Poplars

About the service

Poplars is a residential care home providing the regulated activity of accommodation and personal care to up to 6 people. The service provides support to people with learning disabilities and mental health conditions. At the time of our inspection 6 people were using the service.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture.

Right Support:

The service was commissioned to meet the needs of people using the service. Care and support were provided in a safe, homely, well equipped, well-furnished environment which met people’s physical and sensory needs. People living at the service had adapted their bedrooms to their likings and were supported to attend outdoor pursuits of their choice and their independence was promoted.

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.

Right Care:

There were sufficient numbers of staff to keep people safe. Staff received a wide range of training to ensure they had the skills and knowledge to support people safely. These included, epilepsy awareness, safe administration of medication, safeguarding, dysphasia, positive behaviour support and a 2 day autism training course. Staff promoted equality and diversity in their support for people. People’s specific dietary needs were understood and being met. People told us staff respected their privacy and dignity when providing care and support. A complaints procedure was available and displayed to enable people to access it if they or their relatives had a need. We were told no complaints had been received at the time of our inspection. We observed people being treated with kindness, dignity, and respect.

Right Culture:

The support people received met their needs and aspirations. Support focused on quality of life and followed best practice. Staff involved people, their family and other professionals as appropriate to evaluate the quality of support given and obtain feedback to improve people’s day to day quality of life. People living at the home made choices and took part in meaningful activities and education which were part of their planned care and support. Staff supported them to achieve their aspirations and goals.¿¿¿¿

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 requires improvement (published 29 November 2019) and there were breaches of regulation. Regulation 12 (safe care and treatment), regulation 17 (good governance) and regulation 19 (fit and proper persons employed). 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.

Why we inspected

We undertook this comprehensive inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poplars on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about the management of when required (PRN) medicines.

Follow up

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

Poplars is a residential care home providing personal care and accommodation for up to six people diagnosed with a learning disability and mental health conditions. At the time of the inspection there were four people using the service.

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

There was a relaxed and open culture at the service. We observed people felt comfortable with the staff who supported them. Feedback from relatives and professionals was positive. A relative told us, “All the staff including the (registered) manager have been brilliant with my family member. All I can add to that is the staff are the nicest bunch of people and I couldn’t praise them enough for the job they are doing and for keeping [named person] safe.”

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. There had been a marked improvement in how well people were consulted and involved in their lives. Care was person-centred and focused on promoting wellbeing and supporting people to achieve improved outcomes.

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.

The registered manager had only been at the service for six months and since their arrival they had focused on keeping people safe from risks related to COVID-19. Despite this, they had already made excellent progress in addressing the concerns we found at our last inspection. There was a largely new and enthusiastic staff team who were still settling into the service. Further time was needed to ensure improvements continued and were sustained.

There were effective measures in place to prevent the risk of infection. The provider and registered manager were positive about learning lessons following the COVID-19 outbreak and continued to drive improvements to keep people safe.

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 (published 30 October 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. However, as this was a targeted inspection, we did not review whether enough improvement had been made in all areas and the provider was still in breach of regulations.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

When we last visited the provider had told us they were taking action to promote a more open, person-centred culture and to develop staff skills so they could meet the needs of people who became anxious or presented challenges. We reviewed these actions to ensure people were not being unnecessarily restricted, particularly in light of the national restrictions during the pandemic.

We also 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poplars on our website at www.cqc.org.uk.

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.

Poplars is a residential care home providing personal care and accommodation for up to 6 people diagnosed with a learning disability and mental health conditions. At the time of the inspection there were two people using the service.

The service had not been fully 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. Further work was needed to ensure people's independence was promoted in daily living skills and explore opportunities to develop their community involvement. Further work was also needed to explore the use of communication aids and information technology to support people to express their views about how their care and treatment was delivered.

Accommodation is provided within a domestic, bungalow located in a residential area close to the town centre of Braintree. There were deliberately no identifying signs or anything else outside to indicate it was a care home.

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

The service did not have effective measures in place to ensure the environment people lived in was safe, their medicines managed safely, with incidents and accidents monitored with plans to reduce the risk of reoccurrence. Some risks to people’s safety had not been identified or addressed.

The registered manager was committed to improving the service, but their focus had been on improving the environment without due care and attention to identifying and managing the potential risks to people’s safety. They recognised further work needed to ensure quality and safety monitoring of the service was carried out and did not identify all the shortfalls we found during this inspection.

The registered manager was in the process of recruiting a manager to manage the service on a day to day basis with the skills and capacity needed to provide more effective oversight.

Further work was needed to ensure care plans were up to date and fully reflective of people’s current needs. The registered manager was in the process of implementing a new system of care planning to address this shortfall.

People's capacity in relation to day to day decisions had been assessed. People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Policies and systems in the service supported support this practice.

Staff had received a variety of training to fulfil the roles for which they were employed. There was a consistent use of agency staff. However, there was a lack of systems in place to reassure the registered manager that identification and criminal records checks had been completed by the supplying agency. There was also work needed to ensure agency staff had completed induction training to ensure they had the knowledge and skills to meet people’s needs.

The service worked with other organisations and people were supported to access a range of healthcare services. People were assessed for their risks of malnutrition and dehydration. Staff referred people to their GP and dietitian where risks of losing weight had been identified.

People had not been involved in the planning of menus and their independence promoted in the preparation of food. We have made a recommendation that consideration be given to explore best practice guidance in the use of communication aids to enable people to be involved in the planning of what they eat and drink.

The registered manager had a system for recording and managing complaints but had not received any since the last inspection.

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.

We have found evidence that the provider needs to make improvements. We found three breaches of The Health and Social Care Act 2008 during this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

The service provides a 24 hour care environment for people with mental health needs and learning disabilities. The service supports people to develop essential daily and community living skills. At the time of our inspection there were three people living at the service. The service is registered to provide care for up to six people.

The service had 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 (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.

The staff were aware of risk assessments and the safeguarding processes. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments regarding the managing of the service, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. Where people had been involved in incidents because of behaviour that could have a negative effect on others, the triggers for such behaviour had been identified and action taken to reduce the occurrence.

People received their medicines as they had been prescribed and there were robust procedures for the safe management of medicines.

There were sufficiently skilled and qualified staff on duty throughout the day and night to provide for people’s needs. Robust recruitment and selection processes were in place and the manager had taken steps to ensure that staff were suitable to work with people who lived at the service.

All staff received training to ensure that they had the necessary skills to care for and support the people who lived at the service and were supported by supervision and appraisals. Staff were encouraged to undertake training to gain professional qualifications.

People’s needs had been assessed before they moved to the service and they, their relatives and other healthcare professionals had been involved in determining their support needs and the way in which their support was to be delivered. Peoples consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People using the service were supported to decide what food and drink they had and a variety of food and drinks were available as were snacks at all times.

Other health professionals were consulted as necessary by the service staff to support people to meet their individual health needs.

Staff were understanding, empathic and protected people’s dignity. People were treated with respect and supported with regard to their individual needs.

All people were assessed prior to coming to service to check that the service could meet the person’s needs. On-going assessments were planned and were also arranged with immediate effect if so required. Information was available to people and relatives about how they could make a complaint should they need to do so.

There were reviews of the care provided with family members. Staff meetings were arranged, so that staff could discuss and be involved with the smooth running of the service. People and their relatives were asked for feedback about the service to enable improvements to be made. The service had a statement of purpose and an effective quality assurance system was in place to drive improvements for the future.

The service provides accommodation for up to six people who may require nursing, have a mental health need and might have an additional learning disability and behaviours which can be challenging.

The service had 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 service was last inspected in March 2013 and at the time was judged as compliant for the areas inspected. Since the last inspection our methodology has changed in line with changes to legislation and we now carry out comprehensive, ratings inspections. This was the first ratings inspection for this service. During this inspection we found:

There were enough staff on duty at all times to meet people’s needs and they were sufficiently familiar with their roles.

There were systems in place to ensure people received their medicines as required and at the time prescribed. Audits were in place but not particularly robust. Medicines were administered by trained staff but we saw no evidence that nurses were assessed to ensure they remain competent and up to date with best practice.

Staff recruitment processes were in place but not particularly robust in terms of ensuring staff employed had the right skills, attributes and understanding of the needs of people using the service.

The risks to people’s safety were managed but we felt staff did not always get the balance right between promoting people’s independence and proportionate risk taking.

Staff were supported through an induction process and training but we were not assured that the training was sufficiently robust or provided around the needs of people using the service. The fact that some of the staff were registered nurses was not sufficient. Care staff had not received training around mental health, epilepsy or learning disability. Support for staff was in place but we could not see evidence of how staff were developed and how good practice in the service was promoted.

People were supported to eat and drink but this was managed by staff and there was insufficient opportunity for people to be involved in menu planning to ensure their dietary needs were met and they had their food preferences. We saw at least one person whose weight was not closely monitored.

People’s health care needs were met through a number of different professionals but we were unable to see from records how closely people’s needs were monitored and if people always had regular access to all the health services they needed.

Staff spoken with did not have much understanding about the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and we did not see people being given meaningful choice. Applications had been made as required under Deprivation of Liberty Safeguards (DoLS) when it was considered to be in the person's best interest.

We observed staff working in a functional way and paying attention to rigid routines rather than supporting people in accordance with their wishes and preferences. People’s independence was not sufficiently promoted and there was not enough consultation with people about their wishes.

Care plans were in place and kept under review but we could not see how care was individualised or how changes in people’s needs were recognised and acted upon. This was not a progressive service which helped people reach their goals.

There was limited activity for people and we could not see from their records what people enjoyed or what incentives there were for people in terms of encouraging positive behaviours.

The service was not well led because there was limited engagement with people using the service outside assisting them with their day to day tasks. Staff were not supported to develop and to provide person centred care. There was poor quality monitoring to ensure the service was run in people’s best interest and took into account people’s experiences.

We found 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 this report.

We have also made a number of recommendations which we feel would help the service.

We found that the service was being maintained to a sufficient standard which made the premises fit for purpose and met the needs of people who lived there. The floors were in good condition and free of trip hazards. The environment was free from any offensive odours.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required.

We found that there was a sufficient number of staff on duty to meet the needs of people who used the service. The staff group employed by the service were consistent and the provider had not been required to recruit staff for several years which provided continuity of care to people who used the service.

We saw that consent to treatment for those detained under the mental health Act 1983 and those who were not detained was sought correctly. We observed interactions between people who used the service and staff and saw that staff were kind and caring. Staff knew key information about the people including their triggers for behaviours and how to reassure them.

We found that staff were knowledgeable regarding safeguarding of potentially vulnerable adults. Staff could clearly define the types of abuse and the procedures within the service.

We found that there were sufficient staff on duty. Provision had been made to ensure staffing numbers remained consistent.

We saw that the service had appropriate policies and procedures in place for the management of complaints.