Swindon Family Breaks Service

Swindon Family Breaks Service provides short break services to people with learning disabilities, and supported living to people in specially designed bungalows and people's own accommodation in Swindon. The short break service is registered to provide accommodation and personal care for up to 14 people. There were 2 people using the short break service and 7 people using the supported living service at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People’s care and support was provided in a well-maintained environment. At the time of our inspection refurbishment work was taking place. The provider had ensured this work did not impact on the safe running of the service.

People were supported to take part in activities and interests. The registered manager was exploring more resources in people’s local area to widen the range of activities available.

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.

People were supported to take their medicines in accordance with their individual needs and preferences.

Right Care: People were able to communicate with staff and understand information given to them by staff who supported them consistently and understood their individual communication needs.

Right Culture: The registered manager and senior staff modelled good practice and led by example. People received good quality care, support and treatment from trained staff who were able to meet their needs.

The registered manager regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

Quality assurance processes included a variety of audits. The systems had been strengthened and the registered manager had a clear oversight of the service and how to sustain and develop ongoing improvement.

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 (31 August 2022).

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 regulation 12, safe care and treatment.

At our last inspection we recommended the provider introduced appropriate systems of escalating internal and external safeguarding concerns and ensured all staff were aware of those processes. At this inspection we found the provider had made improvements.

Why we inspected

We carried out an unannounced inspection of this service on 7 July 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swindon Family Breaks Service on our website at www.cqc.org.uk.

Follow up

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

Swindon Family Breaks Service provides short break services to people with learning disabilities, and supported living to people in specially designed bungalows and people’s own accommodation in Swindon The short break service is registered to provide accommodation and personal care for up to 14 people. There were four people using short break services during our inspection. There was one person receiving the regulated activity of personal care in the supported living service during this inspection.

Not everyone using the service received personal care. CQC only inspects where people receive personal care, which is help with tasks relating to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

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.

Right support:

People's care plans were not always up to date and did not always reflect their current needs. The service gave people care and support in a safe, clean, well equipped and well-furnished environment. However, certain health and safety checks had not been completed in line with the provider’s policies. 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 supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. People were protected from the risk of infection. People were treated with dignity; their privacy was respected and they were supported to be as independent in their care as possible.

Right care:

People’s care, treatment and support plans did not always reflect their range of needs and this did not always promote their wellbeing and enjoyment of life. Staff understood how to protect people from poor care and abuse. However, systems to protect people from abuse required improvement. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People who had individual ways of communicating, using body language, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture:

People and those important to them, including advocates, were involved in planning their care. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. Staff placed people’s wishes, needs and rights at the heart of everything they did.

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 30 March 2018).

Why we inspected

We received concerns in relation to a safeguarding incident and end of life care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of 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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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 safe care and treatment 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.

We found the following examples of good practice.

A sanitising station had been set up at the entrance of the service so that hands could be cleaned, shoes disinfected and temperature taken before staff and visitors entered the building.

Visitors to the service had to complete a lateral flow device test (LFD) to check whether they were spreading COVID-19. LFD can be used for visitor testing, including visiting professionals who are not part of a regular testing programme.

Staff followed government guidance in relation to personal protective equipment (PPE) and infection prevention and control (IPC) practice. The service had a sufficient supply of PPE and stock levels were monitored by the registered manager and the provider.

All staff had received recent training in infection control and prevention (IPC) and were seen to be following correct IPC practices at all times, including social distancing.

Staff socially distanced from their colleagues and people as much as they were able. There was a one-way system implemented in the service in order to minimise the risk of infection.

People were supported to keep in touch with others who were important to them in a variety of ways, including video and telephone calls.

People were provided with information about infection prevention control in their preferred method of communication. We saw there were pictures on how to use hand gel on each sanitizer. Social stories were and posters were used to provide crucial information to people.

The environment was clean and hygienic. Cleaning schedules had been increased to ensure touch surfaces were cleaned regularly and additional cleaning was provided to maintain good hygiene standards.

The registered manager ensured regular Covid-19 testing was carried out for staff and people living at the service.

A business continuity plan was in place to reduce the effects of potential disruption to people's care. There were policies and procedures to provide guidance for staff on safe working practices during the pandemic.

Not everyone using Swindon Family Breaks Service receives regulated activity; the CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

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. 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.

People told us they felt safe at the home and they liked the way staff supported them. People’s relatives told us they were happy with the way people were looked after and they felt the service was safe and met peoples` needs. People were protected from the risk of abuse. Staff had received safeguarding training and understood their responsibilities to report any concerns.

Accidents and incidents were managed safely. Any identified trends were discussed with staff and steps were taken to reduce avoidable harm. People's medicines were managed safely by staff who had been trained and assessed as competent in administering medicines. People received their medicines as prescribed.

People were protected from the risk of infection. Staff had attended food hygiene and infection control training and wore personal protective clothing when required. There were effective and up-to-date systems in place to maintain the safety of the premises and the equipment.

People and staff told us there were enough staff to meet people’s needs and support them with the activities they chose to do. Robust recruitment systems were in place which ensured staff were of good character and suitable for their roles.

Contingency plans and evacuation procedures were in place to manage emergencies, and staff were aware of them.

People were supported by staff who were appropriately trained and received regular supervision. Staff had a clear understanding of the application of the Mental Capacity Act 2005.

People's needs were assessed before they began using the service. People were encouraged to eat a healthy, balanced diet and they were provided with access to healthcare professionals when needed.

Personalised care plans were in place for people using the service. Staff knew the people they were supporting and their preferences were recognized to ensure personalised support was delivered. Staff had a good understanding of how to promote people's privacy, independence and dignity.

Most of people and their relatives were happy about the way they spent time at the service.

Complaints procedures were available and displayed throughout the home in a pictorial format. People and relatives knew who to speak to if they had a complaint.

People, their relatives and staff described the new management team as approachable and committed to ensuring people's needs were met. Staff felt supported by the registered manager. They told us that recent changes in the management structure had impacted positively on their morale motivating them to work as a team.

There were effective quality assurance systems in place to ensure the quality of care delivered was monitored.

There was a registered manager in post at the time of our inspection. 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.

People did not receive appropriate care to make sure they were safe at night. Records concerning risks to people's health and safety did not always provide accurate information on how to manage these risks. Some of the information contradicted other information specified in people’s care plans. Steps to manage risks were not always taken.

People felt safe living at the service and staff knew how to protect people from the risk of abuse. The provider's whistleblowing policy protected staff to make disclosures about poor staff conduct or practice, and staff confirmed the registered manager would take a responsive action if they reported such problems.

People’s prescribed medicines were safely managed by staff. Relevant systems and protocols in place ensured people received their medicines as prescribed. Staff’s competence was reviewed regularly to ensure medicines were administered safely at all times.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role. Staff had received induction when starting employment.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

We found the Mental Capacity Act (2005) (MCA) was followed correctly to protect people who were not able to make their own decisions about the care they received.

People were provided with sufficient amounts of food and drink, with all recommendations from health care professionals taken into account. People had access to healthcare professionals should this be necessary. Appropriate health services were contacted when necessary to help people maintain their health.

People were encouraged to be independent and their privacy and dignity were respected. Each person had a personalised care plan in place containing information about their likes and dislikes as well as their care and support needs. The care plans were updated in line with changing needs and people and their relatives were involved in making decisions regarding people’s care.

The service was responsive to people’s needs. People, their relatives or representatives were involved in care planning and reviews. The care plans we reviewed were person-centred and contained unique information about people and how to meet their needs. People were given key information about the service. There were activities people could participate in if they chose to do so. The provider had a complaints procedure and system in operation.

The systems in place to monitor the quality of the service were not fully effective and did not always identify where care being delivered was not safe. There was a positive and transparent culture in the home and people who used the service and staff felt able to raise any issues with the registered manager. There was a range of means people could provide feedback about the service and their comments were acted upon.