Potensial Limited - 7-9 Park Road South

We found the following examples of good practice.

¿ Safe arrangements were in place for all visitors to the home. A signing in process on entry into the home ensured necessary COVID-19 checks were completed. These involved people entering the home showing evidence of being fully vaccination against COVID-19 unless they had an exemption. Taking a rapid flow

device (LFD) test and temperature check.

¿ Personal protective equipment (PPE), including face masks, disposable gloves, and aprons were available for all visitors to use.

¿ Information regarding COVID-19 and infection control processes was available in an easy read form for people who needed them.

¿ Staff received infection control training and specific training on reducing the risks of the transmission of COVID-19.

¿ Staff had access to enough supplies of PPE including disposable facemasks, gloves and aprons. Hand sanitiser stations were available throughout the home in communal and private areas and used PPE was disposed of safely to reduce the risk of cross contamination.

¿ A programme of routine testing for COVID-19 was in place for all people using the service and staff. This meant swift action could be taken should anyone receive a positive result.

¿ Enhanced cleaning and disinfection took place throughout the home to reduce the risk of the spread of infection. This included regular cleaning of frequently touched areas. Cleaning checklists were used to record and monitor when cleaning tasks had taken place.

¿ Policies, procedures, risk assessments and guidance relating to COVID-19 were up to date, which supported staff to keep them and others safe. Systems were in place to ensure staff and visitors to the service were kept up to date with current COVID-19 guidance.

¿ Regular infection control audits were completed and the provider had oversight of infection prevention and control processes.

¿ COVID-19 outbreaks followed current guidance and advice from the infection prevention and control team to contain and manage outbreaks. People were supported to isolate in their rooms when necessary.

Potential Limited – 7-9 Park Road is a residential care service that provides accommodation and support for a maximum of 21 adults living with a learning disability and/or autism. At the time of the inspection 12 people were using the service.

The service now 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 were supported to gain new skills and become more independent.

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

At our previous inspection in July 2018 the service was in breach of Regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.

Consent forms were reviewed and updated and now included information about people’s capacity to make decisions. The forms were regularly reviewed and updated and signed to show the involvement of the person and where appropriate relevant others.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The providers systems for monitoring the quality and safety of the service were now effective in identifying and actioning areas for improvement. Lessons were learnt following the last inspection which led to people experiencing better outcomes.

The amount of people occupied at the service had reduced and the provider had plans to reduce this further bringing the design of the service in line with the principles and values that underpin Registering the Right Support and other best practice guidance. Changes made to people’s support and staff practise provided more opportunities for people to gain new skills and become more independent. Changes to the environment made it homelier and more relaxed.

People were protected from the risk of abuse and harm. Staff had completed safeguarding and health and safety training and they understood their responsibilities for keeping people safe. People were supported to take positive risks as part as an independent lifestyle. Medicines were safely managed and administered to people at the right time. There was a system in place for reporting and learning from accidents and incidents.

People’s needs were assessed and planned for with their involvement. Care plans provided clear guidance for staff on how to support people to achieve effective outcomes. People had regular access to the healthcare services they needed. Whilst people told us they got a choice of food and drink; the menus did not include a choice and the lunch time meal on the first day of inspection did not reflect the menu. The manager agreed to action this.

Staff told us they liked the staff and they were kind and caring. Staff had formed positive relationships with people and their interactions were friendly and familiar. People told us staff respected their privacy, they told us staff always knocked on their doors before entering their bedrooms. People’s views about their care and support was regularly obtained through meetings and care reviews.

Care plans reflected people’s needs and choices in a personalised way and people received care and support which was responsive to their needs. People were supported to access a range of social activities and supported to maintain relationships with those close to them. People were provided with information in formats which they could easily access and understand. People knew how to complain and were confident about speaking up.

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 requires improvement (report published 17 October 2018)

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 inspection was carried out on 17 and 23 July 2018. The first day of the inspection was unannounced.

7-9 Park Road South 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. It is registered to provide support for up to 21 people. At the time of our inspection 17 people were living there.

7-9 Park Road South provides support to people who have a learning disability, some of whom also require support with their mental health. Situated close to Birkenhead town centre the home appears externally as a domestic property on a residential street. Originally a pair of semi-detached houses the building has been converted to make one larger house.

The home has 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. The registered manager has been in post since 2015.

The last inspection of the service was carried out in April 2016 and the service was rated good in all areas. During this inspection we found breaches in relation to Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014.

This was because the provider had not ensured care and treatment was provided with the consent of the relevant person. It was not clear from records whether people’s capacity to make important decisions had been assessed and what if any support they had received to make the decision and review it afterwards.

Although systems were in place for monitoring the effectiveness and quality of the service provided these were not always effective. For example, medication audits highlighted a concern with recording of medication and records showed that this did not improve following the audit process. Systems had also failed to note that not all care plan information was up to date or reviewed. In addition, audit systems had failed to identify that the home was not operating in line with current best practice guidance for supporting people with a learning disability. This includes Registering the Right Support.

You can see what action we told the provider to take at the back of the full version of the report.

In June 2017 CQC published Registering the Right Support. This along with associated good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection we assessed the service in line with this guidance.

7-9 Park Road South did not meet the values and principles of Registering the Right Support and associated guidance. Current good practice guidance encompasses the values of choice, independence, inclusion and living as ordinary a life as any citizen. The size, layout, staffing arrangements at 7-9 Park Road South meant that it does not feel or operate as people’s home. Certain physical aspects to the building and staff practices felt institutional and detracted from a homely atmosphere. This included staff wearing disposable gloves for no identifiable reason and wearing bunches of keys around their neck. We also saw that the office was a hub within the home with staff and people living there spending a significant part of their time in or near to it. People who required support to learn or retain everyday living skills were not routinely provided with this support.

The registered manager had a good understanding of Deprivation of Liberty Safeguards and had applied for these were an assessment indicated it was in the person’s best interests.

Polices were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. People felt safe living there and staff knew what action to take if they felt people were at risk of abuse. A system was in place for raising concerns or complaints and people living at the home felt confident their concerns would be listened to and acted upon.

People received the support they needed to manage their physical and mental health needs. People’s medication was generally safely managed and they received it on time and as prescribed. However, records of medication given to people were not always accurate, although the provider was aware of this record keeping in this area had not improved. In depth risk assessments to support people to manage their own medication had not been undertaken to establish if with support people could become more independent in this area.

Individual care plans were in place for everyone living at the home. The contents of these were varied. Some people had plans that provided clear guidance for staff to follow. Other care plans lacked clear guidance or where not available in all areas the person needed support. It was not always clear if people had understood and agreed to the contents of their plan and if this had been regularly reviewed with them.

Equipment and the building were monitored regularly to ensure they were safe. Where repairs or maintenance had been identified plans were in place for this. The registered manager was pro-active in acting on infection control issue identified during the inspection.

There was enough staff working at the home to meet people’s assessed care needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us that they felt supported and we saw that they had regular supervisions with senior staff.

People told us that they generally enjoyed the meals provided at the home. Where people required a special diet or support with their meal staff were aware of and provided this.

People who were fully independent had facilities for making snacks or a meal. Support was not routinely available for people who required staff support to learn or retain household skills including cooking and laundry skills.

People liked the staff team and staff knew people well. Staff took time to learn people’s interests and hobbies and tried to arrange outings to support people with these.

At the time of our visit, 16 people were living at 7-9 Park Road South and all were accommodated in single bedrooms. Three of these people were having a short stay at the home and one person who usually lived there had been admitted to hospital.

The home is required to have 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.

At the time of our visit the service had a registered manager, two senior support workers, nine regular support staff and two bank support staff, and a housekeeper.

We last inspected 7-9 Park Road South on 13 August 2014 when we found that the service was compliant in all of the areas we looked at.

During the first day of our visit we were concerned that there were not enough staff to fully meet people’s support needs. The manager told us this was due to a combination of some staff being on leave and others being off sick with a viral infection, which some of the people who lived at the home also had. On the second day we visited, there appeared to be enough staff.

The staff we spoke with had good knowledge of the support needs of the people who lived at the home. All staff had received training about safeguarding and this was updated every year. We saw evidence that regular environmental health and safety checks were carried out. We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People had choices in all aspects of daily living. Menus were planned weekly to suit the preferences of the people who lived at the home and alternatives were always available.

People were all registered with local GP practices and had an annual health check. The care plans we looked at gave details of people’s medical history and medication, and information about the person’s life and their preferences. A 'health action plan' was in place for each person and there was a record of medical appointments people had attended.

The home implemented various methods of monitoring the quality of the service including daily checks, monthly audits, and satisfaction surveys. A monthly key worker summary was written for each of the people who lived at the home and a monthly meeting was held for people who used the service.

Is the service safe?

Two people who spoke to the expert by experience said :

'No, I don't feel safe here, there are one or two of the residents that can be rather violent.'

'Yes, I feel safe. The staff here are superb.'

The two staff who spoke to the expert by experience said:

'I think people are safe living here, we do everything in our power to keep people safe.'

'I feel that they are very safe.'

We saw that people's support needs were assessed and plans were in place for meeting their needs and keeping them safe. Staff had received additional training to enable them to keep people safe. A second member of staff was present in the home at night to provide support when needed for the support worker on night duty.

Regular health and safety checks were carried out and recorded to ensure that people had a safe environment.

Is the service effective?

People we spoke with considered that their needs were met at the home. They told us that they were supported to participate in community activities of their choice, to follow their hobbies and interests, and to attend medical appointments as needed. People's individual needs were recorded in their care files and a 'Key Worker Review' was written monthly to record how people's needs had been met. One person told the expert by experience:

'The staff encourage me to learn things. I make my bed and wash and iron my clothes.'

The expert by experience wrote:

'It appeared quite clean and homely and the residents appeared quite free to move around the house as they pleased, they appeared to have good communication with the staff and all seemed very much at ease. There was no planned activity taking place during my visit although all the residents seemed quite content to do their own thing, one resident was writing up what looked like part of a life story and what had happened to them in the past, encouragement was being given by a staff member.'

Is the service caring?

People we spoke with said that they felt supported by the staff. They told the expert by experience:

'I get on with the staff.'

'The staff treat me with respect. If you talk to them nice they talk to you nice.'

'I'm OK with the staff.'

'Yes the staff are kind, caring people or they would not be working here.'

During our visit we observed that people who visited the office for support were treated with patience and respect and were encouraged to make their own decisions.

Is the service responsive?

We saw that people who lived at the home, visitors and staff were encouraged to express their views in monthly meetings and in satisfaction questionnaires. An appropriate complaints procedure was in place for people to use and an external advocacy service was available.

We saw that improvements to the environment had continued to ensure that people had a safe and pleasant home to live in and facilities were available to meet their needs, for example a small kitchen on the first floor for people to use.

Is the service well led?

The home had a registered manager who was supported by a senior support worker. An area manager was responsible for overseeing this and other services and visited regularly. We saw that all of the staff were involved in carrying out and recording regular checks and audits.

Senior staff who spoke with the expert by experience said:

'We have a staff meeting and we get our policies out and discuss how we conduct ourselves to respect service users.'

'If any service user wanted to complain, I would listen and write down their complaint, if it was about me or the manager I would speak to the area manager.'

'I have complaints forms at the front door and service users have their own service user guide and we have an easy read complaints form. Service users can come to the office any time they want.'

All medicines were kept in locked storage. A weekly medicines audit was carried out by senior staff and a quarterly medicines audit was carried out by NHS staff.

People had single bedrooms and had keys to their bedrooms. The home had a comfortable lounge, a conservatory and a dining room, so people had a choice of places to spend their time. There was an adequate number of WC's and bath/shower rooms. At the back of the house there was an enclosed garden with table and chairs, and a smoking shelter. At the time of our visit a major refurbishment of the premises was taking place.

Rotas showed that there were usually three support staff on duty during the day, and one at night. Staff hours were calculated around the hours that people who lived at the home were allocated for one to one support.

We saw that records kept within the service were kept up to date, stored securely, and easily accessible.