Background to this inspection
Updated
2 September 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act.
This was a targeted inspection to check on specific concerns we received about management, medicine record keeping and people’s care and safety.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Elysium Care Partnership Limited – 21b Upper Brighton Road is a residential care home for up to seven young people with learning disabilities and/or autism. There were six young people living there when we inspected. 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with three people, seven relatives, four staff and the registered manager and their line manager. We also received feedback from four healthcare professionals.
We did not use the Short Observational Framework for Inspection (SOFI), as people were self-isolating. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We looked at a range of records that included two care plans of people who received a regulated activity, risk assessments and other records relating to the management, staffing and governance of the service, including audits, accident and incident and medicine records.
After the inspection
We continued to seek clarification from the home to validate evidence found. We requested additional evidence to be sent to us after our inspection. This included further accident and incident records, best interest meetings and audits. We received the information which was used as part of our inspection.
Updated
2 September 2021
This was an unannounced inspection that took place on 11, 12 and 13 December 2018.
21b Upper Brighton 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. The home provides care for up to seven young people including people with learning disabilities or autistic spectrum disorder. It is located in the Surbiton area of Surrey.
The service had a 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 and associated Regulations about how the service is run.
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.
At the last inspection in June 2016, the home was rated overall good with safe, effective, caring and well-led being rated as good and responsive as outstanding.
Younger adults with learning disabilities or an autistic spectrum disorder received a service from the home. They had moved from residential schools, other care home placements or parental homes where their support needs could no longer be fully met. The move had massively impacted on their lives in a positive way that was reflected in their progress, personal achievements and opportunities to try new experiences.
There were numerous, varied activities that the young people benefited from, in the community, at home and elsewhere. Staff took great pains to support and help the young people to make their activity choices, based on the interests they had and things they liked to do. Whilst people did not verbally comment about the activities they pursued, their body language showed us they enjoyed them with lots of smiling, laughter and enthusiasm. This had an impact of people thoroughly enjoying their activities and developing bonds and friendships, through them, with staff, each other and others, outside the home.
The home’s positive impact on the young people was further demonstrated by a significant reduction in incidents and situations where people may display behaviour that others could interpret as challenging. Where people displayed anxiety or anger through aggressive behaviour, staff were available and understood how to defuse situations. They understood that this behaviour was a way of expressing people's needs, emotions, feelings and communicating them. Staff were skilled at turning people’s negative behaviour and frustrations into positives by calming situations, finding out what was wrong or what people wanted and addressing their needs. This was achieved by having a thorough knowledge of each person and their likes and dislikes based on trial and error and growing positive relationships and bonds with them.
Due to people’s limited verbal communication, relatives mainly spoke on their behalf. Relatives told us the home had a warm, welcoming and friendly atmosphere. They said staff treated the young people's safety as a priority. This was whilst still acknowledging that people must be enabled and supported to try new experiences and pursue opportunities by taking acceptable risks. Staff weighed up the benefits of activities with the young people in relation to the risks involved. This was demonstrated by the number of new experiences and activities people safely had whilst continuing with those that they previously enjoyed. This meant people received a service that was individual to them. The service and activities were flexible and changed with people as their needs changed and skills and confidence developed, resulting in more fulfilling and enjoyable lives. Staff said the home provided a safe place for people to live and them to work.
Relatives told us people were extremely happy and enjoyed living at the home. We saw how much people enjoyed the care and support provided by staff, which was reflected in their positive body language and interactions with staff and each other. Staff enabled people to make progress by adopting a very person-centred approach. They recognised people’s achievements, highlighted them and supported the young people to also recognise and celebrate them. This was achieved by staff having a thorough knowledge of people's individual communication and sensory needs and meeting them in a patient and measured way.
People had support plans that were comprehensive and individualised to them. The plans encompassed all aspects of people’s lives that included their social, leisure, educational and life skill development needs. These were reflected in and met by the structured and spontaneous activities that people chose enabling them to live their lives the way they wanted to. Staff paid great attention to people's health, emotional needs and people were encouraged by staff to discuss and meet any health and appropriate sexual needs they may have. The depth of planning and cooperation and its impact was demonstrated in the support plans and files we looked at. People’s support plans were regularly reviewed and updated. This enabled staff to support people in an efficient and professional way. The records kept were up to date and covered all aspects of the care and support people received. The home worked in co-operation with health care professionals in the community.
People were protected from nutrition and hydration associated risks by staff encouraging and supporting them to have balanced diets that also met their likes, dislikes and preferences. Staff also used meal selection to develop people’s life style and decision-making skills in an effective way.
The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) required the provider to submit applications to a ‘Supervisory body’ for authority. Appropriate applications had been submitted by the provider and applications under DoLS been authorised, and the provider was complying with the conditions applied to the authorisation.
The home was very well-maintained, furnished, clean and adapted to meet people’s individual requirements, to a high standard.
Staff received excellent structured training that was organisation, service and person-specific. The quality of the training was demonstrated by the high-quality care practices staff demonstrated and followed throughout our visit. They were very knowledgeable about the field they worked in, had appropriate skills, knew people and their relatives well and understood people's needs in great detail. Their knowledge was used to provide care and support in a professional, friendly and supportive manner, focussed on the needs and wishes of the individual. Our observations showed people knew and trusted the staff that supported them.
Relatives told us that the registered manager and staff were accessible to them, very communicative, worked well as a team and provided them with updated information as needed. The registered manager was responsive, encouraged feedback and consistently monitored and assessed the quality of the service.
Staff told us that the organisation was an excellent place to work and they really enjoyed working at the service. They received top quality support and there were opportunities for career advancement. They felt enabled and supported to develop their skills and progress their careers. Individual skills were acknowledged, harnessed to further practice development and incorporated within the way the service ran. The service and organisation enabled staff to contribute effectively in developing people's individual support as well as developing new ways of working and procedures. Staff also felt their ideas were listened to and implemented.
The organisation’s quality assurance and monitoring systems were geared for continuous improvement and required staff to constantly monitor individual care and support and feedback from people. They also supported staff to reflect on how their actions impacted on people and how people’s lives could be made better and more enjoyable. The records system was well thought through, clear and usable. Staff also recognised the importance of these records as a source of quality improvement and whilst they were very detailed this was not allowed to detract from the care and support people received.
The culture of the service, staff and organisation was open, progressive and transparent. There was a commitment to continuous improvement with care and support being person centred. Relatives felt people and themselves were valued as did staff who considered themselves integral members of the organisation. The National Autistic Society had accredited the organisation and recognised the high quality of the person-centred care and individualised support provided. The organisation worked well with other stakeholders, seeking their opinions and checking if they were satisfied with the service provided.
The healthcare professionals that responded were very positive in their comments about the support the home provides for people.