1 Charmandean Road

About the service

1 Charmandean Road is a residential care home for people living with a learning disability and autistic people. It is registered to provide personal care for up to eight people. People live in one large house. There were eight people living in the care home at the time of inspection.

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

Right Support

People and relatives told us staff supported people to pursue their interests. Staffing levels had improved and this had increased opportunities for people. People told us they were going out more frequently and there were more staff that could drive which had meant people were supported to consider a wider range of activities. One person told us, “I had been swimming which I hadn’t done in ages”. Staff had adopted new approaches; We observed people smiling and happy, engaged in various activities with staff. People were being supported when they experienced emotional distress. Staff had continued to develop their knowledge and used agreed approaches to support people. People received care and support in a safe, clean environment and some areas of the service had been redecorated with plans for more to follow. It was evident that improvements had been made since the last inspection and people were seeing the changes as positive. Managers and staff acknowledged more improvements were needed. This included ensuring incidents involving people were analysed to ensure staff continued to consider techniques and strategies to reduce the frequency and impact of incidents. This would also ensure staff were consistent with each person’s support.

Right Care

We observed people receiving kind and compassionate care. Relatives spoke positively about improvements in the service. One told us their loved one, “Is happy and settled ... I want the best for [person] “and commented on how things had improved, they told us “I have seen the difference”. Staff protected and respected people's privacy and dignity. Managers and staff had a better understanding how to support people who may lack capacity to understand the consequences of choices they made. Staff required more learning about communication and the approaches and tools to use with people in order to create and implement effective communication plans. Senior managers had scheduled additional training for staff to further develop their skills and knowledge. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People and relatives told us they felt safe.

Right culture

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Following the last inspection, the provider had recognised the substantial need to improve the quality of the service people received. They had ensured senior managers with the appropriate expertise were focused on improving the service with clear actions planned. We observed people being supported by staff in a respectful and caring way, staff told us they were valued by senior managers and spoke positively about the interim manager who was leading by example. Staff had a better understanding of people’s sensory needs and ongoing work with Positive Behaviour Support (PBS) assessments had provided staff with techniques and tools which supported people when they experienced episodes of distress. People, relatives’ staff and visiting professionals have all commented on the openness of managers and the drive to improve the culture within the service. Managers and 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 inadequate (Published 25 March 2022). At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since 25 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced comprehensive inspection of this service on 17, 18 and 20 January 2022 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, dignity and respect, safe care and treatment, safeguarding, staffing and governance.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Follow up

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. We will work with the 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.

About the service

1 Charmandean Road is a residential care home providing personal care to eight people with learning disabilities and/or a variety of associated health and support needs. People live in one large house. There were eight people living in the care home at the time of inspection.

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

Right Support

The service did not always support people to have the maximum possible choice, control and independence over their own lives. Staff shortages had impacted on the ability of people to access activities of their choice. One person told us, “I like to go out a lot, but they are always short staffed”. Records confirmed people did not always receive support from staff to pursue their interests due to availability of staff. One staff member told us how peoples records were not always accurately detailing the opportunities people had, “Activities don’t happen as much as they are written on planner.”

The service didn’t always record incidents, these included when people experienced distress. Staff and managers failed to learn from incidents and how they might be avoided or reduced. Staff told us of a number of incidents of self- injurious behaviours which had not been managed within a robust incident management process. The service failed to work with people to plan for when they experienced periods of distress.

The service design did not always promote strategies to enhance people’s independence. The kitchen could only accommodate one person with staff support at a time due to the size of the room. The kitchen had not been adapted for people who used wheelchairs. The building had limited shared space on the ground floor, mostly people appeared to stay in the dining room. There was a lounge on the first floor, accessible via a lift, our inspection took place over three days and we did not observe people using this room. One relative told us, “[Person] is fed up with going upstairs due to constant noise”. People had a choice about their living environment and were able to personalise their rooms.

Right Care

Staff failed to protect and respect people’s privacy and dignity. One person was in a state of undress in shared areas of the home for the majority of our inspection, this included the hallway by the front door. Staff had not considered how to protect this person’s modesty prior to opening the door to visitors. The provider had not ensured staff had effective guidance to support this person which resulted in staff failing to take any action. We sought urgent assurances from the provider about actions they were taking to mitigate the risks to the person and minimise the impact of this on others. People and those close to them expressed concerns with how managers and staff had not protected the person’s dignity and reported this had been a concern for some years. The impact of this for others had not been considered and had impacted on their ability to live freely in their home. One example included some people being unable to be in their own room for private conversations when they chose.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could not always interact comfortably with staff and others involved in their treatment/care and support because not all staff had the necessary skills to understand them. One person told us they felt isolated and expressed concerns about their wellbeing. They provided assurances they were able to speak to relatives and staff about this.

Right culture

People failed to receive good quality care, support and treatment because staff could not always meet their needs and wishes. Staffing levels were reported to be consistently below the number required to meet people’s needs and to keep people safe. The registered manager and provider had not established, or implemented, appropriate staffing levels that either ensured people were safe, or that they received the care they needed. The providers monitoring and oversight processes was not effective and had not identified the substantial shortfalls being identified Some relatives and staff expressed concern about how issues or complaints would be managed, and this failed to minimise the risks of a closed culture developing. This impacted on the services ability to provide 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

The last rating for the service under the previous provider was good, published on 14 October 2017.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Following the inspection the provider has taken some actions to mitigate the risks. This is an ongoing process.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding, staffing and governance at this inspection.

We issued a Warning Notice The provider failed to ensure people were treated with dignity and respect. Staff failed to ensure people’s privacy was maintained. The provider is required to be compliant by 14 March 2022.

We served a Notice of Decision on the registered provider. They are required to supply monthly submissions to CQC in relation to compliance with person-centred care, safe care and treatment, safeguarding, staffing and governance.

Follow up

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. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures