Archived: Mr Adrian Lyttle - Sutton Coldfield Also known as Vesey Road

About the service

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

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

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support.

Right Support

The service did not support people to have the maximum possible choice, independence or have control over their own lives.

We found staff were not always supporting people in the least restrictive way possible or in their best interests. For example; we found there was a restriction of the personal money for one person, for which there was no mental capacity assessment or best interest meetings held.

We also identified staff were using inappropriate responses and de-escalation techniques and there was a lack of positive re-enforcement.

We found staff used controlling language and restrictions towards people who were expressing emotional needs such as; hitting out at other people using the service, saying repetitive things to prompt a response or removing footstools from under people’s legs as they knew staff would then engage with them. This was in part due to the lack of training and guidance for staff to follow. This meant people using the service continued to display the same behaviours as they had no goals or targets in place and staff had no strategies to follow to decrease such incidents.

We found staff training and record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).

People did not always have the support they needed to meet their needs and keep them safe. This increased the risks to people’s health and wellbeing.

Right Care

The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe.

People’s care, treatment and support plans did not always reflect their range of needs or promote their wellbeing and enjoyment of life.

People who were distressed or expressing emotional distress did not have proactive behaviour strategies in their care records. This meant they did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person’s best interests.

Right culture

Care was not always person centred and people were not empowered to influence the care and support they received. One person told us, “I am talked through and not to.”

The systems for reporting were not robust. For example, where concerns in relation to incidents between people using the service had occurred, staff had recorded these but the registered manager and provider had not taken appropriate steps to identify these incidents and take appropriate actions to mitigate future occurrences.

The provider’s governance systems were not always effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

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 Inadequate (report published 06 October 2021) and there were breaches of regulation.

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 the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We had also received some concerns in relation to the management of the service and the safe care and treatment of people using the service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mr Adrian Lyttle – Sutton Coldfield, on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 will take further action if needed.

We have identified breaches in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing and fit and proper persons employed.

Since the last inspection we recognised that the provider had failed to adhere to the conditions of their registration. This was a breach of regulation.

Follow up

We will hold a meeting with 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 remains 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.

Mr Adrian Lyttle – Sutton Coldfield is a residential care home providing accommodation and personal care for up to nine people with learning disabilities. At the time of the inspection there were six people using the service.

We found the following examples of good practice.

¿ The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. On arrival visitors were asked to consent to a lateral flow test (LFT) and their temperatures recorded.

¿ Where possible staff encouraged people to keep a safe distance from each other and there was additional cleaning of touch points in communal areas to mitigate the risk of cross infection.

¿ The service kept in contact with family members through social media and phone calls and where possible, window visits.

¿ Staff were adhering to personal protective equipment (PPE) guidance and practices. There was a plentiful supply of PPE at all PPE stations close to people’s bedrooms.

¿ Clear plans were in place for those who may be required to self-isolate. For those people who may struggle with isolation additional support would be provided.

¿ Staff continued to support people to access healthcare and arrangements were in place should people need to attend hospital and return to the home safely

Mr Adrian Lyttle – Sutton Coldfield is a residential care home registered to provide personal care for up to nine 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 developed a range of audits and quality assurance checks to assist with driving improvement within the service. We identified these systems and processes were not robust and were not kept up to date. 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 was not working in the service full time and there was decreased oversight of the service due to this. The registered manager was unable to be present throughout the whole inspection and delegated this responsibility to the manager of the providers other location and the office administrator.

During the inspection we identified concerns with poor IPC standards. This placed people at risk of infection.

Although special dietary needs were available for staff members in the care plan, staff were observed to not always follow the correct guidance.

Staff were not always recruited safely.

People’s medicines were not always managed safely, and some improvement was still needed.

People were involved in making choices around how they spent their time. Meaningful activities did not always take place. People told us they would like more to do and staff members also told us they would like to be able to do more with people to keep them occupied.

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.

The service has been developed and designed in line with the principles and values that underpin the Right Support, right care, right culture 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.

The provider had made improvements to ensure people were supported to have maximum choice and control of their lives. 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).

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. Staff spoke to people with dignity and respect and took the time to support and encourage people.

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

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 at the inspection we carried out on 17 February 2020 (report published 20 March 2020) and there were breaches of regulation.

At this inspection enough improvement had not been made and the provider was still in breach of regulation.

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.

The service was rated as good at the inspection we completed in July 2017 (report published 01 September 2017). The service was rated as inadequate at the previous inspection completed in May 2016 (report published 20 July 2016) and there were breaches of regulation.

Why we inspected

This was a responsive five key question inspection based on CQC receiving concerns and complaints, that the provider was not providing safe care and there was a lack of management support.

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

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

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 will meet with the provider to discuss how they will make changes to ensure they improve their rating and to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress.

Adrian Lyttle- Sutton Coldfield is a care home providing personal care to people. The service can support up to nine people with a learning disability and nine people were living there at the time of the inspection.

The service was a large domestic style property located in a residential area. There were no identifying signs that this was a care home.

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

At our last inspection a fault with the fire alarm system had been identified. At this inspection we found the same fault remained and the provider had failed to take action to keep people safe, from the risk of fire. The provider had not always notified us of certain events that they are required to do so.

The providers quality monitoring systems and processes were not always effective at identifying where improvements were needed and action was not always taken on issues identified in a timely way.

The provider had made some recent improvements and work was still underway to update their policies and systems in relation to best interest and MCA. This will ensure that people are always supported in the least restrictive way possible and in their best interests.

Improvements were underway to ensure staff received more formal supervision and appraisal to support them to carry out their role.

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.

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 received planned and co-ordinated person-centred support.

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. Staff spoke to people with dignity and respect and took the time to support and encourage people. People were supported to do things they enjoyed doing and to maintain relationships that were important to them.

Staffing levels had recently been increased and staff were recruited safely.

People were supported to access external healthcare professionals to maintain their health and wellbeing. People were supported to have enough to eat and drink and appropriate referrals had been made to healthcare professionals.

There were systems in place for people and relatives to give their feedback on the service.

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 good (published August 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 12 safe care and treatment and regulation 18 failure to notify CQC of specific information. 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 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 return to visit as per our re-inspection programme. If we receive any If we receive any concerning information we may return sooner.

At the time of our last inspection in May 2016 the provider was rated as requires improvement in three out of the four areas we looked at. We found that the service was not always safe, effective or well-led because the systems and processes in place used to assess and monitor the quality and safety of the service were not always effective in identifying shortfalls within the service. For example, people were not always supported by enough members of staff and the provider had not always ensured that safe recruitment processes had been followed. Furthermore, key processes had not been followed to ensure that people were not unlawfully restricted and therefore the service was found to be in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, we found that improvements had been made to the staffing levels and the provider was now following the appropriate processes to ensure that people were not unlawfully restricted in accordance with the Mental Capacity Act 2005. However, further improvements were required to the management oversight of the service.

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

Whilst the provider had some management systems in place to assess and monitor the quality of the service provided to people, these were not always effective in identifying some of the shortfalls identified during the inspection. The registered manager was receptive to our feedback and was open and honest in their communication with us throughout the inspection process. Everyone we spoke with confirmed that the registered manager was approachable, responsive and staff felt supported within their work.

People were supported by enough members of staff in order to keep them safe. However, additional staff resources were being sourced in order to support people to live more fulfilling lives and to engage in activities of interest outside of the home. The provider had improved their recruitment practices to ensure people were supported by staff that were deemed suitable to provide care to people. There was a calm and relaxed feel to the home and everyone we spoke with told us that staff were kind, caring, helpful and respectful.

People were protected from the risk of abuse and avoidable harm because staff received training and understood different types of abuse and knew what actions were needed to keep people safe. The provider had also ensured effective systems were in place to report and investigate any concerns raised, which included working collaboratively with external agencies and reporting these to us, as required by law.

Staff had the knowledge and skills they required to care for people safely and effectively. This included the safe management of medicines so that people received their medicines as prescribed. Staff were also knowledgeable about the Mental Capacity Act 2005 and ensured that care was provided to people with their consent, as far as reasonably possible. Where people lacked the capacity to consent to their care, the provider had ensured that the appropriate processes had been followed in order to provide care to people within their best interests and in the least restrictive ways possible.

People were encouraged to be as independent as possible and were treated with dignity and respect. People had access to enough food and drink in accordance with their dietary requirements and reported to enjoy the food that was prepared for them.

People and/or their representatives were involved in the planning and review of their care, as far as reasonably possible and were aware of the complaints policy and procedure. The provider sought feedback from people who used the service and/or their representatives, as well as from visiting professionals in order to drive improvements.

Mr Adrian Lyttle Sutton Coldfield 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 nine people who require specialist support relating to their learning and physical disabilities. At the time of our inspection, there were nine people living at the location.

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 always safe, effective or well-led because the systems and processes in place used to assess and monitor the quality and safety of the service were not always effective in identifying shortfalls within the service. For example, people were not always supported by enough members of staff and the provider had not always ensured that safe recruitment processes had been followed. Furthermore, key processes had not been followed to ensure that people were not unlawfully restricted and therefore the service was found to be in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

People did however, receive 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 nutrition and hydration 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.

We also found that people received care from staff who had the knowledge and skills they required to protect people from the risk of abuse and avoidable harm and they knew what the reporting procedures were. People were supported to have their medication when they required it 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 friendly, 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. They felt that the registered manager was responsive to feedback and staff reported the registered manager to be a positive role model who was dedicated to providing a high quality service.