Ulysses House

Ulysses House is a residential care home which can support up to 6 people. At the time of the inspection Ulysses House was providing personal care to 5 people aged under 65 with learning disabilities. The service can support up to 6 people. While the service was a large home and bigger than most domestic style properties, the environment was adapted in line with Registering the Right Support. There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

We expect health and social care providers to guarantee people with a learning disability and autistic people have 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.

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

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. However, care plan reviews and best interest meetings undertaken required improvement to ensure the people, their relatives and advocates were involved in decisions and development of their care.

The provider gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Where people wanted support, staff enabled people to access specialist health support. Staff supported people with their medicines, however procedures currently in place required improving to ensure medicines were stored and managed safely.

Right Care:

People received kind and compassionate care. Staff understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People told us they received support from staff who knew them well and understood how to keep them safe. People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing

Right Culture:

People received good care because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, placing people’s wishes, needs and rights at the heart of everything they did. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Risks of a closed culture were minimised by staff so that people received support based on transparency, respect and inclusivity.

The manager demonstrated a commitment to delivering improvements and achieving best outcomes for people.

Rating at last inspection and update

The last rating for this service was good (published 01 April 2020).

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

Why we inspected

We received concerns in relation to the management of the home and staffing. As a result, we undertook a comprehensive inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to regulation 12, safe care and treatment at this inspection. We have served a requirement notice to the provider to improve in this area.

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.

Ulysses House is a residential care home which can support up to six people. At the time of the inspection Ulysses House was providing personal care to five people aged under 65 with learning disabilities. The service can support up to six people. While the service was a large home and bigger than most domestic style properties they had worked to adapt the environment in line with Registering the Right Support by considering the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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 living in the service were safe. The provider assessed known risks presented by people and developed appropriate measures to protect people from harm. We found the recruitment processes was thorough and staff were recruited safely. People received their medicines as prescribed and medicines were stored safely. We saw the home was clean and free of odours. Any incidents and accidents that occurred in the home were recorded and monitored for trends to reduce the likelihood of reoccurrence.

The manager was new in post though had made a positive impact on the moral and supported staff to be able to deliver good care to people. The manager was part of the team and visible to all staff and people living in the service. Clear expectations about the quality of care delivered were apparent through the systems implemented by the manager. People and their families were involved as much as possible in the care delivery. The manager worked effectively with external professionals to ensure positive outcomes. The manager understood and adhered to their duty of candour to be open and honest with people and their families when things went wrong.

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.

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 Outstanding (published 05 September 2018)

Why we inspected

We received concerns in relation to the management of staffing, risk and incidents. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Outstanding to Good. This is based on the findings at this inspection.

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.

At the last inspection on 27 November 2015 this service was rated good in all five key questions, and before that the home has a sustained a history of compliance with legal requirements.

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. People living at Ulysses House could live a life as fully as they were able in a homely environment that had been created to meet their needs.

On the day of our inspection visit 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 was run.

Information about people’s care was provided in format that they found accessible and they could understand. The service was extremely well led. There was a strong person-centred ethos which meant that people were empowered to have choice and control over their lives. The registered manager provided strong and stable leadership and clear direction to the staff team. Staff felt supported and valued.

There were effective systems to monitor the quality and safety of the service provided that placed an emphasis on the quality of people’s lives. These systems were used to continue to drive improvements in the service and the care people received.

The service provided at Ulysses House was extremely person-centred and the staff were passionate about caring for people. We saw that without exception people at the service and relatives were treated with kindness by a staff team that were passionate about providing care to people who they considered to be like family members. Staff supported people with respect and dignity, and had developed some extremely positive relationships with people that were based on respect and trust.

People could maintain relationships with people who were important to them. Relatives we spoke with felt their views and opinions about their loved one’s care were always listened to so that they felt involved in their loved one’s care.

People received care that met their individual needs, people’s views and preferences were sought and staff made exceptional efforts to provide a service that empowered people to develop and live a life that they enjoyed. Staff understood people’s unique methods of communications so that they could meet their needs and involve them in all aspects of their care.

Staff sought consent from people before caring for them and they clearly understood and followed the principles of the Mental Capacity Act, 2005 (MCA). Where people were deprived of their liberty, processes had been followed to ensure that this was done lawfully. Staff understood people’s unique communication styles and ensured that the views of people with communication difficulties were captured and acted upon.

People were protected from the risk of harm because there were robust processes to ensure their safety. Staff all knew and understood their responsibilities in relation to protecting people from abuse and had had received the training they needed to do this. The registered manager had fulfilled their legal responsibilities and had reported any issues to the local safeguarding teams and CQC. Where incidents had occurred, processes ensured lessons were learnt and actions taken to reduce the risk of the situation reoccurring. People were protected from harm because the risks to their safety were clearly identified and measures in place to reduce these risks.

People were supported by enough well trained and competent staff who knew people extremely well. The registered manager followed robust recruitment checks to ensure that staff employed were suitable to support people using the service with all aspects of their care. People’s medicines were managed safely and people were protected from the risk of infection.

People’s individual needs were assessed and there was clear and detailed guidance available for staff about how to meet people’s needs. This meant that staff could gain an excellent knowledge and understanding of how to provide effective support. Staff’s training included what the provider considered mandatory to the specific role, as well as more specialist training to ensure staff had the skills to manage the different aspects of people’s care.

People were supported to have enough to eat and drink and to manage their health needs and saw health professionals regularly as needed. Staff implemented the guidance that was provided by health care professionals to support people to meet their health needs and stay well.

There were four health professionals visiting the home during our visit. Amongst their comments were: "The manager and staff are energetic and have insight. They do a great job in not the easiest environment," "They give us information and they are open and welcoming" and "I have visited at the weekend. Staff are welcoming and there is a well-controlled atmosphere." We saw good interactions between the people that lived in the home and the staff and manager when issues arose during the day.

People had individual care plans and where possible signed these plans to say they agreed with their content. Risks were identified and plans were put in place to keep people as safe as possible. Risk assessments were updated when incidents occurred so that known risks could be appropriately managed.

There were enough staff on duty to ensure that people had opportunities to attend activities as well as meeting their other needs. Staff told us they were well trained and felt supported.

We saw that people that lived in the home had a good relationship with staff. There were appropriate systems in place to identify when people were unhappy and to try and resolve their concerns.

At this visit we found all areas of the home had been redecorated and repairs had been attended to. A contract had been put in place with a local firm to ensure that repairs could be attended to in a timely manner.

Although people living in the home were not at the home at the time of our visit we saw that each person's bedroom had an individual style and evidence of their interests. All communal areas of the home looked appropriately decorated and comfortable.