Archived: Mr Adrian Lyttle - Erdington Also known as Wheelwright Road

Mr Adrian Lyttle – Erdington is a residential care home registered to provide personal care for up to 10 people with learning disabilities. At the time of the inspection there were seven people using the service.

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

The provider had failed to implement robust audits and quality assurance checks to assist with driving improvement within the service. They had not ensured the quality and safety of care was sufficiently monitored and appropriate action was taken to protect people from the ongoing risk of harm.

The registered manager had not been visiting to support the service on a regular and consistent basis. This meant there was insufficient oversight of the service, staff and systems and processes. This meant people were placed at risk as there was no oversight of the service by the registered manager or provider, placing people at risk of harm. The registered manager was unable to be present throughout the whole inspection and delegated this responsibility to the manager of the location and the provider.

The provider and registered manager failed to provide us with documentation and evidence as requested. This was due to them not being able locate the information or it was of such poor standard they made the decision not to submit the documentation.

During the inspection we identified concerns with poor Infection Prevention and Control (IPC) standards that exposed people to the risk of harm. The provider had failed to act on known risk which had been identified by an external auditor, which took place in April 2021. This placed people at risk of infection.

Staff were not always recruited safely. Safe recruitment practices were not followed and this place people at risk of harm due to police checks not being carried out prior to employment commencing.

People’s medicines were not always managed safely, and some improvement was still needed. We found multiple discrepancies with the stock of medicines which could not be explained.

People were supported by a staff team who told us they understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds.

However, the provider had failed to ensure all staff members had received up to date training. This placed people at risk from potential abuse and harm or injury.

On the day of the inspection we saw people were supported by sufficient numbers of staff to keep them safe.

People were supported to access external healthcare professionals to maintain their health and wellbeing.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include age, disability, race, religion or belief etc. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

People were not always 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.

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.

Right support:

• People's choice, control and independence was not always maximised. People were involved in making choices around how they spent their time, however, meaningful activities did not always take place. People told us they would like more to do but they were aware that they had been unable to do certain things due to the pandemic.

Right care:

• Care staff support people in a person-centred way, and promote people's dignity, privacy and human rights. However, the care plans need to contain more robust information to ensure people receive the right care.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

People said they felt safe and were comfortable around staff. Relatives told us they felt their family members were safe. Staff were observed to be kind and caring and there were good interactions including communication which was suitable for their needs. Staff spoke to people with dignity and respect.

Staff were supporting people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice although record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).

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 of this service was requires improvement (published 29 January 2020) and we found breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance. During this inspection we found new breaches of Regulation 12, Regulation 16, Regulation18 and Regulation 19 although the provider was no longer in breach of Regulation 11.

At this inspection the overall rating for this service is ‘Inadequate’ and the service therefore is 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. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance. During this inspection we found new breaches of Regulation 12, Regulation 16, Regulation 18 and Regulation 19.

The service has a history of poor compliance with regulations. It was rated as requires improvement at the inspection we completed in October 2018 (report published 13 December 2018) and there were breaches of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Need for Consent. The service was rated as requires improvement at the inspection completed in May 2017 (report published 28 June 2017) and following the inspection in August 2016 (report published 15 September 2016) the service was also rated requires improvement.

Why we inspected

This was a responsive focused inspection based on CQC receiving concerns and complaints. Prior to the inspection CQC received concerns about poor standards of care and support, poor recruitment processes and lack of leadership. The information shared with CQC indicated potential concerns about how people were being supported and risks being managed. As a result of these concerns we looked at how the provider was managing risks, protecting people from potential harm, recruitment processes and management of the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 retur

Adrian Lyttle is a care home providing personal care to seven people at the time of the inspection. The service can support up to 10 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

The provider had a recruitment process to ensure they had enough staff to support people safely, however, this was not always robust and further improvement was required to ensure applications accurately detailed employee’s previous work history. Risk assessments had improved since the last inspection although some risk assessments still required more detail to give clear guidance to staff to support people safely with their health conditions. Staff had received training in how to keep people safe and could describe the actions they would take when people were at risk of harm. People received their medicines as prescribed.

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 did not support this practice.

The provider’s governance and auditing systems were not always effective and required further improvement to ensure that they were consistently effective in ensuring people consistently received safe care and treatment.

The service did not always consistently apply 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 did not fully reflect the principles and values of Registering the Right Support because the service was not always working in accordance with the requirements of the Mental Capacity Act 2005 and associated practice. Mental capacity assessments were not always in place to show whether people lacked capacity and best interest decisions were not recorded where people needed support in making specific decisions, however, we observed people were asked for consent and given choices in practice.

People were supported by kind and caring staff who respected their privacy and dignity and supported their independence.

People's support needs were assessed regularly and planned to ensure they received the support they needed. People took part in activities in line with their hobbies and interests. The provider had a complaints process to share any concerns.

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 of this service was requires improvement (published 13 December 2018) and we found breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Need for Consent and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

After our last inspection, we issued the provider with a requirement notice to make improvements to become compliant with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Need for Consent and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance. At this inspection we found that not enough improvement had been made and the provider was still in breach of both regulations.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out this inspection because we had received concerns in relation to poor care, safeguarding concerns and staffing levels.

At our last inspection carried out on we judged this service as ‘requires improvement’ in the key questions of safe, responsive and well led and rated the service as ‘requires improvement’ overall. At this inspection we found that the provider had not made the required improvements we identified at our previous inspection and we identified additional concerns. We found that the provider had failed to make sufficient improvements to the efficiency of their quality assurance systems. This meant that this was the second consecutive inspection whereby the provider had failed to achieve a ‘good’ rating in the well led area of our inspection. As a result of our finding we found that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We also found that the provider You can see what further action we have taken at the end of this report

Mr Adrian Lyttle- Erdington 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. provides care and support for a maximum of ten people who are living with a learning disability. There were 10 people living at the home at the time of the inspection.

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.

There was a registered manager in post at the time of our 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.

The provider’s quality monitoring systems had either not identified some of the areas for improvement that we found during our inspection or when identified by their own system had then not been followed up on in a timely way.

People’s needs had been assessed and care plans developed to inform staff how to support people. However, care records did not fully reflect the detail of specific health care conditions. Some risks to people were not always well managed.

The provider was not fully aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions, although records of this were not always maintained.

Staff had received training however this had not always been effective. Staff received supervision from managers and were support to carry out their role.

People were supported for by staff who were trained in recognising and understanding how to report potential abuse. People’s dignity was maintained and people were communicated with in their preferred way.

People were supported to take part in activities and were involved in their day to day care and chose how to spend their day. People were encouraged to maintain their independence and were supported to meet religious and cultural needs.

People spoke positively about the care staff .Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. There was a friendly and calm atmosphere within the home.

People were supported to maintain a healthy diet that met their cultural and dietary needs. Systems were in place to ask people their views about the home and to listen to concerns and complaints.

At the last inspection in August 2016 the provider was rated as requires improvement in three out of the five areas we inspected against; whether the service was safe, effective and well- led. This was because the registered manager had not always fulfilled the responsibilities of their role by ensuring that the service was safe and effective for people living at the home. The registered manager had failed to implement safe recruitment processes and had not identified potential safeguarding concerns in order to protect people from the risk of abuse and avoidable harm. They had also failed to share information with us that they are required to notify us of, by law.

During this inspection, we found that some improvements had been made; however further improvements were required.

The home provides accommodation and personal care for up to 10 people who require specialist support relating to their learning and physical disabilities. At the time of our inspection, there were 10 people living at the home.

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. There was not a registered manager in post at the time of our inspection. The person who was registered to manage the service had recently left. The provider had arranged for a member of staff to deputise and manage the day to day running of the service in the absence of a registered manager. Arrangements were also being made for the registered manager of the provider’s other home in Sutton Coldfield, to apply for their registration with us to manage the service.

The service was not consistently safe, responsive or well-led because the management team had not always fulfilled the responsibilities of their role. The provider’s quality assurance systems had failed to identify the shortfalls found during the inspection and some of the improvements required at the time of our last inspection had not been made.

Accidents and/or incidents were not always recognised as potential safeguarding concerns and key processes had not been followed. The provider had also failed to ensure that there were sufficient staffing levels to support people to live active and fulfilling lives, particularly at evenings and weekends.

Relatives did not always feel involved in the planning or review of the care that was being provided to their loved ones. Relatives were concerned that staff did not always have sufficient information in order to keep people safe from the risks associated with their physical healthcare needs. The provider had not ensured that all of the information that was pertinent to people’s health and safety was readily available to new and/or temporary members of staff, such as person-centred care plans relating to their physical health needs, allergies or personal emergency evacuation plans. However, the acting manager was responsive to our feedback and improvements have been made since our inspection site visit.

People received care and support with their consent where possible and were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

People received care from staff who had the knowledge and skills they required to do their jobs. People were supported to have their medicines when they required them, from staff who had the relevant knowledge and skills they needed in order to promote safe medication management.

The service was caring because people were supported by staff that were helpful and caring. Staff had taken the time to get to know people including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity and respected them as individuals.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives including the care and support that was provided to them, as far as reasonably possible. People felt involved in the planning and review of their care because staff communicated with them in ways they could understand.

People were supported to engage in some activities that were meaningful to them within the home and to maintain positive relationships with their friends and relatives.

Staff worked as part of a team and supported each other within their work. Changes to the management team meant that staff were experiencing a period of adjustment but reported the new manager’s to be approachable in their leadership style.

Mr Adrian Lyttle Erdington was previously registered by a different provider and therefore this was their first inspection under the new provider.

The home provides accommodation and personal care for up to 10 people who require specialist support relating to their learning and physical disabilities. At the time of our inspection, there were 10 people living at the home.

There was 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.

The service was not consistently safe, effective or well-led because the registered manager had not always fulfilled the responsibilities of their role. For example, they had not sent an alert to the local safeguarding authority where required nor had they followed key processes to ensure that people were not unlawfully restricted. The provider had also failed to implement safe recruitment processes.

People received care and support with their consent where possible and were offered choices on a daily basis which included meal preferences. This meant that people had food that they enjoyed and any risks associated with their diet were identified and managed safely within the home.

People were supported to maintain good health because staff worked closely with other health and social care professionals when necessary.

People received care from staff who had the knowledge and skills they required to do their jobs. People were supported to have their medicines when they required them, from staff that had the relevant knowledge and skills they required to promote safe medication management.

The service was caring because people were supported by staff that were nice, helpful and caring and who took the time to get to know them, including their personal histories, likes and dislikes. People were also cared for by staff that protected their privacy and dignity and respected them as individuals.

People were encouraged to be as independent as possible and were supported to express their views in all aspects of their lives including the care and support that was provided to them, as far as reasonably possible. People felt involved in the planning and review of their care because staff communicated with them in ways they could understand.

People were actively encouraged and supported to engage in activities that were meaningful to them and to maintain positive relationships with their friends and relatives.

Staff felt supported and appreciated in their work and reported the home to have an open and honest leadership culture. People were encouraged to offer feedback on the quality of the service and knew how to complain if they needed to.