Uxbridge Road

About the service

Uxbridge Road is a supported living service for up to 9 people with learning disabilities and/or autism. At the time of the inspection, 6 people were living at the service. There were 2 buildings on the same site, accommodation for 2 people in 1 building and for up to 7 people in the other building.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, two people were receiving support with personal care. The other four people had support with other aspects of their care.

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

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

Right Culture:

The provider had systems to evaluate the quality of the service being delivered, but these were not always effective as they had not identified gaps in cleaning schedules. However, the provider took immediate action to make improvements. People and those important to them were involved in planning their care, and overall, people and their relatives were satisfied with the care provided. Staff were supported through supervision and training and told us they felt supported by managers.

Right Support:

People were kept safe from avoidable harm and risks to people were assessed and monitored. Staff were aware of people’s strengths and promoted independence to help people achieve a meaningful everyday life. People were supported to have 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 make decisions and communicated with people in ways that met their needs. Staff also supported people to take part in activities and pursue their interests in their local area.

Right Care:

Staff understood people’s cultural needs and provided culturally appropriate care. Individual needs were addressed. For example, people who had specific ways of communicating, using sounds, certain words, Makaton (a form of sign language) and pictures could interact with staff and others involved in their care and support because staff had the necessary skills to understand them. People’s care plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

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 21 April 2022). 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

This inspection was prompted by a review of the information we held about this service. We carried out an unannounced comprehensive inspection of this service on 22 March 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 and good governance.

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 Caring, Responsive and Well-led which contain those requirements.

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 remained requires improvement. 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 Uxbridge Road 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.

Uxbridge Road is a supported living service for up to nine people with learning disabilities and/or autism. At the time of the inspection, six people were living at the service. There were two buildings on the same site, accommodation for two people in one building and for up to seven people in the other building.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, two people were receiving support with personal care. The other four people had support with other aspects of their care.

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

People living at the service were happy there. However, they did not always have opportunities to take part in meaningful activities or learn new skills. Planned care did not always consider long term aims for people's future.

The staff did not always communicate with people effectively or understand people's communication.

The provider had made improvements at the service. However, the systems for monitoring and improving quality were not always effectively operated, because further improvements were still needed.

People were safely cared for. Risks to their safety and wellbeing had been assessed and planned for. They received their medicines in a safe way and there were systems in place to help safeguard them from abuse.

People's needs were assessed and planned for. Whilst plans did not always consider future needs, they provided a good level of information about how to care for people. Their health was monitored and they had access to other healthcare services. People had enough to eat and drink and this was appropriate for their needs and preferences.

The staff felt well supported. They had access to a range of training and had regular meetings with the registered manager who they felt was open and provided good leadership.

There were systems for dealing with complaints, accidents and incidents. The registered manager had a good overview of the service and understood where improvements were still needed.

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.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: The model of care was improving, and people were afforded some choices and control over their lives. Some people were supported to try new skills and work towards independence. However, others were not and there was limited planning for the future or to support people with a variety of meaningful activities. Additionally, staff did not always understand how to communicate well with people. This meant people did not always receive personalised support which was right for them.

Right care: People's privacy, dignity and human rights were respected. Staff were kind and had good relationships with people. However, the staff did not always understand people's needs, support people to take risks to become more independent or reflect on their own practice in order to empower people and give them more opportunities. The impact of this was little variety in people's lives and limited development of skills. People were supported to stay healthy, to access healthcare services and to understand about healthy lifestyle choices.

Right culture: There was a positive ethos and the staff had responded well to changes made by the management team to improve the service. There was strong leadership and the registered manager had a good understanding of where improvements were needed and how to implement these. People felt well supported and had opportunities to discuss how they felt about the service and changes they wanted.

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 rating at the last inspection was requires improvement (published 18 June 2021).

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 in some areas, but the provider remained in breach of regulations.

Why we inspected

The inspection was planned because we needed to check on whether the provider had made improvements following the last inspection.

Enforcement and Recommendations

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 and good governance 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 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.

Uxbridge Road is a supported living service and is registered to provide personal care for up to nine people with learning disabilities, mental health needs, autism spectrum conditions and behaviours that may challenge. At the time of the inspection seven people were living at the service. The service accommodates people in a main house and a large bungalow annex located in the garden. People have their own self-contained flats and share communal areas, such as a kitchen and living room in the main house and a kitchen and living room area in the annex.

Six people who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People were not always kept safe. We found concerns with the safe management of risks to people including risks associated with medical conditions such as epilepsy, and where people have behaviours that may challenge others. People were also not always protected from the risks arising from weak safeguarding procedures.

There were not enough staff deployed to meet the individual needs of people living at the service and some staff did not have a good understanding of people’s needs. We found limited evidence of supervisions being conducted with staff to allow them the opportunity to talk about their work and to share information in a one to one setting.

Staff were using restrictive practices to limit the movement of some people living at the service. The provider did not ensure that staff had the necessary training and experience needed to manage and reduce behaviours that challenge. We identified concerns with overall levels of staff training. Role specific training was not available to support people with specific health conditions such as epilepsy and not all staff had training in the Mental Capacity Act 2005.

Staff had not always supported people to attend their healthcare appointments, some appointments were missed, and we found poor management oversight to ensure that people had regular health assessments in line with best practice.

People were not supported to undertake activities that were meaningful to them. We found staff did not always actively engage with people, who were often left without any therapeutic interventions.

Staff were kind and relatives confirmed they believed people were happy, although they felt there had been a lot of management changes and a high turnover of staff, which had an impact on people’s wellbeing.

Care plans did not always promote personalised care and lacked information for staff to meet people’s needs safely.

At the time of our inspection, there was no registered manager in post. A registered manager for another of the provider's services had been supporting the service on a part time basis. A senior manager was supporting the service in order to make immediate improvements.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The provider had no effective systems in place to ensure that people’s voices were heard. People were not always supported in the least restrictive manner and their choice and independence were limited. People were not always supported by enough staff who had received the full training required to appropriately meet their needs.

Right care:

People using the service did not receive planned and co-ordinated person-centred support. Care was not always delivered in a way to ensure that people’s human right and dignity were respected. Staff used restrictive practices to limit the movement of people and there was a lack of understanding of people’s needs. Best practice was not sought when supporting people to maintain their dignity.

Right culture:

We were not assured that the provider had made the necessary changes needed to improve culture within the service. Senior management had begun to take action to address shortfalls in communication between care workers and management, but this still required improvement. We found interactions between people and staff were task focused and staff did not activity seek to improve the quality of people’s lives by providing activities that were meaningful.

People's wishes and preferences about end of life care were not consistently explored with them. We have made a recommendation about involving people in decisions about their end of life care.

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

Rating at last inspection

The service was registered with this provider in December 2020 and this was the first inspection since then.

The last rating for the service under the previous provider was requires improvement, published on July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of people’s care and support, staffing, the way people were being treated and safety and governance. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all the key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 breaches in relation to safe care and treatment, person-centred care, safeguarding service users from abuse, good governance and staffing 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 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.