Lansdowne Road

Lansdowne Road is one of a number of services provided by the Frances Taylor Foundation, a faith based organisation. Lansdown Road is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lansdown Road was designed, built and registered before the Care Quality Commission (CQC) ‘Registering the Right Support’ policy and other best practice guidance was published. 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. Care and support is provided for up to nine for people with a learning disability. At the time of the inspection nine people were living in the service. The service is situated in a residential area with easy access to local amenities and transport links.

At our last inspection on 16 March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

Systems had been maintained to keep people safe. The building and equipment had been subject to regular maintenance checks. Infection control procedures were in place. People remained protected from the risk of abuse because staff understood how to identify and report it. People’s care and support plans and risk assessments continued to be developed and reviewed regularly. Medicines were stored correctly and there were systems to manage medicine safely. Issues in relation to medicines highlighted as needing improvement at the last inspection had been addressed.

People and their relatives told us they had continued to feel involved and listened to. The culture of the service remained open and inclusive and encouraged staff to see beyond each person's support needs. The registered manager worked with care staff to develop the service with people at the heart of the service. People had detailed care and support plans which had been regularly reviewed.

A robust recruitment process had been followed and there was ongoing recruitment to maintain sufficient staffing levels. Staff continued to have the knowledge and skills to provide the care and support that people needed. Staff told us they felt well supported and had received supervision and appraisal’s.

People continued to live in a service with a relaxed and homely feel. They were supported by kind and caring staff who treated them with respect and dignity. A relative told us, “The staff here are very nice.” They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health and access healthcare professionals when needed.

Care and support plans were detailed and had been reviewed to ensure any changes in people’s support needs had been identified. People had been supported to join in a range of activities.

People, relatives, staff and visiting health and social care professionals told us the service continued to be well led. Staff told us the registered manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. A system had been maintained to respond to any concerns raised. Senior staff had carried out a range of internal quality assurance audits to ensure the quality of the care and support provided. People and their relatives were regularly consulted about the care provided through reviews, residents meetings and by using quality assurance questionnaires. Relatives told us staff kept in touch with them.

Lansdowne Road provides personal care and support for people who have a learning disability. The service is registered for a maximum of nine people. On the day of inspection there were nine people living at the home with a variety of learning disability and physical needs, some of which were older people. The service supports people to lead independent lives within a safe, homely environment. The provider, The Frances Taylor Foundation, is a national, faith based charity which provides support to people with learning disabilities and older people. Accommodation is provided over two storeys, in single rooms, some with en-suite bathrooms. The service is within easy access of transport links, the seafront and city centre.

The service had a registered manager who was present throughout the inspection. They had been in their post for a number of years and knew the service well. 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.

Management of medicines was not always safe. People received their medicines correctly, on time and as they wished to have them. However, instructions for the administration of ‘as required’ medicines was not always in place and stock balances were not recorded which made it difficult for staff to check if people had been given their medication correctly. We also found that the date of opening was not recorded on two open liquid medications which meant that people were at risk of receiving expired medicine which can be less effective.

Individual support plans were up to date and where a risk had been identified a risk assessment was in place and these were regularly reviewed. However, where people were at high risk of pressure damage risk assessments did not accurately reflect the care provided and lacked sufficient detail. Where there is no clear guidance in place for staff to follow there is a potential risk that actions to prevent pressure damage would not be consistent or sustained.

People were positive about the support they received and the staff at the service. One person told us, “I am happy how this home runs.” Their relatives said that they were happy with the care and support provided. One person told us, “All staff are extremely caring and understanding.” In a recent Relatives and Friends Survey one person wrote, “Every time we visit (her) she is always smiling, and every time she visits us she can’t wait to go back – that says it all to us.”

There was a system in place to record and review accidents and incidents. These were discussed at staff meetings and actions taken to reduce the risk of recurrence.

Staff had received safeguarding training and knew what to do and who to contact if they suspected any abuse. One people said they felt reassured by the way staff dealt with a concern that they had raised.

There were sufficient skilled staff employed to support peoples’ needs and the provider had employed more staff as peoples’ needs had changed. The staff team was stable with many members of staff having worked at the service for a long time. Training was tailored to meet the needs of staff and the people using the service and staff received regular supervision and appraisals from the management team. One member of staff told us, “It’s really supportive to work here.”

Peoples’ health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples’ support plans.

The service acted in accordance with the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the support they receive. Consent was sought from people with regard to the care that was planned and delivered. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005 and applied for DoLS authorisations where appropriate.

The service actively sought feedback from people through weekly household meetings, a comments board, complaints process, complaints and compliments box. Suggestions made by people had been discussed and where appropriate acted upon.

There was a balanced menu in place with snacks and hot and cold drinks provided throughout the day. People said they enjoyed the food and were involved in weekly menu planning. Those people with special dietary requirements or difficulties eating and drinking were supported safely and appropriately.

Care and support was person centred and the wellbeing of people supported through purposeful activity and involvement in the running of the service, such as housework, shopping and menu planning.

Lansdowne Road has a caring and inclusive culture which is promoted through a shared vision and value system. People were celebrated as individuals completing Me and My Life folders and having regular meetings with their key workers. People were encouraged to try new things and work towards goals and future aspirations. One person told us that she had achieved her goal of using public transport on her own, she said, “I’m the most independent person here and I am proud of that.”

There was a robust quality assurance programme delivered by the provider. There were processes in place for gathering feedback with bi- annual quality assurance questionnaires for people and an annual relative’s questionnaire. Feedback from these was positive and we saw that any comments or suggestions were acknowledged, discussed and any associated actions plans had been completed. For example, where a person had asked that their artwork be displayed at the service we saw this framed and displayed in the dining room.

People had lived at the service for a long time and were getting older. The provider had made adaptations to meet their changing health and social needs and had plans to make further alterations to the environment to make it easier for people to move around communal areas.

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 documentation we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service were protected from abuse. This is because the service had systems in place to ensure that any likelihood of abuse was identified and the appropriate action taken to prevent abuse from happening.

We found that there were safeguarding policies and procedure in place. Staff we spoke with said that they were aware of safeguarding issues as well as the Whistle Blowing Policy and that they would be able to raise safeguarding alert if required.

The Care Quality Commission (CQC) is required by law to monitor the operations of Deprivation of Liberty Safeguards (DoLS). While no applications had been submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found that there were adequate number of staff with a good skill mix and experience on duty. We noted that there were on call arrangements in place in case of emergencies and good support from management to ensure that people's needs were met.

Is the service effective?

We found in people's care plan information and systems were in place about the application of best interest and consent as and when required. This indicated that where people did not have capacity to consent, decisions had been made on their behalf and in their best interest.

People had their individual needs assessed and reviewed on a regular basis. We found that each person had a key worker who would work with them to make sure that the individual understood their rights in making their own decisions.

People who used the service benefited from care and treatment that had been tailored for them. Relatives of people who used the service commented about how staff treated them as individual and attended to their needs with respect. People were supported to make choices and decisions and have control over their lives.

Is the service caring?

We saw that people who used the service were treated with respect and dignity. We found that people were involved in all aspect of their care and support. Feedback from relatives confirmed how well their family members were treated and cared for by the staff team. They felt that there was a calm atmosphere and people were encouraged and supported to lead a normal life.

Everyone had a personalised plan that was reviewed on a regular basis. This ensured that the care and treatment they received were appropriate to their needs.

Is the service responsive?

There was a range of activities on offer and these activities appeared to be led by people who used the service. The service provided transport for people, enabling them to access a range of outdoor activities.

We found that the provider had systems in place to deal with comments and complaints. There was a pictorial complaint leaflet available. People told us when they had any concerns; they had raised it with the manager who had dealt with it promptly and effectively.

People who used the service were supported to maintain links with their family and friends.

Is the service well-led?

The service had a quality assurance system in place. We saw that action plans had been drawn and implemented in a timely fashion as result of feedback from the previous satisfaction survey sent to relatives.

We saw minutes from team meetings and the action plan drawn to ensure that where shortfalls were identified, they were addressed within an acceptable time scale. This helped to ensure that the service was continuously improving and people views were taken into consideration.

Staff we spoke with told us that they well supported by management and were able to express their views and concerns and were listened to.

We found the home acted in accordance with the Mental Capacity Act. A care worker said. 'It's about whether they can make decisions for themselves, and how we make decisions for them if they're really not able to do it in their best interests. I'd make small decisions; if it's important then I'll go to my manager.' People were supported to give informed consent and had access to an advocate.

We found the home was clean and well maintained. Government guidance on infection control was followed. The home had a designated infection control lead who told us, 'I always have time to do infection control duties and I feel 100% supported.' A person who used the service said, 'Staff do the cleaning, it's alright, it smells fresh. The equipment is clean that I use, the staff clean it well.'

Medicines were stored securely, administered appropriately and accurate records were kept. People were involved in the management of their medicines. One said, 'Staff always offer me medication and I always take it. Staff give me my tablets, I also am able to go to staff if I am in pain.'

All appropriate checks were carried out before staff started work and they had relevant training. People felt confident in the staff. One person said, 'If I'm not happy I tell staff and it gets better.'

We found there were good systems to gather feedback and check the quality and safety of the service provided.

We observed staff assisting people in making choices and in offering choices, such as a food. We read in people's records how their wishes, likes and dislikes were taken into account in their care and support plans. We saw detailed care plans and saw that people were involved in their care planning and in expressing their wishes. We read that plans had been put in place to involved families and external professionals in making major decisions for some people.

We read in people's notes the process for making major decisions and a person did not have capacity to make them. This process involved outside agencies. We saw minutes of meetings about decision making. This made sure that people's best interests were protected.

We spoke to staff and reviewed procedures for safeguarding from abuse. We found that staff knew how to identify and report concerns, and there were suitable procedures in place to protect people. We found that laundry facilities were not adequate to reduce the risk of infections.

We looked quality assurance and governance systems and found that there were not suitable processes in place to monitor and improve the service.