We carried out a review of the data available to us about U&I Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about U&I Care Limited, you can give feedback on this service.
It provides services for adults with a learning disability and autism, Archers Green is registered to provide support for three adults and at the time of the inspection one person lived in the home.
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 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 service applied the principles and values of Registering the Right Support and other best practice guidance. This ensured that people who use the service lived as full a life as possible, gained new skills achieved the best possible outcomes and promoted independence.
Thorough recruitment and induction processes were in place to ensure staff were suitable and received appropriate training to deliver care and support.
Care and support was delivered on an individual basis and the occupant of the home decided the daily routines. Care, support and activities were planned around individual likes and dislikes. The person was encouraged to participate in activities that were meaningful to them, for example education and given opportunities to experience new activities with varying degrees of success. The person supported had opportunities to connect with other people using the U&I Care Limited services with attendance at social clubs, discos, the time spent engaging with these activities was dependant on their well-being at the time.
The person’s behaviour and responses showed us they felt comfortable with the staff members supporting them. The service worked hard to promote inclusivity and people’s diversity was embraced, staff demonstrated this with their knowledge of how people communicated, made their needs and wishes known, and what worked best to ensure they had a good day.
We discussed with the manager ways to improve people’s understanding of how individuals are supported with choice. This aspect of people’s care across all U&I Care services needs to be reviewed, to be able to manage family’s expectations in line with legislation as people transitioned from children’s service and receive support in adult services.
Recent changes to the management structure of the organisation were seen as positive in supporting clear lines of accountability.
Staff told us they were proud to work for U&I Care Limited and we saw there was a genuine affection for the people they supported. There were processes in place for staff to access support at any time and we were told by staff they felt supported by the management team. Records clearly showed that staff received formal supervision, appraisal and regular training.
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 (published 17 May 2018) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.
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.
When we conducted a previous inspection in September 2015, we rated the service ‘Good’. During this inspection breaches of legal requirements were found and the service was rated ‘Requires Improvement’.
15 Archers Green provides care, support and accommodation for up to three adults with autism/learning disabilities and complex needs. People living at the home are supported by staff on a 24 hour basis. At the time of our inspection there were three people living in the home; each person had their own bedroom and shared communal areas. Two of the bedrooms had en-suite facilities with an additional bathroom and downstairs cloakroom. People had access to a well maintained garden at the rear of the home.
15 Archers Green 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.
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. The registered manager was also the registered provider.
Staff recruitment processes were not always safe. Files that we checked did not demonstrate robust recruitment checks in line with the provider’s policy.
Systems and processes were in place to monitor the quality and safety of the service, however these were not always effective. We saw evidence of quality assurance audits being completed, however they lacked a review and analysis from the management team and had not identified the issues found during this inspection.
Accident and incidents were recorded where required and reviewed by senior staff and managers. However one report did not contain detailed information to provide a rationale as to why physical intervention had been used. This was discussed with the behaviour manager during inspection.
Consent for care was not always gained in line with the principals of the Mental Capacity Act 2005 (MCA). We could not see any evidence of best interest involvement within the support plans viewed.
We saw evidence of detailed risk assessment at Archers Green that provided guidance for staff in managing identified risks. Risk assessments were reviewed regularly.
Each person living at Archers Green had a Personal Emergency Evacuation Plan (PEEP) in place. We saw the PEEPs did not provide guidance for staff to safely evacuate people during an emergency. This was discussed with the deputy manager during inspection.
We saw evidence that medications were stored and administered safely. Staff had received appropriate training to safely administer medication and had their competencies assessed regularly.
Staff had received training in relation to safeguarding adults from abuse and neglect. Staff we spoke with showed a good understanding of how to safeguard adults from abuse and how to report any concerns.
Staff had received training in relation to behaviours that challenge and physical intervention. Staff told us they felt confident dealing with situations when people may present with behaviours that challenge or if they became physically aggressive.
We saw that staff had received training in most areas relevant to their role, however training provided for autism was an 'introduction to autism' delivered by the registered provider and not an accredited training program. Relatives told us they did not feel that some staff had received adequate training around autism and felt this affected their ability to manage people and their behaviours effectively whilst out in the community. This was discussed with the registered manager during inspection.
Staff were supported in their role through supervision and appraisals.
We saw that applications to deprive people of their liberties had been applied for appropriately.
People living in Archers Green did not always have access to health care appointments when required. We saw from care files that appropriate referrals were made for health/medical care but relatives told us that medical treatment was not always requested within an appropriate timescale.
People were supported with their nutritional needs. We saw from care files that people were encouraged to maintain a healthy, balanced diet. Staff encouraged people to be involved in the choices made and the preparation of meals provided.
Relatives told us that staff were kind and caring towards people living in Archers Green. We observed staff to be kind and patient with people and interact in a positive, effective manner.
Staff we spoke with were able to explain how they would maintain people’s dignity whilst providing personal care and the importance of treating people with respect.
Relatives were encouraged to express their views and from the care files we looked at we saw evidence that relatives were involved in the decisions about people’s care. When staff conducted reviews of people’s care files, relatives were involved in any changes that were made.
The care records viewed showed that staff encouraged development and independence from people living in the home. They were encouraged to be actively involved in events throughout the day such as cooking, cleaning and personal care.
Care records were based on individual needs and were reviewed and updated regularly. People living with autism each have individual characteristics and behaviour traits; care files that we viewed contained information specific to the individual. People’s support plans provided detailed guidance for staff to provide the right support.
People living in Archers Green were provided with a wide range of activities; we saw evidence that people were supported to access regular activities ; such as the park, swimming, cinema, shopping, sensory centres and trampoline parks.
The registered provider kept a record of complaints for all five of their locations; there were none recorded for Archers Green. However those recorded for other locations did not provide a detailed account of the complaint or how it was dealt with.
Relatives and staff spoke positively about the registered manager and the management team. Relatives told us the registered manager was always approachable and easy to contact and regularly kept them informed of any changes/updates.
The registered manager showed a continued desire to improve on the quality of care and support being provided to people using their service.
We carried out an announced inspection of U&I Care (Archers Green) on 25 September 2015 and contacted a relative of people living in the home on 30 September 2015. It is with the relative’s permission we have included their comments in this report.
At our last inspection in September 2014 the service was meeting the regulations inspected.
The home provided care, support and accommodation for up to three people. At the time of the inspection there were three people living in the home. Two bedrooms had en-suite facilities, and a further bathroom and downstairs cloakroom. There was an open plan kitchen, dining room and lounge area, and a further large lounge on the first floor for the use of people living in the home. People had access to a pleasant garden at the rear of the home and there was car parking at the front of the home for visitors.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received suitable induction and training to meet the needs of people living at the home, and their work was overseen by a senior member of the staff team, the operations manager and the registered manager.
We saw that the experiences of people who lived at the home were positive. The staff had good relationships with people living at Archers Green. We saw they were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. We observed the care and support given to those living in the home throughout our visit and found all the activities were led by those living there and staff supported them with their wishes. A relative told us they had no concerns about the way their family members were treated. Comments included: “Staffing is great”; “They listen to us and work with us”; “Their ethos is spot on”; “They support my daughters to lead a normal life in the community”; “I can call in at any time, and I am always made welcome”.
People’s needs were assessed and care plans were developed to identify what care and support they required. A relative told us they had regular meetings prior to the opening of the home to ensure individual needs had been identified and appropriate support plans had been put in place. We were told staff were “brilliant”; and “we work so closely with staff”. and “I do trust them”.
Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe and effective recruitment practices were followed. People living in the home were unable to engage with us on this matter but we observed them to be relaxed and comfortable around staff. A relative told us that they would know if there was a problem and their daughters would tell them if they felt upset by any member of staff. She said “I do trust them” meaning she trusted the staff.
Staff had an understanding of the systems in place to protect people who could not make decisions and knew how to follow the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
People’s health care needs were met and their medicines were administered appropriately. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.
The people living in the home were involved in planning and cooking their own meals with staff support. Staff supported them to choose healthy options and experience new menus.
The home was clean and well maintained.
There were systems and processes in place to seek the views of people who used the service and their representatives. Regular meetings were held with families and other health care professionals. These meetings and information from these meetings had developed the new service and informed care plans. This demonstrated that it was a learning organisation.
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
This is a summary of what we found-
Is the service safe?
Staff told us they had safe staffing levels such as one to one staff to help them to safely meet the individual needs and choices of each person living at U&I Care.
Staff had received updated training in safeguarding and felt confident in being able to maintain people's safety. Staff told us they would not hesitate to report any concerns that effected the people they supported and were knowledgeable about their safeguarding procedures.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff had submitted an application to the local authority and had followed relevant good practice in identifying any deprivation of liberty including keeping the front door locked for peoples safety. Staff had a good knowledge base regarding these safeguards. These policies were necessary to ensure the protection of vulnerable people who lacked the ability to consent on various issues.
Is the service effective?
One relative told us they were very happy with the care that had been provided to their family member's and they felt their needs were being met and that staff listened to her opinion and advice regarding how to provide individualised support. We observed the support being provided and it was clear the staff were knowledgeable of people's needs, in particular how they communicated with each person and in their rapport and understanding of how each person communicated their needs.
Staff described the support they provided on a day to day basis including supporting each person in what they wanted to do with each aspect of their support. They told us they tried to go out every day and had developed daily plans with each person so they knew what they had planned and could refer to their plan to help remind them of their day.
Is the service caring?
We observed staff speaking respectfully through out our visit, they were friendly and helpful to the people they were supporting. We observed that people being supported were relaxed and happy in the company of their support staff. Two people told us they liked living at U&I care and they liked the staff. We spoke with one relative. They made various positive comments such as:
"I am very happy with the care, we have all worked very hard and worked together to get things right, the staff have really listened, and what's nice is that they ask me what do I think and ask for advice as to how to approach some things"
Is the service responsive?
Each person living at the service had a detailed support plan in place to help show how their needs including health needs would be met. These records were very detailed and regularly reviewed and audited to ensure they were always meeting people's needs. One relative told us they had been fully involved in the development of their family members care and support. The staff had developed various records such as 'mood charts' which helped them to identify individualised support and helped them to gauge people's reactions to new events and activities, especially for those people unable to vocalise their opinions on an activity they had joined in with.
Is the service well-led?
Staff told us they were well supported by the provider. They felt it was a good place to work and they were encouraged to speak openly and could discuss anything with senior managers and in team meetings.
Relatives told us they were always kept informed and updated regarding their relatives support and needs.
A range of policies were in place and accessible by all staff whereby the staff had to regularly sign to say they had read any updates to their policies and procedure's. The organisation and provider oversight of quality checks at the service showed safe systems in place to show good, safe management of this service.
Staff were observed to treat the people using the service with respect and patience and used a variety of communication techniques to support those who were non- verbal.
We saw that the home was clean and tidy and that people who used the service enjoyed keeping their rooms clean. One said 'I tidy up my room and vacuum my carpet.'
We found that people were supported within a spacious comfortable, clean environment which they were able to access fully.
We spoke with and spent time with one person who uses the service. They indicated that they were happy with the service they received.
We spoke to the relative of a person who uses the service. They told us that they were confident that the service was meeting their relative's needs and that they enjoyed their visits; describing the service as "excellent." They told us that if they had a concern they felt they could approach the staff team at any time.
We spoke to two members of staff who demonstrated a good awareness of the needs and wishes of the people they supported.