202 Weston Road

202 Western Road is a residential care home providing personal care to up to 4 people. The service provides support to people who have a learning disability and/or who are autistic. At the time of our inspection there were 4 people using the service.

People’s experience of the 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. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.

Right Support

The provider did not always assess risks or take action to mitigate identified risks to ensure people were safe. People were not always safeguarded from abuse or avoidable harm. People were not always supported to receive their medicines in a safe way. The service did not always make sure staff had the skills, knowledge and experience to deliver effective care and support.

The provider was not always working in line with the Mental Capacity Act.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People were not always protected from the risk of infection as staff were not consistently following safe infection prevention and control practices. People’s care and support was not always delivered in line with current standards and people did not always achieve effective outcomes. The provider did not always ensure the service worked effectively to deliver care, support and treatment. People were not always supported to live healthier lives. People were supported to eat and drink enough to maintain a balanced diet.

Right Culture

The provider did not always learn lessons when things had gone wrong. People’s individual needs were not always met by the adaption, design and decoration of the premises. The provider did not have an effective management structure. The provider did not always monitor the quality of care provided in order to drive improvements or create a learning culture at the service, so people’s care was not improved. The provider did not fully understand or act on their responsibilities under the duty of candour. People and staff were not always involved in the running of the service and their protected characteristics were not always well understood.

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 11 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety, staff training and oversight. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for 202 Western Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, the premises and equipment, need for consent, person-centred care and good governance.

Please see the action we have told the provider to take at the end of this 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 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.

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.

We found the following examples of good practice.

Competency checks were undertaken to ensure staff were complying with PPE guidance correctly.

The service had produced easy read documents to support people with their understanding of COVID-19.

Infection prevention and control audits were completed, and infection prevention and control policies were in place.

A one-way entry and exit system had been introduced into the home, in order to follow social distancing guidelines.

There was a protocol in place for visitors to follow upon entry to the home, in line with government guidance.

202 Weston Road is a residential care home providing personal and nursing care to four people who had a learning disability and/or autism at the time of the inspection. The care home accommodates four people in one adapted building.

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.

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

People were supported by safely recruited staff, who had the skills and knowledge to provide effective support. Staffing levels were regularly reviewed to ensure there were enough staff available to meet people’s needs. People’s medicines were managed, and staff followed infection control procedures.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement

.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Effective care planning and risk management was in place which guided staff to provide support that met people’s needs and in line with their preferences. 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.

People were supported to access healthcare professionals and advice received was followed by staff. There were systems in place to ensure people received consistent care and support.

People were supported by caring staff who promoted choices in a way that people understood, this meant people had control and choice over their lives. Staff provided dignified care and respected people’s privacy. People’s independence was promoted by staff.

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 were involved in the planning and review of their care. Staff followed care plans to ensure they provided support in line with people’s wishes and diverse needs. People’s communication needs were met, and information was provided in a way that promoted people’s understanding. There was a complaints system in place which people understood. The registered manager had a system in place to gain people’s end of life wishes.

Systems were in place to monitor the service, which ensured people’s risks were mitigated and lessons were learnt when things went wrong. People and staff could approach the registered manager who acted on concerns raised to make improvements to the delivery of care. Staff and management were committed to providing a good standard of care, which was focused on positive outcomes for people.

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 (report published 11 September 2018). 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

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.

At the last inspection in January 2016 the service was rated as Good. At this inspection we found the service was now rated as Requires Improvement.

The home was not always maintained in a way that protected people from the risk of infection. Some areas of the home were not clean and had mould present. The kitchen food preparation area had missing tiles which meant that it could not be cleaned effectively.

The providers quality assurance processes were not effective at resolving shortfalls in a timely manner.

There was a registered manager in post although they were absent at the time of the inspection. 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.

People gave us positive feedback about their experience of living in the home. They told us they were happy, liked the staff and were supported to partake in activities and trips that they enjoyed.

There were sufficient amounts of safely recruited staff to support people and staff understood their responsibilities to recognise potential abuse and to report their concerns.

People’s risks had been assessed and there were detailed risk assessments and plans in place to support staff in reducing people’s known risks. Medicines were managed safely and action had been taken if things had gone wrong and learning put in place to reduce the likelihood of incidents reoccurring.

People were protected under the Mental Capacity Act 2005 (MCA). 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.

People were supported to have food they liked and people were kept safe if they were at risk whilst eating. People had access to other health professionals when necessary and people’s health conditions were monitored and there were care plans were in place to guide staff.

Staff knew people well and people had personalised plans in place. People were supported to partake in a range of activities and trips. People had differing ways of communicating and these were planned for and staff knew how to communicate with people. People were supported to make plans for the end of their life and people’s preferences were recorded. People were able to complain and a suitable policy was in place.

The management team were approachable and visible in the home. Staff felt supported although the formal systems of supervision required strengthening. The last CQC rating was on display and notifications were submitted as required by law.

We found there were breaches in Regulations 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 the report.

202 Weston Road provides accommodation and personal care for up to four people with a learning disability and autism. Four people were using the service at the time of the inspection.

The registered manager supported us throughout the inspection. 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.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The manager had previously made referrals for further investigation when they had suspected abuse had taken place.

People were supported to be as independent as they were able to be through the effective use of risk assessments and the staff knowledge of them. When people became anxious staff supported them in a safe way that met their needs.

There were enough suitably qualified staff who had been recruited using safe recruitment procedures available to maintain people’s safety and to support people in hobbies and activities of their choice.

People medicines were stored and administered safely by medication trained staff.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

Staff were supported to fulfil their role effectively. There was a regular programme of training that was relevant to the needs of people at the home.

People’s nutritional needs were met. People were supported to eat and drink sufficient to maintain a healthy lifestyle dependent on their specific needs.

People were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

Staff were observed to be kind and caring and they told us that were well supported by the registered manager.

Care was personalised and met people’s individual needs and preferences. The provider had a complaints procedure and people's representatives knew how to use it.

The provider had systems in place to monitor the quality of the service.

As a result of our findings the home provided us with an action plan outlining how they would address the issues. During this inspection we saw that the action plan had been implemented and this had resulted in improvements in all the areas of concern.

During this inspection we saw that people were involved in activities appropriate to their abilities. One person who used the service told us, 'I can make tea'.

We saw that there was an effective complaints system. Easy read versions of the procedure were in care plans. Behaviour monitoring sheets had been introduced to enable staff to identify when people who used the service wanted to raise issues.

We checked records and saw they contained risk assessments and support plans which met people's individual needs. We found that recruitment; induction and training records were maintained and kept secure.

We spent time with all the people living in the home and where people were unable to tell us about their experiences due to their learning disability, we spent time observing the support they received from the staff. We also spoke with six members of staff.

We saw and heard the staff were friendly and professional in their approach and interacted confidently with people. There was a relaxed atmosphere in the home, and everyone contributed to some of the household chores to ensure the environment was clean, tidy and comfortable.

People were supported to take part in recreational activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what activities to be involved in including walking, eating out, swimming and going to the pub.

We saw the care records did not include all information about how people needed to be supported and how all risks had been assessed. This meant it was not clear why there were restrictions around some activities in the home including cooking hot meals. Some information within the records had not been updated to reflect current individual circumstances although staff we spoke with knew the support people needed.