. Risk assessments were now more detailed and robust. People had opportunities for positive risk taking and were involved in managing their own risks whenever possible.

• People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People’s care, and support plans, reflected their sensory, cognitive functioning needs. Support focused on people’s quality of life and followed best practice.

• People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• Where people were at risk of placement breakdown there was a clear support plan and regular care reviews. Staff worked well with other services and professionals to prevent admission to hospital.

• People were supported by staff who understood best practice in relation to learning disability and/or autism.

• Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve 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 (and update)

The last rating for this service was inadequate (published 25 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after this inspection to show what they would do and by when to improve.

We carried out an unrated targeted inspection (published 19 September 2020) due to concerns raised by a whistleblower about lack of activities, reporting of accidents and incidents and food and nutrition. We found no evidence at this time that people were at risk of harm from these concerns.

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

This service has been in Special Measures since 25 October 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this inspection to provide assurance that the service is applying the principles of Right support, right care, right culture.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homewards Limited – 48 Leonard Road 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.

Homewards Limited – 48 Leonard Road provides accommodation with personal care for up to four people with learning disabilities or autism spectrum disorder. At the time of this inspection there were three people using the service.

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

We received information following a whistleblowing to the local authority raising concerns about the lack of activities, reporting of accidents and incidents, risk management, safeguarding, staffing and food and nutrition.

Relatives were confident their relative was safe at the service. Staff understood what action to take if they suspected somebody was being harmed or abused. The provider’s safeguarding policy was not robust enough, but they took action, updated the policy and sent this to us following the inspection.

Staff knew how to report accidents and incidents. However, we noted incident forms were not always completed when they should be. The management had taken steps to address this prior to the inspection and provided training to staff about appropriate record keeping.

The provider ensured there was infection control guidance in place. Staff confirmed they were provided with adequate amounts of personal protective equipment such as masks and gloves.

People had risk assessments to keep them safe from the risks they may face.

People were offered a varied and nutritious diet.

People had access to a variety of activities.

Relatives and staff spoke positively about the management 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 for this service was inadequate (published 25 October 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns raised by a whistleblower about the service. The inspection was prompted due to concerns raised about lack of activities, reporting of accidents and incidents and food and nutrition.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe, effective, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homewards Limited - 48 Leonard Road 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.

Homewards Limited - 48 Leonard Road is a residential care home providing personal care to four people with a learning disability or autism spectrum disorder.

The service has not 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 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’s experience of using this service and what we found

People were not always supported by staff who had been recruited to the service in a safe manner. We identified issues with staff references.

Staff were identified to work excessive hours within this service and another service. This put people at risk of unsafe care as staff were not having a sufficient break before caring for vulnerable people.

Risk was assessed and provided information on how to reduce people’s known risks and manage behaviours that challenged the service. However, specific details as provided by staff on how they managed individual risk was not always documented in the risk assessment.

The service had an outdoor washing machine which was not stored in a suitable building and the electrical source posed a health and safety risk as they were using an extension cable and not an outdoor plug.

The service was free from malodour and was generally clean but, people’s bedroom windows and a downstairs bathroom were unclean, and wires were found hanging from a bedroom which posed a health and safety risk to people.

Records showed people received their medicine on time. However, where people may require medicine on an as needed basis there was no guidance on when staff should administer them. We have made a recommendation about the safe management of medicines.

Accidents and incidents were recorded but, staff told us learning did not always take place after their occurrence.

We have made a recommendation about learning after accidents and incidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service didn’t always consistently apply 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 did not fully reflect the principles and values of Registering the Right Support as people did not always receive safe personalised care.

Quality assurance was not effective and failed to identify the issues found with staffing, recruitment, health and safety issues or the cleanliness of the service. Audits sent to us were not detailed or current.

The registered manager was not aware of their duty of candour responsibilities when things went wrong and they did not make themselves present despite being on the rota on the day of the inspection.

Continuous learning and improvements were not always shared with staff at the service. We were told this was done at management level. We have made a recommendation regarding continuous learning and sharing improvements with staff.

Staff knew how to identify abuse and raise concerns to the registered manager or to the local authority and the CQC.

Staff told us they could approach the registered manager and meetings were held to discuss the service which involved people who used 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 for this service was good (published 9 August 2018).

Why we inspected

We received concerns in relation to the management of medicines and staffing. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homewards Limited - 48 Leonard Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe recruitment, staffing, safe care and treatment and quality assurance processes.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Homewards Limited - 48 Leonard Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Homewards Limited - 48 Leonard Road provides care and support for up to 4 people with learning disabilities and/or autistic spectrum disorders. At the time of our inspection there were 4 people using the service.

There was a registered manager at the service at the time of 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 and associated Regulations about how the service is run.

People told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were completed, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of people’s accidents and incidents. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Medicines were stored and administered safely. The home environment was clean.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their best interest. We saw people were able to choose what they ate and drank. People told us they enjoyed the food. The home was well decorated and adapted to meet the needs of people using the service.

People told us that they were well treated and the staff were caring. We found that care records were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities. People’s end of life wishes were explored.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the registered manager was approachable and listened to concerns. The service had various quality assurance and monitoring mechanisms in place.

Homewards Limited - 48 Leonard Road is a care home providing accommodation and support with personal care for men with learning disabilities. The home is registered for three people. At the time of the inspection they were providing personal care and support to three people.

There was a registered manager at the service at the time of 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.

The experiences of people who lived at the home were positive. People and their relatives told us they felt the home was safe, staff were kind and compassionate and the care received was good. We found staff had a good understanding of their responsibility with regard to safeguarding adults.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans in place to monitor and reduce risks. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. People were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests.

People told us they liked the food provided and we saw people were able to choose what they ate and drank. People had access to health care professionals as appropriate.

People’s needs were met in a personalised manner. We found that care plans were in place which included information about how to meet a person’s individual and assessed needs. The service had a complaints procedure in place.

The service had a registered manager in place and a management structure with clear lines of accountability. Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and resident meetings.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they were happy and safe. Comments from people included, "This is my home."

Systems were in place to make sure managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. We found risk assessments had been undertaken to identify any potential risk and the actions required to manage and minimise the risk had been put in place. This meant people were not put at unnecessary risk.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The manager told us that no applications had been made to deprive people of their liberty but staff understood how to submit one and follow the correct process. This meant people would be safeguarded from any potential abuse.

The service liaised with the emergency services and arrangements were in place to deal with foreseeable emergencies.

Is the service effective?

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind and caring manner. There was a relaxed and friendly atmosphere throughout the home.

Care files we checked confirmed that initial assessments had been carried out by the staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Managers' were accessible to staff for advice and support and we saw people being able to access the manager as needed.

Is the service caring?

Relatives in the quality survey said, "Our [family member] has been treated with dignity." During our observation we saw the interactions between staff and people who used the service were kind and helpful. Interactions between staff and people who used the service were very relaxed and took account of the needs of the people who used the service. Staff understood the need to recognise and respect the diversity and human rights of people who used the service.

Is the service responsive?

Staff told us the care and support provided was flexible to the person's individual needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed and updated in the care plan. People knew how to make a complaint if they were unhappy and the manager and staff spoke with relatives on a regular basis and would deal with any issues promptly.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There were good relationships with local GPs and other care providers to ensure the needs of the people who used the service were met.

Staff had regular meetings and were kept updated about any information during the daily handover sessions. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information. Feedback was sought by way of relative/friend satisfaction surveys, staff surveys and 1:1 sessions with people who used the service.

The service had a comprehensive quality assurance system in place. Daily and monthly audits were completed such as a premises check and cleanliness of the home. This ensured a timely response could be given to any issues and the service could maintain and improve quality at all times.

People or their next of kin signed consent for the care plan, agreeing to stay in the home and for the use of their photograph. We looked at three care plans and found them to be person centred and focused on people's needs. All aspects of support and different tasks were shown in picture format which ensured people at the home were involved in their care.

We were shown pictures from a birthday party that had happened recently at the home and we were told by the person that they had cake and their family came over. We spoke to a relative who told us they were at the birthday party and it was nice. We also looked at pictures from a recent gardening class that the home had provided. This all supported people's emotional wellbeing.

The home was clean and tidy and people at the home were wearing clean clothes. The registered manager told us that it is very important that people at the home always are clean and that the home is clean at all times.

Staff went through appropriate checks and the home ensured that they were suitably qualified to care for the people at the home.

There was a complaints policy which was clear and available in different formats. No complaints had been made at the home.

We found that staff we spoke to were knowledgeable about their role and responsibilities. People were being cared for by trained and competent staff. who supported them to lead fulfilling lives. People were encouraged to make informed choices and were protected from harm.

The house was clean and tidy, with mementos of people's lives on display. However, some parts of the home were in need of refurbishment.