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Kingston upon Hull City Council - 220 Preston Road Good

We are carrying out a review of quality at Kingston upon Hull City Council - 220 Preston Road. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 5 April 2019

During a routine inspection

About the service: 220 Preston Road is a residential care home that was providing, at the time of the inspection, personal care to nine young adults with autism or a learning disability. 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.

People’s experience of using this service: The management team were extremely good at planning and delivering care that was tailored to people’s individual needs and preferences. People’s care plans truly reflected their individual needs, interests, wishes and aspirations. This was a huge improvement from the last inspection, where care plans were disjointed and information was difficult to find. The end of life care for one person was delivered in a very compassionate way, which responded to their needs and the needs of relatives and friends. There was a thoughtful and inclusive approach to organising interesting and meaningful occupations and activities for people, which enhanced the quality of their lives.

People lived in a safe environment. Staff knew how to protect people from abuse and harm; risk assessments were completed, which helped staff minimise risk whilst ensuring this was not overly restrictive. Staff were recruited safely and there was enough staff deployed to meet people’s needs. Staff received training and supervision, which provided them with the skills and knowledge to support people safely and effectively.

People’s health and nutritional needs were met. Staff supported people to access health professionals when required; people received their medicines as prescribed. The menus offered people choices and alternatives.

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.

The staff approach was kind and caring. They respected people’s privacy and dignity and supported them to be as independent as possible.

There was a quality monitoring system which consisted of audits, meetings and questionnaires to make sure people’s views were obtained and action could be taken when shortfalls were identified. People felt able to raise concerns or make a complaint. Information about how to complain was in an accessible format.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (the last report was published on 11 April 2018)

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 28 February 2018

During a routine inspection

This inspection took place on 28 February and 1 March 2018 and was unannounced on the first day. At the last inspection in November 2015, the provider was compliant with regulations in all areas we assessed.

220 Preston 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.

220 Preston Road accommodates up to 10 young adults who have a learning disability and autism. The 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. The service has two floors accessed by stairs and is divided into two separate areas with five single bedrooms, a bathroom, a shower room, a sitting room and dining room in each one.

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.

We found some areas of the environment posed a potential risk to people. These included damaged items of furniture, a leaking toilet, some cleanliness issues and low temperature of the hot water outlets. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service had an assessment of their needs, risk assessments and a care plan. There was an inconsistency in the care files with some people having good, informative care plans for specific areas whilst other had basic plans, which lacked update. We have made a recommendation about reviewing the care files to address shortfalls.

There was a quality monitoring system in place, which consisted of audits, checks, surveys and meetings. We found some shortfalls in the auditing of the environment and addressing issues in a timely way. The registered manager told us they would monitor cleaning schedules more thoroughly and ensure shortfalls were addressed quickly.

Staff knew how to safeguard people from the risk of harm and abuse. They had completed training and knew how to raise concerns.

Staff had been recruited safely. There were sufficient numbers of staff on duty at all times, and with an appropriate skill mix, to meet people’s assessed needs. Staff had access to induction, training, supervision and support, which enabled them to feel skilled when supporting people who used the service. Additional training had been delivered to the staff to equip them with skills and approaches when supporting one person with anxious and distressed behaviour.

We observed staff had a kind and caring approach. They knew people’s needs very well and supported them to maintain independence, privacy and dignity. Staff also supported people to make their own decisions as much as possible in order to maintain their human rights. They ensured that when people lacked capacity, they included relevant people in best interest decision-making.

Medicines were stored safely and administered to people as prescribed. There was a shortfall in stock control, which had led to avoidable wastage of some medicines. This was mentioned to the registered manager to address.

People’s health care needs were met and they had access to community health care professionals when required. The registered manager and staff team had developed good working relationships with health colleagues. This had resulted in planned discussions about treatment options and had been supportive of people who used the service when they required treatment.

People’s nutritional needs were

Inspection carried out on 27 and 30 November 2015

During a routine inspection

220 Preston Road is situated to the east of the city of Hull, close to local shops and amenities, with easy access to public transport and sports and social facilities nearby. The service is registered to provide accommodation and personal care for up to nine people with a learning disability and autistic spectrum disorder. There were nine people living at the service on the day of our inspection.

The service is split into two units with four bedrooms on one side and five bedrooms on the other. All the rooms are for single occupancy. Each unit has its own kitchenette that people can use to prepare drinks and snacks, a lounge, dining room, bathroom and shower room, a sensory and activity room. A central kitchen and laundry are shared by the two units. Three separate gardens

are accessible to the rear of the building, with each dedicated to a different purpose to enable all people to benefit from the outside space. Parking is available to the front of the building.

The service has a registered manager, they had been registered since December 2010.

A registered manager is a person who has registered with the Care Quality Commission (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.

We undertook this unannounced inspection on 27 and 30 November 2015. At the last full inspection on 8 November 2013, the registered provider was non-compliant in cleanliness and infection control. We issued a compliance action for this area and received an action plan which told us what the registered provider was going to do to address this issue. A follow up visit was completed on 16 January 2014 and we found the service had taken action in respect of this and was compliant.

The people who used the service had complex needs and were not all able to tell us fully their experiences. We used a Short Observational Framework for Inspection (SOFI) to help us understand the experiences of the people who used the service. SOFI is a way of observing care to help us understand people who were unable to speak with us. We observed people being treated with dignity and respect and enjoying the interaction with staff. Staff knew how to communicate with people and involve them in how they were supported and cared for.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions. People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way, the care plans described their preferences for care and staff followed this guidance.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

We found staff were recruited safely and were employed in sufficient numbers to meet people’s needs. Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on holiday. Staff also supported people to maintain relationships with their families and friends.

Inspection carried out on 16 January 2014

During an inspection looking at part of the service

We did not speak to people who used the service during this follow up inspection.

We found improvements had been made in the way staff supported people to maintain their personal hygiene. Risk assessments had been completed to determine the risk of people accessing hot and cold water without staff support and adjustments to sinks in bedrooms and toilets had been made.

We found domestic hours had been increased, which ensured there was sufficient staff available to clean and tidy the service.

Inspection carried out on 8 November 2013

During a routine inspection

People who used the service had complex needs associated with learning disability and autism and were not able to verbally communicate their views and experiences to us. We used a number of different methods to help us understand the experiences of people who used the service including observing care practices.

We observed staff speaking to people in a kind and caring way. We also observed them asking people rather than telling them what to do. We saw that people were encouraged to make their own decisions about day to day activities. When important decisions were required for people staff ensured best interest meetings were held and family consulted.

We found people had choices about the meals they ate and their nutritional needs were met. Staff provided support to people when eating and drinking in line with their assessed needs.

We found that shortfalls in the amount of domestic staff meant some areas of the home had not been cleaned effectively. We also found systems to prevent the spread of infection could be improved.

We found there were sufficient numbers of staff on duty to support people�s needs. Staff had access to training and supervision and told us they were well supported. Comments included, �We have loads of training� and �We have a good team that is happy and upbeat.� A visiting health professional told us staff had been skilled in supporting people and always contacted them when required.

We found people were able to express their views about the service via daily activities of living, surveys and meetings. Audits and checks were completed to monitor quality, although we found some of these could be improved.

Inspection carried out on 19 June 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because the majority of people who used the service had complex needs which meant they were not able to tell us their experiences.

We saw that choice was offered to people by the use of pictorial information and this included the service user guide which gave clear information about what the person could expect when living in the home.

We also saw that menus where presented in a picture format and were also displayed on the notice board. This ensured that people using the service made their own choices of what to eat.

We saw that care plans were designed in an easy read format, they were individualised and included activity planning. This showed the person themselves had been involved in their development.

We observed staff interacting and engaging with people who used the service and this was carried out in a caring and understanding way.

We spoke with two relatives of people who used the service and they told us they were extremely satisfied with the care and support received by their family member. The relatives commented, �I think it�s a wonderful place. I�m very very grateful for the care my son receives�, �My son has settled very well and his behaviour has improved dramatically and he�s a very different person.�

When we spoke with relatives they confirmed that the home was always, �Clean and tidy� and they felt it was a warm and homely place to live.

Relatives also told us that the manager and staff were kind, caring and always approachable and commented, �The manager is very good, she does a fantastic job� and �The staff are a very good team and when I ask anything they are always helpful.�

Prior to our visit we spoke with the local authority contracting and commissioning department, who told us they had not carried out a monitoring visit to the home and had no current concerns.

Reports under our old system of regulation (including those from before CQC was created)