The Regard Partnership Limited - Clareville Road

Clareville Road is a care home providing care for up to ten people. On the day of our visit nine people lived at the service. The service provides support to people who have a learning disability and some who may challenge the service.

The service was not developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. We were told there were no plans to change the design or development of the service to meet these values and principles. Whilst people did live full lives, the potential impact of the service not working in line with these principles had not been assessed. We have made a recommendation that the provider consider the guidance on Registering the Right Support in any future planning of the service.

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

The outcomes for people using the service promoted as much choice and control as possible. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. However, the layout and size of the premises were not in line with best practice guidance. People were living in a large group setting which is different to how most citizens choose to live their lives.

We met and spoke to all nine people during our visit. However, some people who lived at the service had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore, they were not able to tell us verbally about their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. One relative who provided feedback said; “I have always been happy with him living there.”

People’s relatives said they felt their loved ones were safe with the staff supporting them. Systems were in place to safeguard people. Risks to them were identified and managed.

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.

People received their medicines safely in the way prescribed for them. Infection control measures were in place to prevent cross infection. Staff were suitably recruited. Staffing levels were flexible to enable the service to provide a bespoke service to people to meet their needs.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided.

All relatives agreed that the staff were kind and caring. Their privacy and independence were promoted. Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People had staff support to access day centres, other activities and holidays. This was flexible and provided in response to people’s choices. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. Staff were committed to providing good outcomes for people.

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 18 May 2017).

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.

3 Clareville Road is a care home providing residential care for up to 10 people with learning disabilities. At the time of our inspection there were nine people living at the service.

There was not a registered manager in post; however a temporary manager was in place whilst awaiting the return of the previous 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.

Medicines were administered safely. However we found that peoples PRN protocols were out of date and did not contain details of current prescribed medicines.

People received care from staff that had training and experience. Staff received mandatory training. However, additional training that staff could need to meet people’s specific needs had not taken place. We have made a recommendation about this.

Relatives thought their family member were safe. Staff had a good understanding of how to keep people safe. Guidelines were in place for people to access social media safely and a safeguarding policy and whistleblowing policy were available to staff. Care records contained up to date risk assessments to keep people safe whilst encouraging independence

People's needs were met because there was enough staff deployed at the service. The provider followed safe recruitment practices.

The home had been re-decorated and improvements made to the environment. People were protected from hazards in the home.

People were supported by staff who had supervisions (one to one meetings) and an annual appraisal with their line manager.

Staff worked in accordance with the Mental Capacity Act 2005 (MCA). Staff were able to explain what the MCA was and when it applied. Mental capacity assessments were being completed and best interest meetings were being held. DoLS applications had been completed for all people who required them.

The staff met people's dietary needs and preferences. People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

There was a sufficient range of activities for people to be involved in that met people’s needs.

People were provided with support from staff who were caring. Staff knew, understood and responded to each person’s diverse needs in a caring and compassionate way. Staff knew people well, treated them with respect and encouraged their independence.

People were encouraged to be involved in the running of their home and were able to personalise their rooms.

Care plans were detailed, person centred and contained information on people’s lifestyles and preferences. They contained detail on who was important to them, what people were good at doing, how people communicated and how to recognise someone was in pain. They clearly detailed what support each person required. The care provided was person centred and reviewed on a regular basis.

Relatives knew how to complain and staff knew how to respond to complaints.

Relatives thought the home was well managed. The manager promoted a positive culture and staff were aware of the vision and values of the home. The manager responded well when incidents occurred.

Audits were completed. These included weekly health and safety audits which were completed by staff and people and medication audits. The manager completed a monthly report for her manager which monitored staffing, staff supervision, staff training, risk assessments, staff meetings and an analysis of untoward events

People, their relatives and staff had completed surveys and these had been responded to.

Staff were involved in the running of the home. Regular meetings took place where staff received important messages and shared good practice. Staff felt supported by their manager.

We made one recommendations to the registered provider.

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 and associated Regulations about how the service is run. The registered manager was present during our inspection.

People were not always enabled to participate in external activities of their choice as there were not enough staff deployed in the home.

People lived in an environment that was not well-maintained. However, we did see people’s bedrooms had been individualised to their own taste and some bedrooms had recently been redecorated.

People’s care records were not always up to date, accurate or reviewed often enough to ensure they contained the latest information in relation to the care people required. Information was held in several different places and often replicated.

Risks to people had been identified and recorded and any accidents or incidents were dealt with by staff appropriately. Staff had a good understanding of their responsibility in relation to safeguarding and knew who to report any concerns too. The registered provider followed good recruitment processes to help ensure only suitable staff worked in the home.

Should people need to be evacuated in the event of an emergency there were arrangements in place to help ensure the continuity of their care. Staff had received up to date fire training and had access to the registered provider’s mandatory training as well as training in subjects relevant to the people who lived in the home. For example, epilepsy or autism.

People’s medicines were handling safely by staff and people received the medicines they had been prescribed as well as those they could have that did not need a prescription. People were supported to access external health care professionals when appropriate.

People were involved in choosing what they ate and were encouraged to assist with meal preparation. People could make their own choices in their care and were supported to be independent. People were treated with care and respect by staff.

Where people’s liberty was restricted or they could not make a decision due to their level of understanding, staff followed legal requirements in relation to the Mental Capacity Act. For example, mental capacity assessments had been completed and deprivation of liberty safeguard applications made.

Visitors were welcomed into the home and people were supported to maintain relationships that were meaningful to them. Staff recruited independent advocates for people when appropriate.

Complaints information was made available to people and complaints acted upon by the registered manager. People and their relatives were encouraged to give their feedback on the care they received. Staff were involved in the running of the home and felt supported by the registered manager.

Quality assurance checks were carried out to help identify areas that required improvement.

During the inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection, the service provided care and support to nine people. Most were not able to tell us about their experiences of living at Clareville Road because of their complex needs. However, we were provided with feedback from one person and five relatives. We also spoke with the registered manager and six members of staff as part of this inspection.

We reviewed records that related to the management of the service which included support plans, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that people were able to move around the home and garden freely. We saw that risk assessments were in place to provide information to staff to help minimise the risk of any harm to people.

We found that the provider had ensured that staff were provided with information that related to safeguarding vulnerable adults. Staff were able to tell us what they would do if they had any concerns. One relative we spoke with told us, 'I feel 'x' is safe there.'

Staff had been trained in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Staff were able to tell us about the use of 'best interest' meetings in relation to a person who lacked capacity to give their consent.

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. All of the relatives we spoke with confirmed this. One relative told us they had seen a difference in their family member since they moved in to Clareville Road. They told us, 'They used to be on a lot of medication, but staff have managed to reduce it quite a lot.'

Discussion with staff confirmed that staff knew and understood people's individual care and social support needs.

Is the service caring?

We saw that people were encouraged to be independent but were helped when they needed any support.

People's preferences, interests, and diverse needs were met. We saw the activity plans for the people who used the service and heard how they were tailored to the individual. One relative told us, 'They structure things for each individual.'

Is the service responsive?

We saw in the support plans, and also heard from staff, how they had responded to a deterioration in one person's health. Staff had worked with an outside health professional to manage this change.

Is the service well-led?

There were regular meetings for the people who lived at the home.

We saw that the service asked people who used the service, their relatives and visiting professionals to complete a satisfaction questionnaire. The results of these questionnaires were used to improve the service.

People told us they liked the food, got enough to eat and that they could have a snack or a drink at any time.

One person told us their favourite meal then checked and found it was on the menu for dinner that day.

People also talked about their favourite film and movie stars, the planned activities for that day and the person who had recently moved on to another home.

We found people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found that the provider had not always assessed capacity to consent for all of the people who live at the home and had not always taken appropriate steps where people lacked capacity, in line with the Mental Capacity act.

We found that the home was not always protecting people, by not properly assessing the need for window restrictors and the use of the residents' call bell system; by not maintaining smoke seals on bedroom doors; and by leaving chemical hazards accessible that are required to be kept locked safely away.

We found that files containing information about staff and people who use the service were kept securely and confidentially.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received. One person told us that the staff were "lovely" and "helpful". We saw that people could "come and go" as they please.

We saw that staff interacted well with the people who used the service. Staff interactions often resulted in positive outcomes for service users. We observed staff encouraging people living at the service to be as independent as possible such as supporting people to prepare their own lunch or making a cup of tea or coffee.

There were systems in place for maintaining a clean and hygienic environment. The manager had taken appropriate steps to reduce the spread of a contagious vomiting virus in November 2012 and had accessed appropriate services and information such as the Health Protection Agency and NHS Direct.

We found that there were sufficient levels of staff with the appropriate skills and qualifications to meet the needs of the people living at the home. One person we spoke to told us that the staff were "friendly" and "very nice".

There was a complaints procedure available to all people living at the service and additional information was available in an easy-to-read format for those people with learning disabilities or who had difficulty with reading and writing.