Littleton House Also known as Crowne Home Care Limited

About the service

Littleton House is a support living service, providing personal care to 20 people at the time of inspection. The service provides support to people who have a learning disability or physical disability.

There were six houses, containing individual flats. Each person had their own bedroom and bathroom facilities. Each house contained a shared communal lounge and kitchen area.

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

People received a service that was safe and well-led. There were systems in place to monitor the quality and safety of the service.

Infection prevention and control practices were safe and spot checks were carried out by the management team.

People were supported by staff who knew them well. Staff received relevant training and knew how to recognise and escalate safeguarding concerns. Peoples medicines were managed safely, and staff had been recruited safely.

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.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were support to have maximum choice, control and independence. Care was person-centred and promoted people’s dignity, privacy and human rights. The ethos, values and attitude of the management team and staff ensured people lead confident, inclusive and empowered lives.

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 September 2021) and there was a breach 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the safeguarding of people using the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Whilst undertaking this inspection we assessed whether the service was applying the principles of right support, right care and right culture.

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. 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 requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Littleton House 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. If we receive any concerning information we may inspect sooner.

Littleton House is a supported living service providing personal care to 20 younger people, at the time of the inspection, some of whom have a learning disability or may have a physical disability.

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

People had not received a service that was consistently well led. Whilst there were systems in place to monitor the quality and safety of the service, we found these needed further improvement.

Whilst many aspects of infection prevention and control (IPC) practice were safe we determined further improvement was needed in formalising some areas of checks that were carried out.

People were supported by staff who were knowledgeable about how to recognise and escalate safeguarding concerns. People’s medicines were managed safely and people were supported by staff who had been recruited safely.

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.

Based on our review of Safe and Well-Led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

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 26 February 2019)

Why we inspected

We received concerns in relation to visiting restrictions at the service and hours of support people received. 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 Good to Requires Improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Littleton House 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.

This service provides care and support to people living in six separate supported living settings, so that people can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The office is onsite of the supported living homes, so we were able, with people’s permission, meet and speak with them during our visit.

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.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. The report was published 01 February 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

People’s experience of using this service:

• People continued to tell us they felt safe and well supported.

• Staff had a good understanding in how they protected people from harm, and recognised different types of abuse and how to report it.

• Potential risks to people had been identified and people had involved with decisions in how to reduce the risk of harm.

• There were enough staff on duty to keep people safe and meet their needs.

• People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

• People’s care continued to be assessed and reviewed with the person involved throughout.

• People were supported to have a healthy balanced diet and were given food they enjoyed.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

• Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

• Staff treated people as individuals and respected the choices they made.

• People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team.

• People were supported and encouraged to maintain their hobbies and interests.

• People had access to information about how to raise a complaint, where complaints had been received the provider had managed these inline with their policy.

• The registered manager was visible within the service, they spent their time listening to them.

• The checks the registered manager made to ensure the service was meeting people’s needs focused upon people’s views and experiences.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This service is registered to provide personal care to people in their own homes. At the time of the inspection the service was providing care and support to 20 people who lived in shared accommodation on the same site as the location of the office for Littleton House. Some people were receiving 24 hour support and others received fewer hours of support each day, according to their assessed needs and level of independence.

A registered manager was employed at the service. 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.

Staff were trained in recognising possible signs of abuse and they knew how to report any possible suspicions to the relevant authority. Staff demonstrated awareness of possible warning signs of safeguarding concerns and the action to take. All of the staff we spoke with told us they were confident that if they reported any safeguard concerns to the manager they would be dealt with appropriately. Action had been taken to respond to concerns about staff practice but the local authority had not been notified of these issues.

People were usually supported by staff who were familiar with their needs but there was some use of agency staff to cover staff vacancies. Staff were recruited appropriately and there were sufficient numbers of staff to meet people’s needs. People’s medicines were safely managed and administered by staff who had received training and had been assessed as competent to administer medicines.

Staff had received induction training when they first started to work for the service and received on-going training to make sure that they continued to have the skills to provide people with appropriate care and support.

People were supported to eat enough food and drink by staff who understood their nutritional needs. People's health was supported by access to a variety of health professionals.

People said staff were caring and that they had built up close relationships with the members of staff who supported them. People told us they were able to make everyday choices for themselves. People and, where appropriate, their relatives were consulted about their preferences and people were treated with dignity and respect. Improvements were needed to make sure people’s privacy was consistently respected. Staff we met spoke enthusiastically about the people they were supporting, and were able to explain people’s needs and preferences.

Staff we spoke with told us the registered manager was friendly and supportive, however two care professionals described two examples where they felt the practice of the registered manager could be improved. We saw there was a process for staff to contact the registered manager during out of hours if they required additional support or guidance.

People who lived at the home, their relatives and staff were encouraged to share their opinions about the quality of the service and there were effective systems in place if people wished to make a complaint.

Improvements were needed to how the service was managed to include systems for responding to incidents and some aspects of record keeping. The registered manager showed us that the provider has recently purchased a new care planning and quality assurance package and told us it was intended to fully complete this process by February 2016.

During our inspection we spoke with the registered manager, business manager, two care workers, two people who received support from the agency and the relative of a person who received support from the agency.

People expressed their satisfaction with the service they received. One person told us that the staff who supported them were 'nice.' Both people who used the agency told us that staff supported them to participate in lots of activities. A relative of a person using the service told us, 'It's absolutely brilliant. Staff are always on time and there have been no issues.'

During the inspection we looked at two people's care records. It was not evident that care was always planned in a way that ensured people's safety and welfare.

Recruitment practices needed to be improved. The arrangements for ensuring staff were of good character were not always robust.

Staff told us that they felt well supported in their role. They told us that they found the manager approachable and that they were able to call the office if they had any concerns.

People using the service had opportunities to express their views about the service they received.