CareTech Community Services Limited - 25 Garrads Road

About the service

CareTech Community Services Limited - 25 Garrads Road is a care home providing personal care for up to 14 people in one adapted building and a self- contained bungalow within the grounds. At the time of our inspection, there were 12 people using the service. People living at the home had learning disabilities.

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

The service demonstrated how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support: People received safe care because staff knew their care needs well. Staff supported people to achieve the best outcomes in meetings their goals and aspirations.

Right Care: Staff attended to people's care needs with care and compassion. People's care records were person centred and up-to-date.

Right Culture: The management team was involved and available for support at all times. Values were set to implement the improvement-driven culture.

The staff team was planning to complete a learning disabilities training

which was recently introduced. Medicines' stock management and records related to the mental capacity assessments required improving which we will review at our next planned inspection.

Policies and procedures related to infection control and prevention were followed by staff to prevent people and visitors from catching and spreading infections. People's care records guided staff on how to support people safely with their health conditions and risks associated with them. Appropriate recruitment checks were carried out before staff started working with people.

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.

There was a clear management structure in place which supported staff's initiative and developing of skills to ensure effective care delivery. People were encouraged to set goals for themselves and staff helped them to increase their independence. Staff encouraged people's communication so that they could make decisions themselves whenever possible.

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 overall rating for this service was good (published 23/02/2019).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for CareTech Community Services Limited - 25 Garrads Road on our website at www.cqc.org.uk.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This was a focused inspection and the report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

Caretech Community Services Limited – 25 Garrads 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.

The care home accommodates up to 14 people in one adapted building. There are bedrooms

on the ground and first floors of the main house in which people live, as well as a self-contained flat on the second floor and a self-contained bungalow within the grounds. People living at the home had learning disabilities, and required support to maintain their mental health. Some people also had physical disabilities. At the time of our inspection eight people were living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was now a registered manager in post at the home. 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 home had a permanent registered manager and deputy in post, with a management structure that had implemented and developed positive changes to the service. The staff team was now settled, and whilst there were some vacancies; a regular cohort of agency workers were used to ensure consistency across the home.

Staff were safely recruited, with full verification checks completed prior to people commencing their employment. Safeguarding processes were robust in ensuring that any allegations were promptly identified and reported accordingly. Incidents and accidents were investigated in a timely manner. There were infection control measures in place to ensure that hygiene levels were maintained, alongside the regular review of health and safety compliance. People’s medicines were administered safely to ensure people received them at the appropriate times. Risk assessments were clear in identifying any potential risks to people, and the steps needed in order to help mitigate any risks.

People were supported to have maximum 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.

Staff training was in the process of being updated to ensure that all were up to date with the providers requirements. Regular supervision and appraisal were provided to staff to support them in their roles. People were well supported to maintain a balanced diet and staff supported people with their nutritional requirements. Access to healthcare professionals was provided when people needed it, with staff support where required. Staff worked together effectively to ensure they met the needs of people at the home. The premises was decorated appropriately for the people living there, with people’s preferences reflected in their rooms.

Staff demonstrated a caring and thoughtful approach to the ways they supported people. They knew individual needs well and treated people with dignity and respect. People were supported to be as independent as they were able to, and express their views in relation to the care they received.

People received care that was personalised to their needs, with care plans that reflected individual preferences and views. A range of activities was on offer to meet the need of each individual living there. The provider had identified a need to ensure each person had the opportunity to express their end of life wishes, and this was planned for completion in February 2019. Complaints were recorded and responded to appropriately.

The registered manager had improved staff morale across the service and developed the staff team. Quality assurance checks were robust in identifying any areas for improvement and making positive changes. People, staff and relatives were supported to give feedback on the service.

The care home is registered to accommodate up to 14 people with learning disabilities who also need support to maintain their mental health. Some people also have physical disabilities. There are bedrooms on the ground and first floors of the main house in which people live, as well as a self-contained flat on the second floor and a self-contained bungalow within the grounds. The ground and first floors of the main house are self-contained, each with its own kitchen, dining room and lounge, so that people live in smaller groups of their peers within the care home. There were 10 people using the service on the first day of our inspection, and nine when we returned on the second day.

At the time of our inspection, the home did not have a registered manager in post. The provider organisation’s locality manager was overseeing the service when we visited for the first day of our inspection, and a permanent manager had been recruited and started working nine days prior to our second visit. The new permanent manager intended to apply to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

This unannounced inspection took place on 6 November and 28 December 2017. We undertook a focused inspection on 6 November 2017 as we had received information of concern from a staff member working at the service, as well as concerns from one of the local authorities who commission placements for people at the service. The focused inspection looked at whether the service was safe and well-led. We returned on 28 December 2017 to complete the full comprehensive inspection of the service.

The home was previously inspected on 12 January 2017 and rated requires improvement in all key questions. The inspection in January 2017 was carried out to check that actions to improve the service people received had been undertaken, following an inspection in May 2016 in which the service was rated inadequate in safe, effective and well-led, and overall.

The changes in management of the service over the 12 months prior to our inspection had resulted in a service with inconsistent leadership and oversight of risks and quality. Recent changes left people feeling safer and the provider was working towards improving the service by establishing a more robust permanent staff team, including the appointment of a manager.

The above issues notwithstanding, people told us they received a service that met their needs and respected their preferences and wishes. The service operated within an evidence-based practice framework, following the principles of positive behaviour support and active support to assist people to live their lives to the fullest within their local community.

Staff respected people’s dignity, privacy and choices. Staff understood and worked within the requirements of the Mental Capacity Act 2005 and, where necessary, people’s rights were protected by the use of Deprivation of Liberty Safeguards to keep them safe.

Staff supported people to pursue the activities of their choice within and outside of the care home, and further improvements were planned to facilitate this for all of the people who used the service.

People’s individual communication needs were understood by staff, and information provided within the home was presented in ways that people could understand. Complaints about the service were managed appropriately and responded to.

There was a registered manager in post. 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 is on maternity leave since the last inspection.

We carried out an inspection of this service on 20, 22 and 27 May 2016. Six breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last inspection, by selecting the 'all reports' link for CareTech Community Services Limited - 25 Garrads Road on our website at www.cqc.org.uk.

At this inspection we found that the registered provider met the legal requirements we inspected. We could not improve the rating to good because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

One of the key factors of change we observed was in the daily management of the service. There was a new home manager employed at the service. The manager has taken action to develop the service to improve the quality of care people received.

People lived in a service that was clean and odour free. The communal areas and people’s bedroom were clean, tidy and odour free. The service was well maintained and repairs were identified and reported promptly to the maintenance team for action. However we found that the maintenance team did not always respond in a timely manner to act on the repair requests made.

Safeguarding processes in place supported staff to protect people from harm. People were protected from the risk of abuse and harm. Systems in place provided guidance for staff to reduce the risk of financial abuse and there were robust financial audits carried out. Staff understood how to identify the signs of abuse and to raise allegations of abuse with the local authority for investigation promptly.

Risks to people’s health and well-being were managed by staff in a way that was effective. Risk management plans provided staff with guidance to reduce their occurrence so people were kept safe.

The level of staff was sufficient to meet the needs of people. The registered provider’s recommended levels of staff were on duty to safely support people. Additional staff were used to support people with individual activities. The registered provider followed a robust recruitment process. Pre-employment checks were carried out to ensure suitable staff were employed. Newly recruited staff were assessed as safe before they provided support to people at the service.

Medicines were managed safely. People had their medicine from staff, these were stored appropriately and medicine administration charts were accurate with gaps for non administration of medicines explained. There were systems in place for re-ordering, recording and the safe disposal of medicines.

Staff had access to training, supervision and appraisals. Staff completed regular e-Learning and face to face training which prepared them to care for people effectively and to develop and build on new knowledge. Supervision meetings were held on a regular basis and staff confirmed this. Staff had the opportunity to discuss concerns about their role during these meetings. There was a schedule for an annual appraisal planned for all staff which helped them focus on their professional development and role within the service.

People gave staff their consent to care and support. Staff provided people with enough information to enable them to make decisions on the care and support they received. Staff understood what Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were and how to support people who had a DoLS authorisation in place.

People had meals of their choosing as they wished. There was sufficient to eat and drink that met people’s wishes, needs and health conditions which people said they enjoyed.

People had access to health care services to meet their health needs. When people’s healthcare needs changed these were acted on promptly and action taken to resolve their health concerns.

People were treated with dignity and respect and their privacy valued. The interaction between people and staff were friendly and respectful. Staff showed they respected people’s wishes and their personal space.

People's care needs were assessed and the support planned met those needs. People and their relatives were involved in assessments and development of their care and support. People contributed to their care needs by making care choices for themselves. People had regular reviews of their care and their support was tailored to meet those needs. People were supported with social activities which met their interests and hobbies. Staff supported people to take part in activities at the service or within their local community as they chose.

People and their relatives knew how to make a complaint about the service. People were provided with details on of how to discuss concerns they had about the quality of care they received.

The registered provider had surveys which people and relatives were able to record their feedback about the service. There is a process in place for regular feedback of the quality of care. Any areas of concern were identified and action put in place to resolve those concerns.

The manager undertook regular monitoring of the service to review the quality of care provided. Any areas of concern were identified and an action plan developed to resolve issues and to improve the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a registered manager in post. 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. However the current registered manager was leaving the service on maternity leave. The deputy manager is acting up as the manager of the service and plans to submit an application to register with the Care Quality Commission as the registered manager.

The last time we inspected this service in July 2013 the service was meeting all the regulations.

At this inspection, we found the registered provider had breached five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches of regulations were related to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, and staffing. CQC is considering the appropriate regulatory response to resolve the problems we found in respect of these regulations. We will report on action we have taken in respect of these breaches when it is complete.

The provider had safeguarding policies in place to give staff guidance to protect people from abuse. However, people were at risk of abuse because the registered manager had not promptly raised allegations of financial abuse we found. We identified that staff had mishandled people’s money because money was being lent between people using the service, their financial records were not calculated correctly and did not always match the money available to them. We were concerned about these practices and we raised a safeguarding alert with the local authority safeguarding team.

Staff did not always have the training, supervision and appraisal to support them in their roles. Some staff completed the registered provider’s mandatory training. Staff did not have the opportunity to discuss their professional development needs because they did not have regular supervision and appraisal. Staff we spoke with did not feel listened to and their concerns raised acted on by the registered manager. The morale of staff was low and this was because staff felt that they did not work together as a team. There were no regular team meetings where staff could discuss their concerns or challenges in their role. Staff were not able to provide feedback to the registered manager, because mechanisms were not in place.

Medicines were not always stored safely. We found medicines that were open for more than 3 months in the fridge. This was in contrast to the registered provider’s guidance for staff. However we found people’s medicines were administered as prescribed. There were PRN [as and when required] protocols in place for people.

People did not always have access to health care services to meet their health needs. We found that one person did not have support with their weight management needs. A person whose wheelchair had not been working effectively was not reported for repair promptly by staff.

Recruitment processes were not effective to ensure suitable staff were employed to work with people. We found staff had begun to work with people before their Disclosure and Baring System [DBS] checks were returned. People were therefore at risk from unsafe care from unsuitable staff. since the inspection we have been informed that the provider has decided that staff will no longer be employed before a suitable DBS check has been received. At times there were insufficient numbers of staff caring for people, particularly at night. There was a high turnover of permanent staff and the registered provider used agency staff to cover staff absences.

People did not always receive their assessed care and support to meet their needs. A person using the service was paying the registered provider for additional support. We found that the registered manager did not have records that accounted for these additional hours. People were not always supported to access social activities they enjoyed or they were interested in because the registered manager did not provide in these.

People, relatives and staff did not give formal feedback because this was not sought by the registered provider. However there were regular resident’s meeting which people attended to discuss issues relating to their care needs.

The service was not always clean, and free from unpleasant smells. Therefore, there was a risk of infection for people. The service was not in good state of repair and maintenance work did not take place promptly when required.

Regular monitoring and review of the service did not occur because the registered manager did not monitor the quality of care.

People consented to care and support to meet their needs. Staff cared for people in line with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff received training in MCA and DoLS and demonstrated their knowledge to care for people effectively without unlawfully depriving them of their liberty.

Staff were aware of people’s nutritional needs. People were involved in regular meal planning meetings to discuss the meals for the week. Meals provided met people's preferences and nutritional and people could make choices of meals they liked. However people’s nutritional needs associated with maintain their health were not always met.

People were treated with dignity and respect and their privacy valued. Staff knew people well and showed them kindness and compassion when delivering care and support for them.

People's care was planned with their involvement and delivered to meet their needs. People and their relatives were involved in making decisions on their care needs. Risks to people were identified and staff had guidance in place to help them manage those risks and reduce their recurrence.

People and their relatives were aware of how to raise a complaint about the service if they wished. Staff supported people to make a complaint about aspects of the service if required this. The registered provider had a complaint policy and process which staff and people using the service were familiar. When people started using the service people received a copy of the complaint process in a format they understood.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

One person told us, "It's very good here. The staff are nice and we all get on together. Staff help me to have a wash and wash my hair. They make my hospital appointments and come with me to the appointment as well. I make my own breakfast and snacks. I like going to the local pub, especially on curry night - that's fun. Staff take me in my wheelchair so that saves me cab money as well. I make plans with the help of my keyworker (a member of staff allocated to each person using the service). I feel safe here and would recommend it to anyone. Today we are having 'bubble and squeak' for dinner. I put that on the menu because it's one of my favourites".

Another person proudly showed us their newly decorated bedroom. It was highly personalised and reflected their keen interest in football. They told us, "I like my new room. I feel safe and happy here and I like the meals. I am going to the gym today and I play football as well".

Another person who was using the service told us, "It's peaceful here. I like to chill out and watch TV".

Staff on duty told us the manager was well organised, supportive and showed good leadership. Staff were well trained.