Old Hospital Close (21)

Old Hospital Close (21) is a residential care home providing personal care to up to five people in one adapted building. The service provides support to those with a learning disability or autistic spectrum disorder, mental health, older people and those with dementia. At the time of our inspection the home was at full capacity.

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

Day to day management and oversight of the service needed some improvement, as the service had not had a registered manager for some time.

We identified issues with records management in that areas of update and improvement had not always been identified. This included updates to people’s risk assessments, staff supervisions, PRN ‘as required medicines protocols, submission of statutory notifications and staff recruitment files.

Care staff knew people well and had worked at the service for along period of time. We observed that people were comfortable with staff and interacted positively. People received their medicines when they needed them.

The premises were clean with regular infection control checks in place. Regular checks were in place to maintain the home. Where risks to people had been assessed steps were in place to support staff to reduce the likelihood of those risks occurring.

Staff received regular training and told us they felt well supported in their roles and that the management team around them were responsive. People were supported to eat meals of their choosing that met their dietary needs.

People were well supported and cared for, by staff that knew their individual needs and support requirements. Staff treated people with dignity and respect with care records reflecting their preferences.

People were supported to express their end of life wishes. Care records promoted independence and supported involvement in activities. There was a suitable complaints process.

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.

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 were supported to be as independent as they could be in their care support and day-to-day activities.

Right care: People received personalised care, which reflected their choices and views. Care support was reviewed in line with people’s presenting needs. People accessed the local community.

Right culture: The culture of the home focused on the wellbeing of the people living there, with staff and management demonstrating an understanding of individual needs.

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 28 August 2019)

Why we inspected

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 Old Hospital Close (21) 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 a breach in relation to good governance at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Old Hospital Close (21) is a care home, located in Balham, where up to five people with learning disabilities can live. It shares staff with a sister home based at number 12. At the time of the inspection there were three people using the service. People lived in an adapted building in individual bedrooms, with a shared kitchen and dining space, a lounge and a garden.

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 and their relatives told us they felt safe living at Old Hospital Close (21). Safe recruitment procedures were in place which meant that only suitable staff were recruited to support people. There were enough staff employed to meet people’s needs, while they were at home or out in the community. Staff were aware of the risk to people and what steps they would take to keep them safe from harm, there were suitable risk assessments in place to support this practice. People were kept safe as possible from the risk of infection as the provider followed appropriate infection control guidelines. Staff completed incident forms if any unforeseen accidents happened.

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. 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. Staff received regular training and supervision which helped them to support people in the most appropriate manner. People’s healthcare needs were assessed and referrals made to healthcare professionals if needed.

People were cared for by staff who were caring and compassionate. People told us they enjoyed being in the company of staff and it was evident that there was an easy-going relationship between people and the staff team. The service anticipated people’s needs and recognised when they were distressed, it worked with teams of professionals to provide appropriate support and care. Staff supported people to maintain their independent and provided the right level of support according to their level of need. People led active lives and attended a number of day centres throughout the week. Staff supported them to access local amenities and maintain contact with family.

Support plans for people focussed on both short and long term targets and were based around improving people’s independent living skills. People had key workers who helped them to access a range of health and social care services and who met with them on a regular basis to ensure their needs were being met and they were happy with their current living arrangement. People were supported to raise concerns through individual key worker meetings or through regular ‘house’ meetings. Staff acted upon these. Where formal complaints were raised, the provider investigated and took appropriate action in response.

There was a long-standing registered manager who was well respected by people, relatives and the staff. Staff demonstrated that they supported people in line with the provider’s vision and values. The quality of the service was measured through audits, external monitoring and regular feedback with people and the staff team.

Rating at last inspection

The last rating for this service was Good (published 18 February 2017).

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

Old Hospital Close (21) 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 12. At the time of the inspection there were four people using the service.

People using the service told us they were happy and enjoyed living there. They spoke positively about the day centres they attended and said that staff were kind towards them.

People were encouraged to maintain their independence. We observed people making their own breakfast and getting themselves ready to go out on the day of the inspection. We also observed care workers encouraging people to carry out their personal care and to complete daily living tasks such as collecting their laundry for washing.

Relatives that we spoke with told us they were happy with the support their family members received from the service. They told us that they knew the staff and were kept informed if anything happened. People were supported to maintain relationships that were important to them.

Regular meetings were held where people were able to discuss issues that were relevant to them in a group environment, which included activities, menus, staffing and any concerns. People were also able to discuss issues privately through one to one meetings with their key workers who they met on a monthly basis.

People had their health and medicine support needs managed appropriately by the provider. Healthcare professionals such as therapists and psychiatrists were involved in providing additional support if needed.

The provider was complying with the Mental Capacity Act 2005 (MCA) and had submitted applications to legally deprive people of their liberty where it was felt they were not free to leave the service on their own for their own safety.

Care plans were individual to people and based around encouraging their independence and improving their daily living skills. These were reviewed on a monthly basis.

Staff told us they felt supported and enjoyed working at the service. They received regular training which was monitored to ensure it was up to date, which helped them to support people more effectively. They also received regular supervision and were given areas of responsibility which helped them to motivate them to carry out their duties.

The service was well managed. We received positive feedback about the registered manager from relatives and staff. A number of audits were carried out to monitor the quality of service provided to people, some of these were based around the ratings systems used by the Care Quality Commission (CQC).