Archived: CareTech Community Services Limited - 87 Bouncers Lane

87 Bouncers Lane is a care home providing accommodation and personal care for up to three people with learning disabilities and autism. At the time of the inspection three 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 and/or autism to live meaningful lives that include control, choice, and independence. However, people using the service did not always consistently receive planned and coordinated person-centred support that was 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

People were not always safe and were at risk of avoidable harm. Risks to people’s safety had not been regularly reviewed. Behaviours that challenged were not always managed well and the systems in place were not effective enough to mitigate these known risks. Medicines were not always managed safely.

There had been a significant turnover of support staff, managers and senior management. Relatives expressed great concern over this and told us people’s needs may not have been met. Professionals were concerned over the impact of many staff changes. Peoples anxiety resulting in challenging behaviours may have increased due to a disruptive staff team. Some staff were not trained in specialist behavioural management techniques.

The kitchen, shower room and some communal areas were not clean, outside the house appeared to be shabby. Inside, the house was bland and lacked homely comforts.

Although care plans were person-centred they had not been regularly reviewed. This meant that information on how to support the person was out of date and staff may not have followed appropriate guidance or practice.

The service did not 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. However, people's support did not always focus on them having as many opportunities as possible for them to gain new skills and become more independent.

The staff were caring and had positive relationships with the people they supported. People had their own private space and access to the communal areas and garden.

The provider had recruited a new home manager. There was confidence from the locality manager and support staff that this would mean improvements within 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.

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 07 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 from 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.

One relative told us they felt the home was a very safe place to be. Staff were trained to identify any abuse and take appropriate action. Safeguarding incidents had been thoroughly investigated and reported in writing to the commissioners and the local authority safeguarding team. The correct action was taken by the registered manager to prevent further incidents between people. We have made a recommendation the registered manager ensured all notifications were also sent to CQC.

Individual risk assessments were completed which minimised risk for people helping to keep them safe and as independent as possible. All accidents and incidents were recorded and had sufficient information to ensure preventative measures were identified.

We observed staff responding to people in a calm and compassionate manner consistently demonstrating respect. Staff knew peoples individual communication skills, abilities and preferences. Staff supported people to choose activities they liked. People had taken part in activities in the community and holidays with staff. People were supported by sufficient staff and they were able to access the community with them.

Staff were aware of the Mental Capacity Act 2005 (MCA) to protect people when they needed support for certain decisions in their best interest. Care plans included people’s mental capacity assessments and identified how choice for each person was displayed by them. Most people made everyday decisions as staff knew how to effectively communicate with them. The service was working within the principles of the MCA and Deprivation of Liberty Safeguards (DoLS) and conditions on DoLS authorisations to deprive a person of their liberty were being met.

A range of social and healthcare professionals supported people. They told us the staffs’ attitude was excellent and they were knowledgeable and communicated well with people and their relatives. Medicines were well managed and given safely. People’s care plans identified how people liked to take their medicines. People were supported by staff that had the skills and knowledge to meet people’s needs. Special diets were provided to maintain and improve people’s health and wellbeing. People had a choice of meals and went shopping every day for fresh produce they could choose.

Quality checks were completed and examples told us that action plans identified where changes were made to address any shortfalls. Relatives and health and social care professionals were asked for their opinion about the service. The registered manager was accessible and supported staff, people and their relatives through effective communication.

Staff we spoke with understood the need to report safeguarding concerns. Staff had completed all mandatory training relating to safeguarding except conflict management. The manager was addressing this gap. People's support plans contained relevant information about any physical interventions that may be needed to protect them or others.

The home was clean and bright. Systems had been put in place to ensure cleaning was undertaken. This was supported by regular checks and audits by the registered manager and an external company. We saw evidence that remedial actions were identified and followed up to keep the home clean and hygienic.

There were appropriate protocols to help staff know when and how to administer 'as required' medicines. These were kept up-to-date. Medicines were stored safely and the cabinet temperature was monitored to ensure medicines were stored at the recommended temperature. All staff had regular competency checks and training to ensure they followed medicines procedures.

The registered manager now had a system in place to monitor the training needs of staff. Almost all mandatory training had been completed. Staff told us the service was progressing well and they met regularly with their manager to discuss their training needs and performance.

One relative said 'they are absolutely fantastic. They are not perfect but if we have any issues they are dealt with immediately'. Support plans were person centred and were followed by the staff. Staff were knowledgeable about people using the service and sought to maintain their independence. One relative commented on how each person was catered for as an individual.

The provider could not verify that all staff had received safeguarding training although staff demonstrated that they knew the relevant policies. Restraint guidance was not clear enough in care records to ensure staff only used approved techniques.

Staff understood the procedures around the storage and administration of medication, except the need to monitor medication cabinet temperatures. One medication protocol was missing and others had been updated without date or name.

The provider had good systems in place to monitor quality. Relatives felt well listened to and communicated with. Although record keeping had improved, we found some important inaccuracies in care records that needed correction.

Staff were very positive about the support that they received although we found some gaps in training. The people in the home seemed comfortable with staff and we saw some very positive interactions. We saw people being involved in decision making and being encouraged to be active and involved in activities in and out of the home.

Although staff knew people's needs and preferences well, this was not always reflected by the care plans. One in particular needed updating. The provider was not able to show us evidence of having sought feedback about the service.

The cleanliness of the home was not of a high standard. This was not helped by some outstanding maintenance work.