1 Lansdowne Road

We found the following examples of good practice.

Staff followed safe and robust visiting procedures. People could nominate three named visitors, and the essential care giver role was available in addition to this. The registered manager and the operations manager told us communication had taken place with people, and relatives, surrounding the role of the essential care giver. When safe to do so, and in line with guidance, staff welcomed named visitors to the care home.

Visitors were required to produce a negative rapid COVID-19 test prior to visiting their relative. Additionally, health declaration and temperature checks were completed. We saw evidence of these procedures in place. Additional communication methods, such as telephone calls, video calls, and email contact supported communication between relatives, people and staff.

External health and social care professionals, and visitors, evidenced COVID-19 vaccination status, and had to produce a negative rapid COVID-19 test before entering the care home. Furthermore, health declaration and temperature checks were completed. The only exception to this was for emergency workers, to ensure no delay of their review and care for people.

Personal protective equipment (PPE) was available at the care home, and guidance for PPE usage was displayed. Staff wore PPE correctly, and were seen to work safely throughout the inspection visit.

The care home was visibly clean and hygienic. Frequently touched areas, such as door handles and handrails, received enhanced cleaning. Staff told us they had access to the required equipment, and cleaning products, to maintain a safe environment.

1 Lansdowne Road is a care home that provides personal care to people with a learning disability and/or autistic people. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. At the time of inspection, 12 people were living at 1 Lansdowne Road.

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

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 the key questions of Effective, Caring, Responsive and Well-led, The service was somewhat able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

1 Lansdowne Road is larger than average for a care home supporting people with a learning disability and autistic people. As a domestic property, the building fitted into the local residential area and there was nothing outside to show it was a care home. People were provided with care that promoted their dignity, privacy and human rights. However, whilst the size of the location did not impact on the ability of the service to meet people’s basic care needs, the provider had not fully considered how to maximise people’s choice, control and independence.

Since the last inspection, some improvements had been made and people were now being given more opportunities to develop their independence, such as by helping with household tasks. However, work was still required to identify and support people to achieve their goals and aspirations. This had been identified by the provider during a recent audit and steps were being taken to address this. For example, a key worker system was being embedded at the service to further enhance the person-centred care provided and increase focus on the outcomes for the people supported.

We have recommended the service reviews the ‘Right support, right care, right culture’ guidance and considers the ways in which it can further promote person-centred care, which promotes choice, inclusion, control and independence.

People were not able to tell us in detail about their experiences of living at 1 Lansdowne Road. However, they appeared relaxed in the presence of staff and comfortable with the support they received. Both relatives and staff reported an improved, person centred culture at the service since the last inspection.

People were supported by trained staff, who felt supported by the management team. People’s healthcare and nutritional and hydration needs were met, and staff ensured they liaised with external professionals, where required.

The provider’s governance systems were effective in identifying the improvements required at the service and plans were in place to action the issues recorded.

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 Requires Improvement (published 14 June 2019).

Why we inspected

This was a planned inspection based on our ongoing monitoring of the service. We undertook a focused inspection to assess any improvements the provider had made. This report only covers our findings in relation to the Key Questions of Effective, Caring, Responsive and Well-Led, which were where improvements were identified as required at the previous inspection.

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 coronavirus and other infection outbreaks effectively. We were assured the service was managing appropriately infection prevention and control risks, in relation to COVID-19 and in line with guidance.

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 requires improvement to good. 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 1 Lansdowne Road on our website at www.cqc.org.uk.

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.

1 Lansdowne Road is a care home that provides personal care to people with a learning disability and/or autistic spectrum conditions. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. 12 people were using the service. This is larger than recommended by current best practice guidance ‘Registering the Right Support’.

‘Registering the Right Support ‘guidance promotes that people who use services 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 them having control, choice, and independence. People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

The manager was working with the provider to develop the service in line with these values. However, the outcomes for people did not fully reflect this and more work was needed to embed this way of thinking within the culture of the service.

Outcomes for people depended on the approach taken by individual staff, some of whom worked in line with these values. However other staff were more task focussed and did not involve or empower people.

People’s care plans were personalised to give guidance to staff on how to support people effectively. However, more work was needed to ensure staff had enough guidance about how to support people in relation to their communication needs.

People and their relatives were involved in discussions about their care and in developing their care plans. However, this was limited for some people because their support in relation to their communication needs was not well developed.

We have recommended that the provider looks into further training for staff in line with current good practice in relation to person-centred care and into supporting people’s communication needs.

People were not able to tell us in detail about their experience of living at the service. They appeared at ease in the presence of staff, and appeared comfortable with the support they were offered. Relatives all confirmed that their family members were happy living at 1 Lansdowne Road.

Some staff were very engaged with people and the impact of this on people was clearly positive, and they appeared pleased to be supported by these staff.

Risks to people’s health and well-being were identified and monitored. Guidance was in place for staff on how to support people with these risks.

Staff were knowledgeable about safeguarding people from avoidable harm and how to report their concerns internally and externally to local safeguarding authorities.

People were not always supported to have maximum choice and control of their lives choice and control of their lives; the policies and systems in service were being developed to support improvements.

Relatives and people told us staff were caring. People`s dignity and privacy was promoted and respected by staff People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.

Staff encouraged people to maintain their interests and take part in activities, both at home and within the community.

There were enough staff to meet people`s needs. Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge.

The provider`s governance systems and processes were improving and the manager had a plan in place to continue to develop these systems to support ongoing improvements.

Rating at last inspection:

At the last inspection in January 2018 the service was rated ‘Requires Improvement’ with several breaches of regulations. This was because the provider and the registered manager had not had good oversight of the service. Improvements were needed in the culture of the service, the management of medicines, the management of the risk of infection, and how people were supported to make decisions. Although improvements have been made since the last inspection and no continuing breaches were found, further work was still needed in some areas.

This is the second time this service has been rated requires improvement.

Why we inspected: This was a scheduled inspection based on the previous rating to assess improvements the provider had made.

Follow up: We will have a discussion with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We checked to see if the care service had been developed and designed in line with the values that underpin ‘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 should be able to live as ordinary a life as any citizen. The registered manager did not have good knowledge of this guidance, and this was reflected in our findings during this inspection.

At our previous inspection in August 2015 we rated the service as ‘good’ in all five of the questions we ask. At this inspection we found the service was now rated ‘requires improvement’ in each of the five questions. This was because we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We also identified a number of areas that, although not breaches of regulations, required improvement to meet with current guidance about good practice for services for people with learning disabilities or autism.

This unannounced inspection took place between 17 January 2018 and 21 February 2018. We visited the service on 17 January 2018 and between 05 and 21 February, we reviewed information sent to us by the registered manager and spoke with the relative of a person who used the service.

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 is run.

Risk Assessments were not adequately detailed or individualised. Some risk assessments had not been recorded when decisions had been made to put restrictive practices in place.

Medicines were not managed safely because stock taking processes were not effective and protocols were not in place to ensure ’as required’ medicines were administered as intended by the prescriber.

Although the premises were sufficiently clean, effective measures to control and prevent infection had not been taken. The arrangements for managing clean and dirty laundry, the storage of cleaning materials and the auditing of infection control measures required improvement.

People felt safe living at the service, with the staff and with the support the staff gave them. People were protected as far as possible from abuse and avoidable harm by staff who were trained and competent to recognise and report abuse.

There was a sufficient number of staff to make sure that people’s needs were met safely. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. Staff were clear about their responsibility to report accidents, incidents and concerns.

Assessments of people’s support needs were carried out before the person came to live at the service to ensure that their needs could be met. Mobile phones for use when people went out unescorted were available to people. However, the use of technology had not been explored beyond this and opportunities were lost to determine whether or not people might benefit from this.

Staff received induction, training and support for them to do their job well. However, knowledge of the Mental Capacity Act 2005 was not strong across the staff team and this had an impact on how people were supported to make decisions about their care.

People had enough to eat and drink and menus appeared balanced. However, people told us that food sometimes ran out so menus were not always accurate. People’s choice, preferences and involvement in preparing meals were not sufficiently promoted.

When required, staff supported people to access external healthcare professionals such as GPs and the service worked well with other service providers to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way. They were not sufficiently involved in planning their support or enabled to be as independent as they wanted to be.

People had good relationships with staff and described them as kind and supportive. Staff knew each person well.

Each person had a support plan but these were task centred and not sufficiently personalised. People were not encouraged to identify goals and aspirations or make plans as to how they would achieve them.

A complaints process was in place and people and staff were confident that any issues would be addressed by the management team. Some people had plans in place to support them to have a pain free and dignified death in line with their wishes, and in some instances, the wishes of their family. Other people did not have these out of choice.

Although the manager spoke of wanting to promote a person centred culture within the service, there was a lack of clear strategy about how this was to be achieved, and current practices promoted a task centred and risk averse approach to care. Due to a lack of clearly understood values, staff lacked a coherent approach to their work, which impeded people’s opportunity to develop their skills and have control of their own lives.

The quality assurance system in place was not robust and did not identify issues found at this inspection. Audits and monitoring checks on various aspects of the service were carried out but it was not clear how these had been used effectively to make continuous improvements to the service.

People, their relatives, staff and other stakeholders were asked to give their views about the service and how it could be improved.

You can see what action we told the provider to take at the back of the full version of the report.

We found there were sufficient staff on duty, and those we spoke with told us they felt well supported. We found that they had been correctly recruited and were checked as being safe to work with vulnerable adults.

The home had a complaints procedure which we observed had been adhered to. We saw that complaints had been logged, investigated and responded to correctly and in a timely fashion.