Cranbourne House

Cranbourne House is a residential care home providing accommodation and personal care to up to 8 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 5 people using the service.

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

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

Right Support:

Risk management when people were expressing distress or agitation was unreliable. Staff were inconsistent when recording and reporting incidents and concerns. Managers investigated incidents which were appropriately recorded but this was not always done quickly enough. These shortfalls had not been picked up through the provider’s governance arrangements.

Systems for learning lessons were in place but unreliable practice meant some events were not analysed and lessons were not always learned.

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 supported people to engage in person-centred activities.

Right Care:

Care plans were comprehensive and reflected people’s individual needs.

People were relaxed in the company of staff and interactions were mostly positive. One incident of concern occurred which was dealt with by the management team promptly and appropriately.

The service worked effectively with external stakeholders. The management team and staff understood the importance and benefits of working alongside other professionals.

Right Culture:

The service promoted person-centred care involving people who used the service and their families.

Staff felt well supported in their role and had opportunities to share their views.

The provider had a range of systems and processes to monitor the quality of the service and drive improvements.

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 4 January 2021) and there was a breach of regulation relating to infection prevention and control measures. 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 regulation relating to infection prevention and control measures.

The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive inspection.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection carried out on 24 July 2019 to calculate the overall rating. This is based on the findings at this 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 COVID-19 and other infection outbreaks effectively.

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

Enforcement and Recommendations

We have identified breaches in relation to how the management of risks to people and governance arrangements at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 meet 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 and will work with the local authority to monitor progress.

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Heathcotes Cranbourne House is a residential care home for adults with a learning disability who may have dual diagnoses and associated complex needs. The home accommodates 8 people. At the time of the inspection there were 7 people living at the home.

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

Staff did not always follow the provider’s COVID-19 policy or infection and protection government guidelines. This posed a risk where staff could transfer infection.

Staff understood the importance of safeguarding and the provider worked closely with the local authority. Issues regarding safety and risk were being overseen by the safeguarding team.

Medicines were managed safely. There were close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly. People had detailed person-centred care plans.

Recruitment was managed safely and there were enough trained and experienced staff to meet people’s 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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Cranbourne House looked like a large family home and there were no identifying external signs to indicate the house was a care home. All the bedrooms had en-suite facilities and people had been supported to personalise their rooms. The home was within easy access of local amenities. Staff were discouraged from wearing uniforms. The model of care maximised people’s choice, control and independence. People had access to specialist and mainstream support with their health and social needs.

People received person-centred care which promoted their dignity, privacy and human rights. People were supported to follow their interests and take part in activities in the local community. People were supported to be involved in the day to day running of the home. Accessible information including pictures and symbols was used to support their understanding and engagement.

Staff had completed Non-Abusive Physical Intervention (NAPPI) training. This meant they used positive behaviour support plans and de-escalation techniques to support people and minimise the need for physical interventions. The registered manager and care staff demonstrated the values and attitudes to support people using the service to lead inclusive lives. Some poor practise including staff working in cliques had recently been identified. The provider had responded to this promptly and completed a detailed action plan. This included changing the way rotas operated and increased staff supervision.

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 the service was good (published 27 August 2019).

Why we inspected

We received concerns in relation to the people not being protected from abuse. 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.

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 Heathcotes Cranbourne House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe infection prevention and control practises. Please see the action we have told the provider to take at the end of this report.

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.

Heathcotes Cranbourne House is a specialist residential service for adults with a learning disability who may have dual diagnoses and associated complex needs. The service has eight en-suite bedrooms and provides twenty-four-hour support. At the time of our inspection, six people were living at this service.

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.

There were deliberately no identifying signs, intercom, cameras, industrial bins 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 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.

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

People felt safe living at this service as they were supported by staff who had received training in recognising and reporting abuse.

There were sufficient numbers of staff in the home to meet people’s needs. Staff were recruited using safe procedures and on occasions, one person who lived in the home was part of the interviewing process.

Instances when staff needed to use legal forms of restraint had significantly reduced. Low level forms of restraint were occasionally used at the time of inspection. At the same time, people’s dependency levels had reduced. This had been achieved through building relationships between people and staff based on trust, discussion with relevant professionals and careful risk assessing.

Medication was safely managed as people received their medication as prescribed and the systems to support this were effective.

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.

Positive outcomes were seen where people had specific dietary needs. People had been assisted by staff to manage their diet and we saw they had lost or gained weight in line with their health needs. Other specific dietary needs relating to risk and religion were being met.

The registered manager and staff team worked in partnership with a range of professionals. People had health action plans which showed the involvement of health professionals in meeting their needs.

People and one relative told us they liked the staff who provided their care and support. Through our discussions with staff and examples of interactions we observed, we concluded people were supported by staff who knew their needs well. People’s privacy and dignity was respected and they were encouraged to live independent lives.

People had a wide range of risk assessments to support activities of daily living both inside and away from the home.

Care plans were sufficiently detailed and person-centred. They provided essential information for staff to provide effective care. Regular reviews of care plans were taking place. People received social stimulation both within and away from the home.

Complaints were dealt with appropriately. The service was well-led by a registered manager who was motivated and ensured their staff team received formal and informal support. Audits and spot checks showed oversight of the service provided for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14 November 2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration of the service.

Thematic review

The Secretary of State has asked CQC to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. We found the use of restraint had reduced significantly since people first moved into the home. Only low-level restraint was being used at the time of our 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.