CareTech Community Services Limited - 19 Wheelwright Road

About the service

CareTech Community Services Limited - 19 Wheelwright Road is a residential care home providing personal care to six people at the time of the inspection. The service can support up to six people.

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

Right Support

¿ The provider had not always assessed, monitored and mitigated the risks associated with people’s care.

¿ Staff had supported people with their daily medicines in a way that achieved the best possible health outcome. We found that monitoring of ‘as required’ medicines required further improvement.

¿ The provider ensured the home’s environment was clean, well equipped and well-furnished.

¿ People had a choice about their living environment and were able to personalise their rooms.

¿ Staff enabled people to access specialist health and social care support in the community.

¿ Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

¿ Staff enabled people to access specialist health and social care support in the community.

Right Care

¿ People had not always been supported to take part in activities and pursue interests based on their individual preferences.

¿ People had not been supported to develop goals and aspirations based on their individual preferences.

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

¿ Staff understood how to protect people from poor care and abuse. The provider worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ The provider had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture

¿ Staff evaluated the quality of support provided to people. However, people had not always been involved in these reviews.

¿ The provider enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

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 and update

Our last inspection of the service was a focussed inspection of Safe and Well Led and the service was rated requires improvement (published 23 October 2020). There were 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 improvements had not been sufficiently made and the provider remains in breach of regulation. The service had been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

This inspection was prompted in part by a review of information we held about this service.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well Led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, safe care and treatment and systems to ensure safe and good quality care at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

CareTech Community Services Limited- 19 Wheelwright Road is a residential care home providing care to six people who are living with a learning disability or autism at the time of the inspection.

The care home accommodates six people in one adapted building. Two people have their own flats and the four other people share communal living areas. The service has been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support (RRS) in respect of the environment. The building design was similar to other homes in the residential area and was in keeping with other homes in the street. There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home.

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

People received safe support with their medicines. There had been improvement in safeguarding systems and in systems around supporting people with behaviours that challenge. Further improvement was needed to ensure these became fully effective and embedded into practice. There were sufficient staff available to support people safely.

There had been some improvements made to the provider’s governance systems. However, we found that systems had not been consistently effective in identifying some of the areas for improvement that we found at the inspection. Further improvement was needed to ensure the systems were fully effective and embedded into practice.

Staff reported a positive change in the culture of the service and the positive effect this had had for people living at the home.

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 overall and inadequate in well led (published 2 July 2020). We identified multiple 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 enough improvement had been made in some of the areas of concern we had previously identified, and the provider was no longer in breach of two regulations relating to safeguarding and safe care and treatment. However, enough improvement had not been sustained in the monitoring of the service and the provider remains in breach of this regulation (Regulation 17, Good Governance).

The last rating for this service was requires improvement (published 2 July 2020). Following this inspection the service remains rated requires improvement. Whilst the service had previously been rated Good in February 2019, the last two inspections have rated the service as requires improvement.

Why we inspected

There were significant concerns raised around the culture and safety of the service at the last inspection. Whilst we had received assurance that improvements were in progress a decision was made for us to inspect to assess the culture of the service and to assess the improvements we had been informed about. The ratings from the previous comprehensive inspection for the other key questions not inspected were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CareTech Community Services Limited- 19 Wheelwright Road on our website at www.cqc.org.uk.

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.

CareTech Community Services Limited - 19 Wheelwright Road is a residential care home providing personal care to six people who are living with a learning disability or autism at the time of the inspection. The service can support up to six people.

The care home accommodates six people in one adapted building. Two people have their own flats and the four other people share communal living areas.

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

The service had not always 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 did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive of them.

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 did not fully reflect the principles and values of Registering the Right Support as people did not always have opportunity for meaningful activities, there was limited opportunity for independence and people did not have regular input into developing their care.

People did not always receive safe care. We found that safeguarding processes were not robust, and steps had not been taken to mitigate all risks to people. Staff were recruited safely and there were sufficient staff available to support people. People received their medicines safely and were protected from the risk of infection.

People did not always receive effective care. Staff training had not been planned or monitored to ensure all staff had the skills needed to carry out their work. Staff had not received support through consistent supervision. Whilst people were supported to eat meals of their choosing, we found the meal time experience could be further improved. People were supported to receive healthcare in line with their individual needs.

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

People did not always receive care that was delivered with dignity and respect. Whilst we saw caring interactions between staff and people there were also times where staff displayed a lack of understanding of people’s individual needs. People had not always received appropriate support with behaviours that challenge.

People did not always receive responsive care. People had not had consistent opportunity for meaningful activities or inclusion in their community.

People had not received a service that was well-led. We found significant shortfalls in the monitoring of and systems within the service. We had reports of a poor culture within the service where some staff felt unable to raise concerns with the management team.

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 23 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about medication practice, poor and inappropriate use of restraint and restrictions on people’s choices. A decision was made for us to inspect and examine those risks. We received further safeguarding concerns following the first two days of inspection so returned on the 28 February 2020 to examine those concerns.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive 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.

Enforcement

We have identified breaches in relation to providing safe care and protecting people from abuse, ensuring people are treated with dignity and respect, supporting people to receive person centred care, and the leadership and monitoring of the service at this inspection.

We raised our urgent concerns with the provider following the first two days of inspection and asked for information of how they intended to safeguard people living at the service. We continued to raise concerns with the provider following the third day of the inspection.

The provider has been responsive and open in their conversations with us and has shown a willingness to improve the failings we identified. We continue to be in close contact with the provider who is engaging with us.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

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.

19 Wheelwright Road is a residential care home, spread across two adjoining houses; in one house four people shared communal facilities and in the other house people lived in two self-contained single occupancy flats. The home provided personal care and support to six people aged under 65 at the time of the inspection.

The care home had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focussed on values include choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service can live as ordinary a life as any citizen. However, it was clear that people living in 19 Wheelwright Road were given such choices and their independence and participation within the local community had been and was continuing to be encouraged and enabled.

Peoples experience of using this service:

At this inspection we found that people who used the service continued to be supported in a safe way. Wherever possible people were supported to have choice and control over their daily lives.

Staff were kind and compassionate and knew people well. People received their medicines safely. Aspects of people’s safety were protected and promoted throughout the home.

People continued to receive care and support that was personalised to meet their individual needs. Potential risks to people had been assessed and managed to lessen any risks related to people’s daily lives.

The home continued to have effective systems in place to check that the service was effectively managed and that people had a good quality of life. People were supported by staff who were well trained and keen to help people live fulfilled lives.

The was no registered manager at the home since the previous manager had left. We were told of steps the provider was taking to recruit a new manager. The acting manager was experienced, knew the people well and afforded a good degree of continuity for people living in the home. The acting manager shared the provider’s clear vision of how people were to be supported. The acting manager shared this enthusiasm with staff who supported this way of working.

Audit processes were in place and used by the provider to check and ensure that people were being supported to receive good quality care.

The home continued to meet the characteristics of good in all areas; more information is available in the full report.

Rating at last inspection: The home was rated Good (report published in June 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

The home is made up of two linked terrace houses located in the Erdington area of Birmingham and provides care and support for up to six adults who have a learning disability. One of the houses is divided into two flats, with ground floor facilities, that could be adapted for people with restricted mobility, should the need arise. At the time of inspection there were six people living there.

There was a registered manager in post 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.

People received a safe service. Procedures were in place to ensure that people received a service that was safe; staff followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured the risk to people was minimised.

People received care and support from staff that were trained and supported to be effective in their role. People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health. People’s privacy, dignity independence and individuality was respected and promoted at all times.

People received care from staff that were suitably recruited, supported and in sufficient numbers to ensure people’s needs were met.

People were able to raise their concerns or complaints and processes were in place to ensure complaints were investigated and responded to, so people could be confident they would be listened to and their concerns taken seriously.

People received a good quality service, which was well managed. There were processes in place to monitor the quality of the service people received, ensuring that the provider could easily recognise and act on any shortfalls in the quality of the service.

We considered our inspection findings to answer 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?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was clean and hygienic and met their needs.

At the time of the inspection, there were no Deprivation of Liberty Safeguards procedure in place. Staff had received training, so they knew how to safeguard people at risk of abuse and we saw best interest decisions had been made to protect people from harm and advice given from local safeguarding teams.

One relative also told us that they thought their relative was very safe living at the home.

The provider had emergency procedures in place to keep people safe from harm, these included adequate fire evacuation procedures and missing person's protocols. There was also quality assurance audits completed to make sure that the building was in good order and safe for people to live in.

Is the service effective?

Some people who were able and all of their relatives, told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well, which meant that people received an effective service. Staff had received adequate training to meet the needs of the people living at the home.

When we spoke to one relative, they told us that the service was very good and had helped to improve their relative's behaviour since they came to live there. This also showed evidence of an effective service.

Is the service caring?

We asked two relatives if they had any concerns about the care provided by the home and they told us that were happy with the care provided.

Observations during the visit showed staff being compassionate and caring to the people they were supporting. We found good interactions taking place and staff responding in a thoughtful and kind manner.

Is the service responsive?

We could see from care records, that when a person's needs changed appropriate actions were taken to ensure that needs were met, including for example; arranging for people to see a GP. Activities were organised around what people liked to do, for example; going shopping when they wanted to and we saw evidence of staff quickly responding to requests from one person who wanted to go to the shops to buy toiletries.

When we spoke to the health care professional, they said that they thought the service was responsive to the needs of people living there.

Is the service well-led?

We found a good staff team in place; staff had very good knowledge of the home and what care the service provided to people living there. A quality assurance process was in place to ensure that the quality of the service was maintained and further improved.

Two relatives told us that they were kept regularly updated by the staff team if any changes occurred. One relative told us, 'They always seem to have things in hand and know what's going on with my relative.'

Staff had the information they needed to know how to support people to meet their individual needs. We observed that staff knew how to support people in the way they preferred and to meet their individual needs. We saw that people's healthcare needs had been monitored and met.

We saw that people who lived there were given their medicines as they had been prescribed by their doctor to ensure their healthcare needs were met.

All staff spoken with told us and we saw that staff had the support they needed to safely support people who lived there to ensure their wellbeing.

People and their relatives were asked for their views about the service and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.

We saw that records were accurate and stored safely so that people were protected from the risks of unsafe or inappropriate care.

We spoke with three members of staff and the registered manager. We pathway tracked the care of two people, this involved looking at their care records, speaking with them where possible and their relatives to help us understand people's needs. We also spoke with staff and observed care to see how people's needs were being met.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse so that people were protected from the risk of harm.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staffing levels were adequate to meet people's care needs in a safe and timely manner. We saw staff supporting people according to their level of assessed need.

Systems were in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.