Old Hospital Close (12)

About the service

Old Hospital Close (12) is a residential care home providing personal care. Five people lived there at the time of our inspection.

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

Right culture

Staff did not feel that management were always visible or approachable in the service. Staff put people’s needs and wishes at the heart of everything they did. People personalised their rooms and were included in decisions relating to the interior decoration and design of their home

Right support

Governance processes were not always effective in providing good quality care and support. Staff had training on how to recognise and report abuse and they knew how to apply it. People, including those unable to make decisions for themselves, had as much freedom, choice and control over their lives as possible because staff managed risks to minimise restrictions. The service worked well in partnership with advocacy organisations and other health and social care organisations, which helped to give people using the service a voice and improve their wellbeing.

Right Care

Staff were patient and used appropriate styles of interaction with people. Staff were calm, focussed and attentive to people’s emotions and support needs such as sensory sensitivities. People had the opportunity to try new experiences, develop new skills and gain independence. People had individual communication plans/ passports that detailed effective and preferred methods of communication, including the approach to use for different situations.

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 14 September 2018)

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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 and Recommendations

For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: 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 a breach in relation to good governance at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection, we found the service remained Good.

Old Hospital Close (12) 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.

Old Hospital Close (12) provides accommodation for five people with learning disabilities. It is in Balham, close to local amenities and transport links.

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 at the service. 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.

We received positive feedback from people and their relatives about the caring attitude of the care workers. They told us they felt safe living at the service and were settled there. Each person was assigned a key worker who met with them every month to discuss any issues they had and to also formally monitor how they were progressing.

People were supported by staff to take their medicines and had records in place which promoted their health needs. People were able to see their doctor or another health professional if they were not feeling well and the staff supported them to do so. Relatives told us they were kept informed by the provider of any changes to their family member’s health.

Meals were planned during regular resident’s meetings and people with support needs in relation to eating and drinking were supported by staff. Where appropriate, advice and support was sought from community therapy teams.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were only deprived of their liberty to receive care and treatment when this was in their best interests, the provider sought legal authorisation to do so under the Mental Capacity Act 2005 (MCA).

People lived independent lives and were supported by staff to access various community activities. People attended various day centres and enjoyed going to the gym and bowling.

Risk assessments were reviewed regularly and any control measures were proportionate to the level of risk identified. Staff were aware of risks to people's wellbeing and how to keep them as safe as possible.

People’s support plans were based around their goals and what care workers could do to help to maintain or improve their independence. Key workers helped people to achieve their targets.

People were consulted about how the service was run, regular resident’s meetings were held and feedback was sought and acted upon. Staff were familiar with how to communicate with people and used a range of tools to do so, for example visual aids, objects of reference and Makaton.

Staff told us they felt supported by the registered manager. They received regular training which helped them to carry out their role more effectively.

The service was well-led. The registered manager was aware of his responsibilities. Regular monitoring and quality assurance audits were carried out which helped to maintain the service provided to people. An external team carried out mock CQC style inspections and specific medicines, finance and health and safety audits took place. An action plan was in place to take remedial action where necessary.

Old Hospital Close (12), (formerly called St James' Care Home (12)), provides accommodation for up to five people with learning disabilities. It is located in Balham, close to local amenities and transport links. It shares staff with a sister home based at number 21. At the time of our inspection, there were four people living there, three males and one female. The home is arranged over three floors. People live in single bedrooms, with shared bathroom and kitchen facilities.

There was a registered manager at the service. 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.

We were not able to speak with any people using the service as they all had limited verbal communication. However we did observe staff supporting and caring for people which they did in a calm, measured way. They spoke with people gently and encouraged them to be as independent as possible, supporting them when needed and letting them take control when appropriate. There was a good atmosphere at the service on the day of our inspection.

Care workers were familiar with people's support needs and how they communicated. Care records contained communication profiles for each person, explaining the best way to communicate with them and ways to help communicating easier.

Care workers spoke about the Mental Capacity Act 2005 and its uses in relation to people using the service. Where people were not able to consent to their care or treatment, best interests decisions were made on their behalf and restrictions placed on people to keep them safe only when the provider was legally authorised to do so.

People’s support needs in relation to their medicines, general health and nutrition were all met by the provider.

People spent the majority of their time at the day centre during the week and were supported by staff when going out in the community. They ate out together on a regular basis and went to the cinema and day trips. Families were encouraged to maintain contact with people and relatives told us they were kept in the loop by the provider and had no concerns about the safety of their family members living at the service.

Care workers were motivated and felt supported by the registered manager. They were provided with training opportunities to make them more effective in their roles and received regular supervision from the management team.

Care workers spoke highly of the registered manager saying that he led by example and was always available to offer support and advice. The registered manager was passionate about the changes he had implemented and spoke about his vison for the service with clarity.

Some major changes had been made to how the care records were written. We found that although the new style was person centred and more simplified than the previous style, records had not been completed and some of the support plan goals did not always correlate to the assessed support plans in place for people.