Archived: Turning Point - 1 Hamilton Road

1 Hamilton Road is a residential care home providing personal care and support for up to two adults who have complex support needs including learning disabilities and / or autism. The home accommodates two people in one adapted building, each person having a separate flat with adapted facilities.

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 were a range of systems in place to assess and monitor the quality and safety of the service. However, these had not always been effective in mitigating identified risks. Safeguarding and staff recruitment processes were not as effective and robust as they should be.

There was a positive, inclusive culture and ethos within the service. The registered manager and staff engaged well with people using the service, their relatives, and external stakeholders.

Staff we spoke with were friendly and caring and treated people with respect.

People’s medicines were stored and well managed to ensure their safe and proper use.

People’s needs were assessed and care and support plans were person-centred and reviewed.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

Records showed people received regular and on-going health checks and support to attend appointments. People's health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

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 demonstrated a good knowledge of people’s individual needs and preferences regarding their support. People were supported and encouraged to be involved in making decisions about their care and support.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 18 August 2018) and there were multiple 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 significant improvement had been made but had not been sustained in all areas and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

1 Hamilton Road is a ‘care home’. People in care homes receive accommodation and their 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.

1 Hamilton Road accommodates two people in one adapted building, each person having a separate flat with adapted facilities.

The care service has largely been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. More work was needed to promote these values including choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a registered manager. 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.

Records relating to premises and equipment safety checks were not all complete.

Staff had not been receiving appropriate support and supervision to carry out their role working with people with complex needs. Supervisions and team meetings were now being scheduled.

Monthly reviews had not been taking place in line with the provider’s policy and were to be re-started.

We have recommended that the provider continues to review the current levels of staff support to ensure both people who use the service receive person centred care and support.

There had been a lack of management stability, which had affected staff morale. Staff we spoke with did not feel informed or that they were listened to and were unsure about some of the management arrangements currently in place.

Quality assurance processes were insufficient to identify and address shortfalls in the service. Action plans were now beginning to be developed to address areas where improvement was needed. An external quality assessor had been commissioned to provide support with this.

Staff understood how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff demonstrated knowledge of people’s support and risk management plans.

There was a programme of initial and refresher training for staff. There had been a lapse in some staff training and competency assessments. Further training and workshops were now being booked.

The service had been recruiting new staff and using agency staff in the interim. The provider was funding specific training for the agency staff to enable them to be effective members of the support team.

Recruitment practices were safe and relevant checks had been completed before staff worked in the service unsupervised.

People’s medicines were stored and managed so that they received them safely.

The service took account of people’s mental capacity and consent.

People were supported to eat and drink enough to meet their needs.

People received regular and on-going health checks and support to attend appointments. People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

Overall the design and layout of the premises met people’s needs.

There was a core group of staff who knew the people they supported well and had developed positive caring relationships with them. People were treated with dignity and respect.

People were encouraged and supported to make decisions about their care and support and staff tried to promote people’s independence wherever possible.

People were supported to maintain relationships with people important to them.

Care plans recorded people’s individual preferences and the core group of long-term staff knew people well.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.