We carried out a review of the data available to us about Church Road on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Church Road, you can give feedback on this service.
Church Road specialises in the care of people with learning disabilities, autism and physical disabilities. The service is registered to provide care to a maximum of nine people, nine people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the size of the service having a negative impact on people was mitigated by the building design. The service was divided into two areas. Church Road Heights provides accommodation for up to four people in self-contained flats. The main home is able to accommodate five people in en-suite bedrooms with shared communal areas. The provider arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.
People’s experience of using this service and what we found
The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People had individual activity plans in place based on their assessed needs. We found the activity plans were not always being followed by staff. The provider was aware of this and had plans in place to address it.
The way people’s medicines are managed had improved since our last inspection. People received their medicines in the way prescribed for them. The systems to safeguard people had improved. There were effective governance systems in place to monitor the quality of the service.
There were enough staff available to support people. Staff were recruited safely. Risks to people were identified and guidance was in place for staff to reduce the level of risk to people.
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.
Staff received regular training and were knowledgeable about their roles and responsibilities. Staff received one to one supervision and told us they felt supported.
Support plans were detailed and reviewed regularly.
People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.
People were supported by caring staff who worked towards promoting their dignity, privacy and independence.
We received some mixed feedback from relatives on how they thought their concerns and complaints would be listened and responded to.
People and staff commented positively about the registered manager and deputy manager. We received some mixed feedback from people’s relatives relating to the management of the service and communication. Staff told us the culture of the service had improved.
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 18 September 2019). At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12, (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment) and regulation 17, (Good governance). We also found one breach of regulation 18 of The Care Quality Commission (Registration) Regulations 2009 (Notification of other incidents).
Following this inspection, we served a warning notice for regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We completed a targeted inspection on 21 November 2019 to check the action the provider had taken in response to the regulation 13 breach. At that inspection we found the requirements of the warning notice had been met.
The provider completed an action plan after the last inspection in relation to regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and regulation 18 of The Care Quality Commission (Registration) Regulations 2009 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 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.
Church Road specialises in the care of people with learning disabilities, autism and physical disabilities. The service is registered to provide care to a maximum of nine people. The service is divided into two areas, Church Road Heights provides accommodation for up to four people in self-contained flats. The main home is able to accommodate five people in en-suite bedrooms with shared communal areas. At the time of the inspection there were nine people using the service.
People’s experience of using this service and what we found
The provider, manager and the deputy manager had taken steps to improve the service and ensured people received safer care. An action plan to address the warning notice served by CQC had been implemented. The requirements of the warning notice had been met.
There were improved systems in place to ensure safeguarding concerns were reported to the appropriate authorities, such as The Care Quality Commission (CQC) and the local authority. Staff knew how to recognise, and report abuse both internally and externally.
Rating at last inspection and update
The last rating for this service was Requires Improvement (published September 2019) when there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 13 (Safeguarding service users from abuse) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 31 August 2019.
Why we inspected
This was a targeted inspection based on the warning notice we served on the provider following our last inspection. CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other 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.
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.
The service has 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. However, we found the outcomes for people did not fully reflect the principles and values of Registering the Right Support. This was because there were concerns relating to some staff members practice and the culture of the team. The provider was addressing this.
People’s experience of using this service and what we found:
Safeguarding concerns were investigated internally but not always reported to the local authority or the Care Quality Commission (CQC). Not all staff were aware of external safeguarding reporting procedures. We received some mixed feedback relating to the staffing levels. Some aspects of medicines management needed to be improved. We reviewed staffing rotas that demonstrated there were enough staff available to meet people’s needs. Staff were recruited safely.
Some concerns were raised relating to the staff culture of the service which the provider was in the process of addressing. People told us they liked the staff and felt involved in their care. People told us staff respected them and promoted their privacy and dignity, however we received some mixed feedback from relatives about the terminology staff used when referring to people, the deputy manager was addressing this.
The CQC had not been notified by the provider of all incidents which had occurred in line with their legal responsibilities. The systems in place to monitor and improve the quality of the service were not fully effective. The provider and deputy manager demonstrated they were committed to making improvements to the service and had started taking action to address concerns.
Risks to people were identified and guidance was in place for staff to reduce the identified risks. People had detailed plans in place for staff to follow if they became anxious. Incidents were analysed, and lessons were learnt to prevent further incidents.
Rating at last inspection: Good (report published June 2018).
Why we inspected: We received concerns about people’s safety based on information received through safeguarding. Information of concern was also received about the culture of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe, Caring and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the ‘Safe’, 'Caring' and ‘Well-Led’ sections of this full report.
Enforcement: We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of this full report.
Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Church Road on our website at www.cqc.org.uk.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
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At this inspection we found the service remained Good.
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. (Registering the Right Support CQC policy.)
People received care and support that was safe and personalised to their specific needs and wishes. People took part in a variety of activities according to their interests and abilities.
There was a warm and friendly relationship between people who lived and worked at the home. Staff knew people well and used skill and empathy to enable communications to take place. Staff offered people choices and understood how to support people when they were unable to make decisions for themselves
The provider had systems and processes in place to keep people safe and minimise the risk of abuse. People were supported by sufficient numbers of staff to meet their needs in a relaxed manner. Staff levels had recently been increased to enable people to participate in more activities and social outings.
People received effective care and support from staff who had the skills and knowledge to meet their needs. Staff were offered opportunities to review and up-date good practice in line with current guide-lines.
People had access to a variety of health care professionals to make sure their health care needs were assessed and met.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
The variety of accommodation and support in the service enabled people to live a life that balanced their needs for independence and safety.
People's privacy was respected and everyone had access to their private rooms if they wished to spend time alone.
People lived in a home which was well managed by a competent management team and had a commitment to continuous improvement. Staff felt well supported and their morale was good which created a happy place for people to live.
Further information is in the detailed findings below
Church Road is registered to provide care and support to up to 11 people. The home specialises in the care of people with learning disabilities, autism and physical disabilities. The home is split into two main areas; Church Road Heights provides accommodation for up to six people in self-contained flats and the main part of the home is able to accommodate five people in en-suite bedrooms with shared communal areas. At the time of the inspection there were eight people using the service.
The last inspection of the home was carried out in August 2014. No concerns were identified with the care being provided to people at that inspection.
There is 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 building had been refurbished since the last inspection in response to the needs of people using the service. Self-contained flats had been created to promote people’s independence whilst still providing round the clock care and support. One person told us “The flat has made me. I can do much more for myself. I have my own routine but the staff still help me if I get anxious.” The main part of the house had also been refurbished and provided a smaller more comfortable environment than previously. There was a calm and relaxed atmosphere throughout the home.
There were sufficient numbers of staff to keep people safe and to provide care and support in an unhurried manner. People told us staff were always kind and caring. People who were unable to express their views verbally, looked comfortable and relaxed with the staff who supported them. Relatives commented on the how caring staff at the home were.
The management of the home was described as open and approachable and we were told by people, staff and relatives that they would be comfortable to raise any concerns. Where concerns had been raised within the home appropriate action had been taken to make sure people were fully protected.
People were able to make choices about all aspects of their day to day lives. Staff used a variety of communication methods to help people to make choices. Where people lacked the capacity to make decisions for themselves staff knew how to support them in accordance with their legal rights.
Everyone had a care plan which was personal to them and people or their representatives were involved in reviews of their care. Care plans gave information about people’s needs, wishes and preferred routines. This meant staff had enough information to provide appropriate support to each individual.
People took part in a wide range of activities according to their personal interests and abilities. People had access to transport which enabled them to access community facilities and to visit friends and family.
Staff supported people to access healthcare professionals to meet long term health care needs and to treat acute illnesses. One person told us “If I’m not well they get the doctor to come and see me.” A relative told us they thought the staff had been excellent in monitoring and seeking support for a person’s health condition. Where people needed to take prescribed medicines, these were safely administered by staff who were competent to do so.
The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?
The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
This is a summary of what we found:
Is the service safe?
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. All the people living at Church Road were unable to make some decisions about their care and treatment so were receiving some elements of their care under care of the Mental Capacity Act.
We observed that the registered manager had followed due process in applying for DoLs to ensure safety and essential treatment.
The staff we spoke with were knowledgeable and aware of their responsibilities under the Mental Capacity Act. We observed that best interest assessments had been conducted for people who lacked the capacity to make decisions about certain aspects of their care and to ensure safety.
Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home.
Policies and procedures were in place. Risk assessments had been conducted for all people living in the home and staff we spoke with were confident that the training they had received as part of induction and mandatory training helped them to care for people living in the home.
Staff told us they felt well supported, worked well as a team and that communication was very good.
Is the service effective?
The care plans and risk assessments we looked at suggested that care was effective and regularly reviewed and changed in response to changing needs. We saw evidence of multi-professional and family involvement in individual care plans.
People living in the home were unable to verbally communicate with us. It was clear from what we observed and from speaking with staff that they understood people's care needs well and were able to interpret non-verbal communication. Staff had received training to ensure they had the skills and knowledge to meet the needs of people living in the home.
Is the service caring?
We observed people being cared for by kind, respectful and attentive staff. Staff members told us 'It's come a long way, it's a really nice place and we try to give them a better quality of life' and 'We encourage and support independence whenever possible, people's individuality is respected.'
We saw detailed information in people's individual care plans that identified preferences and dislikes to ensure that care and treatment was tailored to the needs of the individual. We observed people's privacy and dignity being maintained.
Is the service responsive?
We saw evidence of family members suggesting increased communication and how the service had responded. This had been achieved by sending monthly information sheets covering activity, treatments and accomplishments. This demonstrated a responsive service that actively seeks people's views and opinions and responds to them.
Is the service well-led?
There was a registered manager in place who was registered with the commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Feedback was obtained on a six monthly basis from family members and on an annual basis from visiting professionals. Comprehensive health and safety risk assessments and audits were undertaken on a regular basis.
Staff told us 'The manager is supportive and accessible' and 'I have had lots of support from the team.' Staff told us they had regular training, supervision and appraisals.
We observed a variety of policies and protocols to ensure the safety of people living in the home. Quality assurance processes were in place and up to date.
The manager told us that despite the inconvenience of the current protracted building work, staff were able to see 'the bigger picture' that will result in safer and more appropriate accommodation to meet people's needs.