Langston Care Limited - 37 Hill Top View

37 Hilltop View is a small residential home providing personal care to three people with learning disabilities at the time of inspection. The service can support up to three people.

The home is located on a cul-de-sac close to local amenities and is neighboured by another home registered with the commission and managed by the same provider. The home is an ordinary residence that has had some adaptations to meet people’s needs.

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.

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

The Secretary of State has asked the Care Quality Commission (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 some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People were supported by sufficient numbers of staff who had been recruited safely and had an understanding of safeguarding procedures. Risks to people’s safety were considered and lessons were learnt when things went wrong. People received their medicine as prescribed and effective infection control measures were in place.

People’s care plans contained detailed information that ensured care was delivered to the standard required. Staff received training to enable them to meet people’s care and support needs. People were supported to maintain a balanced diet and had access to drinks throughout the day. The service worked well with other agencies and ensured people had access to healthcare services. The building was adapted to meet the needs of the people living there.

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.

People were well treated, and the team supported people to express their views as far as reasonably possible. People’s independence was promoted, and people’s privacy and dignity was maintained.

People had access to personalised activities and were supported to maintain important relationships. The provider understood the Accessible Information Standard and a complaints procedure was in place. While no one was in receipt of end of life care the home had considered people’s advanced wishes.

The service promoted a positive culture and the management team was described as supportive and approachable. People were clear of their roles and understood their responsibilities under the duty of candour. The service engaged people and worked in partnership with others. The service could demonstrate continuous learning and how this improved the care people received.

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 Good (published 4 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Langston Care Limited - 37 Hill Top View is registered to provide personal care for up to three people who present with varying levels of learning disabilities. There were three people living at the home when we inspected.

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.

The provider needed to improve the way they monitored the quality of the service they were providing. Action was required to ensure audits identified where improvements needed to be made.

People were kept safe from harm because staff understood their responsibility to protect them from abuse and poor care. People’s risks were assessed and staff were provided with management plans to support people in the least restrictive manner. Staff maintained a consistent approach to support people when they became anxious or presented with behaviours that challenged their safety. There were processes in place to ensure staff were suitable to work with people in a caring environment.

Staff had access to training to improve their knowledge of care and enhance their skills. Staff sought people’s consent before providing care and supported people when they needed help with their decision making. People received their medicines as needed and staff had recorded them accurately. People were provided with meals that met their individual needs. The advice of specialist healthcare professionals was sought whenever necessary to maintain people’s health and wellbeing.

People received kind and compassionate care. Staff supported people to maintain their dignity, independence and privacy. Staff gained information about what was important to people so that they could provide care which met their preferences. People were encouraged to try new activities and staff recorded what they did or did not enjoy to ensure what they did met their preferences.

Relatives and visiting healthcare professionals were given the opportunity to share their views of the service. Staff felt supported and were provided with updates through a regular meeting schedule.

We inspected this service on 18 May 2016. The inspection was unannounced and undertaken by one inspector. At our last inspection on 9 July 2014 the provider was meeting the legal requirements we inspected.

37 Hill Top View is registered to provide personal care for up to three people who present with varying levels of learning disabilities. There were three people living in the home when we inspected.

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.

The provider did not have an audit programme in place to monitor the quality of care they provided to bring about improvements when necessary.

Staff knew how to recognise abuse and the actions they should take to report their concerns. People risks had been assessed and there were plans in place to ensure risks were managed. Medicines were stored and managed safely and people were supported to take their prescribed treatments.

Staff understood and respected people’s needs and provided kind and supportive care in their home environment. Staff reflected people’s wishes and preferences in the way they delivered care. Staff understood how to support people who did not have the capacity to make their own decisions. People were offered a varied and nutritious diet and received support when they needed specific nutritional assistance.

People were encouraged and supported to engage in activities and outings that gave them an opportunity to socialise. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health and wellbeing whenever necessary. People were supported to maintain the relationships which were important to them.

There were suitable recruitment practices to ensure that the staff employed were suitable to work with people. Staff received training and support to deliver a good quality of care to people and a training programme was in place to address identified training needs.

Below is a summary of our finding based on our observations, speaking to people who used the service, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask:-

Is the service safe?

In general we saw that risk assessments were in place where risks had been identified, with plans of action to inform staff how risks could be minimised. However one person did not have a risk assessment in place regarding a particular moving and handling manoeuvre. This meant that the risks regarding this had not been recorded to ensure that any actions required had been put in place to minimise the risks identified.Following our visit the provider sent us evidence to show that this was now in place.

Sufficient numbers of qualified staff were available to meet people's needs.

Is the service effective?

Although in general the care provided corresponded with information in care records, not all care plans and risk assessments reflected the care that people received. This meant that this person's records did not accurately reflect the level of support needed.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection. People appeared comfortable with the staff that supported them.

Is the service responsive?

People's health and care needs were addressed promptly and referrals made to relevant health professionals as required.

People's preferred routines were followed to promote personalised care and support.

Is the service well-led?

The home has been without a registered manager since January 2014. The acting manager advised us that she was in the process of applying for registration.

Staff told us that they received the support needed to undertake their job and told us that the acting manager was approachable and available to them when needed.

In this report the name of a registered manager appears. They were not in post and not managing the regulated activities at this service at the time of the inspection. Their name appears because they were still a Registered manager on our register at the time. The provider told us that recruitment to the manager post was underway.

We found that people who used the service were respected and were involved in how their service was run.

We saw that people's care and welfare needs were being met. A relative told us: 'I've got a good relationship with the home, I'm happy with the care the girls give'.

We found that the service had systems in place to manage people's medication safely.

The service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure and representatives of people who used the service knew how to make a complaint.

We read comments made by family members in questionnaires sent out by the manager to gain people's opinions on the services they received. We saw that people made positive comments about the services. One person commented, 'B' obviously looks very happy we are extremely grateful to all the staff that care for her'. Another person said 'Staff are very pleasant and very caring and attentive at all times'.

We were able to read one person's diary. The daily entries in the diary were written with the support of the person's care worker. The information in the diary provided us with details of how people spent their day to day lives.

We found that staff understood people's individual and personal needs. Staff showed that they knew how people communicated their needs. Staff said they had received training to help them understand how to meet the needs of people in their care. We saw that staff treated people kindly and respectfully.

We read documents that showed that the provider regularly audited the service people received at 37 Hill Top View.