Archived: London Borough of Greenwich - 99 Elliscombe Road

London Borough of Greenwich – 99 Elliscombe Road is a supported living service that provides personal care and support for people with learning disabilities and/or autistic people. The service accommodates up to four people in one adapted building. At the time of our inspection there were two people receiving care and support.

People’s experience of using this service

People told us they were supported to understand risks and they knew how to stay safe. Risks were well managed. The provider ensured people were protected from the risk of acquiring infections and the service was clean and hygienic. Medicines were managed safely by staff who had received relevant training. There were sufficient staffing levels to maintain people’s safety and ensure their social care needs were met.

People’s health and social care needs were assessed, and plans put in place to meet these. The provider met people's nutritional and hydration needs and supported them to have a balanced diet. People were given ongoing information and guidance to help them understand and manage their health conditions. 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 told us the staff were kind and caring and knew them well. People were treated with dignity and respect and they were supported to learn and maintain daily living skills.

The provider ensured people were supported to attend activities of their choice in their local community. Communication needs were considered, and detailed guidance was in place to help effective communication.

There were quality assurance systems in place to ensure care and support were kept to a good standard. The service worked with a range of healthcare and multidisciplinary professionals to achieve good outcomes for people.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• People told us how they were in control of how they lead their lives and were supported to learn and maintain daily living skills.

Right care:

• People were treated as individuals and their personal preferences were known and upheld by staff that knew them well.

Right culture:

• The provider engaged and included people in all aspects of their support, including the selection of new staff. Staff were proud of how they worked together as a team to ensure people were supported to make decisions for themselves and lead the life they wanted.

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 (19 May 2018).

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 our last inspection of this service on 21 and 22 January 2016 the service was rated Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

The service had 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.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks.

The service had an effective system to manage accidents and incidents, and to prevent them from happening again. The provider carried out comprehensive background checks of staff before they started working and there were enough staff available to support people.

Medicines were managed appropriately and people were receiving their medicines as prescribed. Staff received medicines management training and their competency was checked. All medicines were stored safely. The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures.

The provider had trained staff to support people and to meet their needs. The registered manager supported staff through regular supervision and appraisal.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible and the policies and systems in the service support this practice.

Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their healthcare appointments. The registered manager and staff liaised with external health and social care professionals to meet people’s needs.

People, and where appropriate their relatives were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, caring, and respectful. Staff protected people’s privacy and dignity and promoted independence.

People were supported to maintain relationships with people that mattered to them. People's needs were reviewed and monitored on a regular basis. The service had policy and procedures about managing complaints. People knew how to complain and told us they would do so if necessary.

There were systems in place to monitor the quality of the service provided. People's views about the service were sought and considered through satisfaction surveys. Staff felt supported by the registered manager. The service worked effectively with health and social care professionals.

London Borough of Greenwich – 99 Elliscombe Road is a supported living service that provides personal care for up to four adults who have a range of needs including learning disabilities. At the time of our inspection four people were using the service.

There was no 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 current manager’s application with CQC to become a registered manager was in progress.

The service knew how to keep people safe. There were clear procedures in place to recognise and respond to abuse and staff had been trained and was aware in how to follow these. Risk assessments were in place and reflected current risks for people who used the service and ways to try and reduce the risk from happening. There were sufficient numbers of staff to support people at the service and in the community. The service followed appropriate recruitment practices to keep people safe. Appropriate arrangements for the management of people’s medicines were in place and staff received training in administering medicines.

Staff received an induction and training to help them undertake their role. Staff were supported through regular supervision, annual appraisal and team meetings. The service had processes in place to assess and consider people’s capacity and right to make decisions about their care and treatment where appropriate and to establish their ‘best interests’ in line with the Mental Capacity Act 2005.

People received enough to eat and drink and their preferences were taken into account. Staff helped people to keep healthy and well, they supported people to attend appointments with healthcare professionals when they needed to.

We observed staff had a good understanding of people’s needs and were able to support them. Staff supported people in a way which was kind, caring and respectful. We observed that people looked relaxed.

People’s care and support needs were regularly reviewed to make sure they received the right care and support. Care records focussed on people as individuals and gave clear guidance for staff.

Staff encouraged people to follow their own activities and interests. People told us they felt comfortable about raising any concerns they had with the manager and knew how to make a complaint if they needed to.

The provider regularly sought people’s and staff’s views about how the care and support they received could be improved. Staff felt supported by manager. There was an effective system to regularly assess and monitor the quality of service provided. Learning from audits took place and appropriate changes were implemented.

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

Is the service Safe?

People living in the home had assessments of possible risks to their health and safety and these were reviewed as and when required.

Staff had the training and knowledge they needed to make sure people living in the home were cared for safely. We saw all communal parts of the home and some people's bedrooms (with their permission) and found the premises and equipment were safe and well maintained.

Is the service effective?

People's care needs were assessed and they told us staff understood their needs and provided the care and support they needed. People were involved in making decisions about their health and personal care wherever possible. If people could not contribute to a specific aspect of their care plan, staff worked with other professionals to assess the care they needed.

People's care plans were detailed and covered all of their health and personal care needs. The health care records we looked at demonstrated that people had access to external health care professionals' support as required.

Is the service caring?

People we spoke with told us staff were kind and caring. Each of the care plan files we looked at described the person's likes, dislikes and daily routines.

We observed staff maintained an individual's dignity and demonstrated respect whilst providing care and support.

Is the service responsive to people's needs?

People we spoke with confirmed staff sought consent before care was provided. Staff we spoke with were able to demonstrate how they would seek consent from a person using the service. We observed staff treated people with respect and involved them in making choices and decisions about their care.

When people did not have the capacity to consent, the provider had acted fully in accordance with legal requirements.

Is the service well-led?

There was no registered manager at the service and the home was managed by an agency manager in the interim. The provider told us that they were in the process of recruiting a permanent manager. Staff told us they felt supported by their line manager. They also told us they understood their roles and responsibilities.

The provider had effective systems to regularly assess and monitor the quality of service that people received. These included regular audits of medication, care plans, health and safety. There was evidence that learning from these audits took place and appropriate changes were implemented.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that people were involved in making decisions about their care and treatment. We found people's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. Staff we spoke with felt they were adequately supported in their day to day tasks. There were appropriate arrangements in place to manage medicines. We found that care records were fit for purpose and kept securely.

We found that although the provider did not have a policy to determine when consent was always required, people who used the service were encouraged to verbally consent to their care and support. The provider acted appropriately when people did not have the capacity to manage aspects of their care. We found people's care and support needs were assessed and regulalry reviewed, and most people had up to date risk assessments in place. We found some shortfalls with the way the provider managed people's medication including the safe storage and administration of medicines. Staff we spoke with felt they were adequately supported, and the provider had systems in place to ensure staff were adequately trained and supervised. The provider kept records about people who used the service, however some records contained out of date information and records were not always stored securely.