Living Ambitions Limited - 231 Stafford Road

Living Ambitions Limited - 231 Stafford Road is a residential care home providing the regulated activity of accommodation and personal care for up to 6 people with a learning disability. At the time of our inspection there were 4 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The support provided to people had improved since our last inspection. People received the support they required to have their needs met in line with their preferences. People were supported to have 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.

Right Care

At our last inspection there were insufficient staff available to provide safe care and support at all times. At this inspection we found there were enough trained and supervised staff available to meet people’s needs safely and effectively. The environment of the service had been improved since our last inspection and people’s risks were identified, assessed, and mitigated. Care records were up-to-date and provided staff with the guidance they required to meet people’s needs.

Right culture

Whilst the service still did not have a registered manager in post, the process for recruiting one was at an advanced stage. Staff were no longer demoralised and disorganised. The staff team had been organised to provide care and support effectively and the views of people and staff were gathered to shape how support was provided. Quality assurance processes had improved to enable monitoring, and drive improvements at the service. These need to be embedded and sustained.

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

The last rating for this service was inadequate (published 07 September 2023). 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living Ambitions Limited - 231 Stafford Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Living Ambitions Limited - 231 Stafford Road is a residential care home providing the regulated activity of accommodation and personal care to up to 6 people with a learning disability. At the time of our inspection there were 5 people using the service, one of whom was in hospital.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Safe, Effective and Well-led key questions, the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

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

Right support: The provider failed to ensure people had the right support. The care records guiding staff as to the support people required were inadequate. Risk assessments, needs assessments and support plans were missing. Those in place contained inaccuracies and were out of date. Short staffing meant that people were supported with a high level of agency staff use. The provider failed to provide agency staff with an induction. This meant agency staff did not know people’s needs or preferences or how to support them.

Right care: Staff cared about the people they supported but were frustrated by their inability to deliver person centred care because of the provider’s failings. People’s care records were in disarray. People’s weekly activity timetables did not accurately reflect what they did. This is because the timetables were out of date and there were not always enough staff available to support people to do the things they wanted to. Staff received training but they did not receive supervision or appraisal. Essential improvements were required to the home. For example, without the services specialist bath being repaired, one person had no choice in how their personal care was received other than to have a bed bath.

People were not supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests, but the provider’s systems in the service did not support this practice.

Right culture: The provider failed to promote the right culture at the service. Staff were stressed and demoralised having been through a period when the service had no management at any level. This included the failure by the provider to ensure a manager, deputy manager, senior support worker, shift leaders or keyworkers were in place. Staff described the multiple safeguarding alerts raised during this period as “inevitable.” Staff felt “abandoned” by the provider’s leadership as they struggled to maintain the service which was short staffed. This resulted in staff working many additional 14 hour shifts, with one member of staff working 300 hours in one month to protect people from the risk of neglect and the failure of the service to provide basic care and support. The provider’s leadership failed to demonstrate the values and attitudes expected of them by people, their relatives, staff and healthcare professionals.

The provider had temporarily redeployed one deputy manager from another of its services to address the wide range of serious and immediate problems at the service. This inadequate level of response further demonstrated the provider’s lack of urgency in ensuring people’s safe care and treatment.

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 August 2017).

Why we inspected

We received concerns in relation to safeguarding, management and staffing at the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only. 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.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective 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.

After this inspection the provider forwarded us an action plan which stated the steps they will take to address the concerns that we found.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living Ambitions Limited - 231 Stafford Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, staffing and the provider’s leadership of the service.

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 have requested further action plans 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last Care Quality Commission (CQC) inspection on 14 July 2014, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

The service had a registered manager in post. 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 a 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 also responsible for managing another of the providers care homes.

People continued to be safe at 231 Stafford Road. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. The premises and equipment were safe for people to use because staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs and food preferences. They also received the support they needed to stay healthy and to access healthcare services.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People continued to receive personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in leisure activities, pursue their social interests and to maintain relationships with people that mattered to them.

The registered manager, along with the deputy manager who was permanently based at the home, continued to provide good leadership. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

Further information is in the detailed findings below.

Care Solutions Limited ' 231 Stafford Road had five residents at the time of our inspection. People at the home had difficulties to express and communicate their views about the quality of the service. We talked with three people who used the service with the help from the manager and staff. We asked them if they liked living in the home and they said yes. One of the answers was a definite 'Yes, thank you'. People also said that they liked the staff and that the staff were supportive and helped them a lot. People were also satisfied with the meals that were provided and said that they felt safe in the home.

People told us that they were involved in a variety of activities both in the home and the community. One person said they were going to a church on Sundays and played bowling on Fridays. Another person liked playing music on his keyboard and doing arts and crafts in his room and at the college. We observed during our inspection that people were treated kindly and with respect.

We saw that people had detailed person centred care plans and they were involved in the development of the plans. We found that people's needs were identified; their care plans were available and were reviewed on a regular basis. People's health was monitored and received medical attention when it was needed.

We found that the home was adequately staffed and staff had the qualification, skills and experience to support people according to their care plans to meet their needs.

People we spoke with told us the staff that worked at the home were kind and caring, and felt staff listened to them and took their views seriously. During our inspection we saw staff treated the people using the service with respect and dignity.

We saw staff encouraged people to make informed choices about how they lived their lives. For example, we observed staff providing people with appropriate support and infirmation to choose the meals they ate and the social activities they participated in.

We also saw staff encouraged people to maintain their independent living skills and to do as much for themselves as they could do safely.