Aspire in the Community Rushbrooke House

Aspire Community Support Services is a residential care home for 6 people with learning disabilities.

The home consisted of two buildings, the main house which can accommodate four people and a detached bungalow which can accommodate two people with more behaviours that challenge. At the time of the inspection four people were living at the service.

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

People said they felt happy and safe at the service; they were calm, settled and had good relationships with the staff. Actions were taken to protect people from the risk of abuse or neglect and concerns were raised to the appropriate partner agencies.

Medicines were managed safely and staff had a good knowledge of medication systems. Risks to people’s health, safety and wellbeing were assessed and steps were in place to minimise incidents. Where incidents did occur, the service sought to learn lessons to minimise similar situations re-occurring. There were enough staff available to support people living at the service.

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 people with autism 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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autism.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People were living active healthy lives with support from staff at the service. People were supported to maintain choice and control over their lives. People were supported to pursue areas of interest. People were supported to have choice and control over their care following the Right Support, right care, right culture principles.

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 12 May 2020) and there were four 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part, by notification of a specific incident, following which a person using the service died. We are making further enquiries separately regarding this incident. As a result, this inspection did not examine the circumstances of the incident. We also checked the providers compliance with the warning noticed issued at the last 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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We have seen improvements in the well-led and safe domains. Last time these were rated as requires improvement. Following our recent inspection, these have been rated as good. On the last inspection, the service was rated good in caring, requires improvement in effective and required improvement in responsive. Although these areas were not reviewed at this inspection, the ratings for these key questions were used in calculating the overall rating at this inspection. As effective and responsive remain requires improvement, the overall rating for the service has remained required improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aspire Community Support Services on our website at www.cqc.org.uk.

Aspire Community Support Services is a care home for people with learning disabilities. 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 home consistent of two buildings, the main house where four people live and a detached bungalow which houses two people with more complex behavioural needs. At the time of the inspection six people were living at the service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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 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 layout of the building and general setup was conducive to person centred support and we saw this led to all aspects of people’s care being planned on an individual basis, although we found some care quality issues within the bungalows which are explained below.

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

Overall the service applied the principles and values of Registering the Right Support and other best practice guidance although improvements were needed within the bungalows to ensure this was consistently applied. These principals ensure people who use the service can live as full a life as possible and help achieve the best possible outcomes that include control, choice and independence. Better management and oversight of people’s activities, diet and behaviour was needed within the bungalows to ensure people received the best possible outcomes.

People said they felt safe living in the home. Action was taken to protect people from abuse, however some incidents were not reported to the relevant bodies. Risks to people’s health and safety were assessed however, following incidents and staff raising concerns, there was sometimes a lack of evidence of preventative measures put in place. Medicines were managed in a safe and proper way. There were enough staff deployed to ensure people’s needs were met.

Staff in the bungalows needed more support to help manage the needs of people who lived there. People had access to a range of food based on their choices, however nutritional needs were not consistently met in the bungalows. Overall 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.

Staff were kind and caring and treated people well. The service listened to people and treated them with dignity and respect. People’s independence was promoted although some people needed more structured goals and objectives.

People’s care needs were assessed. Reviews and evaluations of people’s care took place, however this process was inconsistent within the bungalows. The service was responsive to dealing with concerns and complaints. People had access to a range of activities although better oversight and review of these was needed within the bungalows.

People and relatives said overall the service provided good care. Staff morale was mixed with staff requiring more support within the bungalows. Whilst we found some very positive aspects of the service, systems and processes within the bungalows needed improving to ensure the service was not in breach of regulation. People who use the service were listened to and their views valued.

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 20 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Is the service Safe?, Is the Service Effective?, Is the Service Responsive?, and Is the Service Well-Led? Sections of this full report.

Most of the concerns we raised were already known by the provider and manager and a plan was in place to address these. We saw positive action had been taken to address some areas of our concern by the second day of our inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to management of safeguarding incidents, meeting nutritional needs, staff support, governance of risk and the lack of reporting incidents to CQC. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve the service. 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.

Aspire Domiciliary and Respite Support Service provides residential care for adults with learning disabilities, who may have behaviours that challenge and associated complex needs. This service is also registered to provide care to people in their own homes. At the time of our inspection, no one in receipt of this service required personal care.

At the time of our inspection 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.

One person and a relative told us they felt the service provided safe care. Notifications were routinely submitted to the Care Quality Commission as required as a condition of registration. However, we found one incident which took place in January 2017 had not been reported. We recommended the registered provider review systems for reporting such incidents.

Based on feedback from relatives, staff as well as our observations during this inspection, we identified there were adequate staffing levels to meet people’s needs. Recruitment was appropriately managed as relevant background checks had been completed to ensure staff were safe to work with vulnerable people.

Risks to people had been identified, assessed and reviewed. The home was clean and tidy and records showed regularly scheduled maintenance had been completed. This included all relevant fire safety checks.

Staff completed an induction and received ongoing support through a programme of supervision and training. The process for carrying out annual staff appraisals had commenced before our inspection took place.

Staff were caring and compassionate and engaged people in friendly interaction, respecting their preferences and communication style. Relatives told us staff respected people’s privacy and dignity and staff were able to describe how they managed this. People’s cultural, religious and sensory needs were met by staff at this service. People had been referred to advocacy services for additional support in decision making.

People were given choice by staff as part of their daily routines. This included meal planning and preparation. Staff encouraged people to take part in activities in the community and we saw evidence that this happened.

Mental capacity assessments and Deprivation of Liberty Safeguards (DoLS) were documented in care records. Care plans were found to be person-centred and contained details about people’s routines and their care preferences. These were regularly reviewed.

Staff were pro-active in ensuring people were supported to access healthcare services and shared recent examples with us. We looked at the management of medicines which we saw were stored and administered appropriately. Records showed staff had received medication training. The registered provider had identified the need to carry out staff medication competency checks. People received their medicines as prescribed.

Complaints were suitably managed. Feedback from a recent survey for people and their relatives showed high levels of satisfaction.

Quality management systems were effective as audits were detailed and covered the requirements set out in the health and social care regulations. Action plans were created with identified timescales and these were followed up as part of subsequent audits.