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Inspection carried out on 10 September 2019

During a routine inspection

About the service

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

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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

Inspection carried out on 7 August 2018

During a routine inspection

The inspection took place on 7 August 2018 and was unannounced. 202 Weston Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It can accommodate up to four people in one adapted building, split into two floors. There were four people using the service at the time of our inspection.

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.

Inspection carried out on 8 January 2016

During a routine inspection

This inspection took place on the 8 January 2016 and was unannounced.

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.

Inspection carried out on 15 May 2013

During an inspection to make sure that the improvements required had been made

This was a follow up inspection of 202 Weston Road in relation to issues which had been identified on our previous inspection in November 2012. During the previous inspection we were concerned that people who used the service were not fully involved in their care. We found that records we had expected to find were not present in people�s care plans. We found that one record had incorrect information about the complaints procedure.

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.

Inspection carried out on 22 November 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people using this service as part of our planned schedule of inspections. The inspection was unannounced which meant the provider and the staff did not know we were coming.

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.

Inspection carried out on 11 May and 27 June 2011

During a routine inspection

The previous key inspection report told us that relatives and people using the service had been satisfied with the care they received.

During our visit we spoke with people using the service and staff members. We also spoke with relatives. Feedback comments about the service included, �I can ask staff If I�m not sure�, �staff are pretty good; they are well trained to do their job.� �We know the people living here very well, and we can anticipate their needs.�