39 School Lane

39 School Lane is a Care home service without nursing providing accommodation and personal to up to 8 people. The service provides support to younger adults some of whom may live with mental health support needs. At the time of our inspection there were 6 people using the service.

People’s experience of the 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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

People were encouraged to make their own decisions and these were respected by staff. Staff now focused on people’s safety and rights, so people would be less anxious and enjoy the best well-being possible. 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. Where people wanted some assistance to make key decisions about their care, staff supported them, following best practice in decision-making. People were able to personalise their rooms and received care and support in a safe and clean environment that met their needs. The registered manager and provider planned to introduce more checks on the garden area, so they could be assured the equipment and storage of items met people’s needs and mitigated risks to their safety. Staff supported people with their medicines in a way which achieved the best possible health and well-being outcomes.

Right Care

Staff had training on how to recognise and report abuse and they knew how to apply it. The leadership at the home checked key areas of people’s safety and considered if there was any additional action they could take to work with people to mitigate their risks. Staff enabled people to access specialist health and social care support in the community and advocated for them when they wanted this support. People, the registered manager and provider were working together to ensure there continued to be enough appropriately skilled staff to meet people’s needs, and keep them safe. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and safety.

Right Culture

People told us they liked the new staff and management team supporting them and they were treated as equal partners in their care and the development of the home. The leadership at the home recognised some elements of the culture of the home required further development and were supporting this. However, people were achieving good outcomes which had a significant positive impact on their well-being, health and day to day lives. Staff evaluated the quality of support provided to people, focusing on the person and other professionals as appropriate. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 05 August 2023.

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 improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. When we last inspected 39 School Lane on 05 August 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for 39 School Lane 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.

39 School Lane is a residential care home providing 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 8 people using the service.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Based on our review of Safe and Well-Led the service was not able to demonstrate how they were meeting some of underpinning principles of “Right Support, Right Care, Right Culture.

Right support: People were not always supported in a way which promoted their safety and well-being. Staff did not always identify when people were at risk of abuse. People were supported by staff who knew them well and who they felt comfortable with.

Right care: People were supported to make choices about their care however care records did not always clearly document if a person had capacity to make a decision. People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We found records relating to medicines were not always completed in line with guidance which meant there was a risk of people being over medicated or receiving medicines that were ineffective.

Right culture: The service was not always well-led. The quality assurance systems to assess and monitor the service were not always in place, and where they were, they were not effective. We found the provider did not have enough oversight of the service to ensure it was being managed safely and quality maintained. Quality assurance processes had not identified all of the concerns in the service. This meant people did not always receive high quality care. The provider took action after concerns were raised to them to improve the oversight of the service and the safety of people who used it.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 26 October 2021.

Why we inspected

The inspection was prompted in part by information of an incident following which a person using the service was placed at risk of avoidable harm. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. The information shared with CQC about the incident indicated potential concerns about the management of risk of people not being protected from the risk of abuse.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 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 this 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 39 School Lane on our website at www.cqc.org.uk

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.

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 have identified breaches in relation to safe care and treatment, safeguarding people from abuse, how the provider assessed people’s capacity to make decisions, staffing and good governance at this inspection.

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

Full information about CQC's regulatory response to the more serious concerns found during inspections is

added to reports after any representations and appeals have been concluded.

We will continue to monitor the service and will take further action if needed.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

39 School Lane is a residential care home providing personal and nursing care to eight people with mental health conditions under the age of 65. The home provides individual apartments within one building for people who have come from long stays in hospital or other services who need time and space for rehabilitation before moving into the community.

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

Staff understood how to keep people safe. Risk relating to both people and the environment had been assessed and well managed. Medicines were administered safely with people supported to do this independently where appropriate. There were enough staff who knew people well to provide support. Staff wore appropriate personal protective equipment in line with government guidance.

Managers ensured staff were suitably trained and supported so they could do their roles well. 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.

Care plans were developed in partnership with people and their relatives to ensure they were in line with people’s preferences, religious and cultural beliefs and values. Staff respected people’s preferred way of communication and referred to people by their chosen names. The home received very few complaints and many compliments which the registered manager had processes in place to manage and share with people and the staff team.

The registered manager had policies and processes in place to review and learn from incidents and events at the home. These were used to makes improvements within the home. The home had a contingency plan in place which covered emergencies and management of Covid-19. Staff loved working in the home and felt well supported by managers who worked in an open and transparent way.

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

This service was registered with us on 05/08/2020 and this is the first inspection.

Why we inspected. This was a planned inspection because the service had not been previously rated.