Cypress Road

Cypress road is a respite service providing accommodation for up to 4 people, who require personal care. The service has approximately 25 people who access the service over a 12-month period. The service provides support to people who have physical health needs, learning disabilities and autistic people. At the time of our inspection there were 2 people using the service.

The service is set out across 1 floor, with capacity to separate the service in to 2 units. There is a kitchen, dining room, lounge, communal bathroom and sensory room dividing the 2 units. Each bedroom had an en-suite facility. The service had an office with a sleep-in facility for staff.

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 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's support needs and risks were assessed to identify how their care could be provided safely.

Right Care:

People received kind and compassionate care. Staff had received appropriate training, knew people well and supported them in line with their preferences. People’s care plans were detailed and reflected people’s choices. Peoples medicines were managed safely.

Right Culture:

Feedback from people, relatives and staff was mostly positive about the care received. Care provided was person-centred and people were encouraged to make decisions around their care. The service worked in partnership with other health and social care professionals to ensure people’s care was effective. The provider was working to improve the culture at the service and the robustness of newly implemented governance processes, including more regular and robust audits.

We have made a recommendation about the embedding of governance processes.

Recruitment was managed safely. The service was well maintained and accommodated people’s physical and sensory needs. The service had not received any formal complaints but had a process in place to support this.

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 09 December 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Why we inspected

We undertook this focused inspection 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 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 Cypress Road on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about embedding newer quality assurance processes to improve the culture and governance at the service.

Follow up

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

Cypress Road is a respite service providing personal care to four people at the time of the inspection. The service supports up to 30 people over the course of a year with varying amounts of respite.

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

There was a lack of effective provider oversight. The concerns identified in the audits had not been addressed quickly enough and demonstrated a lack of rigour. This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 good governance.

Risk management needed to be more robust as it relied on staff’s knowledge and length of time in service rather than being documented in full. Staffing levels were sufficient but the lack of drivers impacted on people at weekends when activities were more limited.

The registered manager was trying to develop improvements but there was a lack of overall direction for the service as they were sharing their time between two services. The vision for the service was unclear. The internal environment was tired, but plans were in place with the building’s owner to refurbish. Rooms were adaptable and could be altered according to people’s needs and wishes. The outside area was very accessible and geared for people’s sensory needs.

We observed positive interactions between people and staff. Staff were friendly, supportive and attentive, and respectful of people’s dignity. Staff felt supported and said they access to training and supervision, although the latter was not always individual. Communication between staff was good and work practices were reviewed and reflected on which showed a culture of wanting to change and improve. Medicines management was safe.

Staff could recognise possible signs of abuse and knew how to report such concerns. 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.

Care documentation reflected people’s needs but the service needed to consider how to better involve people and make records more accessible as they had for other parts of the service. Quality assurance systems did assess overall service delivery but had demonstrated reduced levels of performance due to pressures on time. However, all issues had been addressed at the point of inspection.

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 25 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified a breach in relation to provider oversight 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cypress Road is a registered care home providing 24 hour respite support up to four adults with a learning disability for a maximum of 56 days in one calendar year.

The service does not provide nursing care.

The service had 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 were treated with dignity and respect and staff interacted with people in a kind, caring and sensitive manner. People were protected from harm. Staff knew what to do if they were concerned people were not safe. Risk was well managed across the service. Where people were assessed to be at risk there were practical and effective measures in place to keep them safe.

There was a regular and consistent staff team. The provider had appropriate recruitment checks in place which helped to protect people and ensure staff were suitable to work at the service. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported in their role and we saw that staff had received training and formal supervision had been regularly provided.

We found that detailed assessments had been carried out and that the care plans had been developed around each individual's needs and preferences. People and their relatives told us they agreed the care plans and were fully involved in making decisions about the support delivered.

People were happy and relaxed with staff. Systems were in place for people to raise concerns and they could be confident they would be listened to and appropriate action would be taken.

People's medication was well managed and this helped to ensure that they received their medication safely. They were supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice. People participated in a range of activities within the home and in the community and received the support they needed to help them to do this.

People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians.

The provider had effective quality assurance systems in place. People and their relatives were encouraged to feedback on their experiences and staff tried to involve people where possible in day to day decisions and the running of the service.