Newtown (65a)

65a Newtown is a residential care home providing personal care to two people with autism and / or learning disabilities at the time of the inspection. The service can support up to three people.

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

The provider did not have robust contingency plans for providing a safe service when they were short of staff. The contingency plan did not set out any rationale for the assessment that the service was safe with one member of staff in the building.

Staff had a good understanding of the support people needed. Staff were supporting people to do as much for themselves as possible.

People were supported to take any medicines safely and staff sought advice from health services when necessary.

The provider had made changes in response to the COVID-19 pandemic and there were good infection prevention and control measures in place.

People had been supported to develop detailed support plans, which were person-centred and gave staff clear information on how to meet their needs.

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. Not all key questions were inspected at this time, but the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture in relation to the Safe and Well-led key questions.

Right support: People and their representatives were involved in the creating support plans and regularly reviewing them. The service supported people to be as independent as possible.

Right care: We did not look at the caring key question at this inspection. However, we did observe some interactions between people and staff. These demonstrated genuine care for people from staff. People appeared comfortable with staff and enjoyed their company.

Right culture: People living at the service were valued for the individuals they were. People were supported to be involved in the daily running of the service and their wider community.

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 January 2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about staffing levels. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 65a Newtown on our website at www.cqc.org.uk.

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.

65A Newtown provides care and support for three people who have autistic spectrum disorder and is a ‘care home’. 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 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.” Registering the Right Support CQC policy.

A registered manager was 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.

There were people that used non-verbal language. While their communication plans stated they used pictures and object of reference to communicate, their care plans and information was not in their preferred method. For example pictures. The registered manager said equipment was now available to provide information in picture format.

Quality assurance systems were in place and where shortfalls were identified action plans were developed to meet the set standards. While audits had identified people’s views were not formally gathered action had not been taken to introduced on how to gain feedback about the service. processes.

We observed the people at the service accepted staff support and approached staff for attention. The staff we spoke with said they had attended safeguarding training. They knew how to identify abuse and the procedures for reporting their concerns.

Risk assessments were in place for people with medical conditions such as epilepsy and for people that showed anxiety through verbal and physical aggression. Action plans gave staff guidance on the actions to take to ensure people were protected from harm and were able to take risks safely. Staff were aware of the actions needed to minimise risks to people.

Incident and accidents reports were completed and analysed for patterns and trends.

Staff told us there was some lone working but mainly two staff were on duty. The rota showed that two staff were on duty during the day and at night there was one waking staff. The registered manager said two staff were mainly on duty to allow for people to go out during the day and evening.

Medicines were audited which included the stocks held and medicines ordered. We saw medicine administration records (MAR) were signed to indicate medicines administered. Some people were prescribed ‘as and when required’ (PRN) medicines for pain and to reduce agitation. We saw for one person the medicine care plan stated that the person may not tell staff when they were in pain and staff needed to look for changes in behaviour as the person may be in pain. The member of staff took immediate action and included how staff were to identify the person was in pain into the support plan.

Staff told us the training was good. There was mandatory training which staff we spoke with said they had attended. One to one supervision was with the line manager. The member of staff on duty had not had regular supervision although the line manager had made attempts to organise them. The registered manager said this was to be addressed. Discussions with the member of staff were to take place.

Staff knew the day to day decisions people were able to make. We saw people’s capacity to make decisions about their care and treatment was assessed. Where people lacked capacity best interest decisions were taken.

The people at the service had support with their healthcare needs. People were registered with a GP and had annual health checks. There was specialist support from epilepsy nurses and psychiatrists. Hospital passports were in place which included key information to medical staff on how to care for people in the event of an admission.

We saw good interactions between people and staff. Staff knew people well and ensured objects were positioned in a way that supported people’s need for structure and routine. Members of staff guided inspectors to ensure people’s need for consistency was not disturbed. For example, allowing one person to carry out a task undisturbed in the kitchen.

Care plans were person centred. One person told us sometimes they looked at their care records. Care plans included people’s preferences, their ability to manage their care and the support needed from the staff. Arrangements were in place for people to have in-house activities, one to one outings and trips in the local community.

The complaints procedure was kept in people’s files. The procedure was in accessible format.

We made recommendations about people's accessible information and about ensuring feedback from people is gathered.

Staff we spoke with were knowledgeable about the people they cared for. They emphasised the importance of understanding people's routines, non verbal communication and behaviour to anticipate need. Staff had received the appropriate training to care for people safely and effectively. People were relaxed in their home. They had an activity programme which promoted their independence and reflected their personal interests.

We found people had the appropriate support to make decisions and consent to care.

The provider had an effective system in place to ensure people received appropriate support and care provided by other health and social care services.

People's records were up to date, were regularly reviewed and were an accurate reflection of the care and support need and received.

People's privacy and dignity were respected. Their independence and involvement in the community was promoted by regular social activities and responsibilities within the home.

Staff were knowledgeable about people's lives. We observed staff understood people's individual routines and the impact on behaviour if routines were disrupted.

We saw risk assessments and support plans had not been updated regularly. Monthly keyworker reviews had not been completed for some months.

People were involved in choosing the menu. One person told us "the food is great." Food looked tasty and a well balanced menu was offered.

Staff were confident in their understanding of what constituted abuse and their role and responsibilities in the reporting process.

During the visit we saw there were enough staff on duty to take people out for their regular activities and provide the care needed.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.