Hall Road

About the service

Hall Road is a care home for up to 7 adults with epilepsy, a learning disability and/ or autism. At the time of the inspection there were 7 people receiving care, accommodation and personal care.

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

Right support: Model of care and setting maximises people’s choice, control and Independence;

People were not always supported to have maximum choice and control of their lives and the service may not always have supported 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.

There were risk assessments in place covering the care and support provided, personalised to people’s individual risks. However, environmental risks were not always appropriately managed in line with best practice. The service had not been well maintained and the décor was described as ‘shabby’ by a relative.

Safe medicines management processes were not consistently followed. Infection control measures were in place. A range of health and social care professionals were involved in people’s care and the team worked closely with them to meet people’s needs.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse through training.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Staff received a range of training to understand people’s needs and their role. Staff received support through supervision. People received food and drink they enjoyed and choices were available.

There were enough staff to support people safely and staff knew people well. Each person received individual support through the day.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives;

There was not a registered manager in post as required by the provider’s registration with the CQC. Systems and processes in place to review the quality and safety of the service had not sufficiently identified and addressed the concerns we found during the inspection. We had concerns that actions identified by staff were not completed in a timely manner.

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

Rating at last inspection

At the last comprehensive inspection the service was rated good (report published 24 April 2018). We inspected in January 2021 and 2022 to look only at infection control procedures.

Why we inspected

This inspection was prompted by a review of the information we held about this service and length of time since the last inspection comprehensive. 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 Hall Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, premises 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.

7, Hall Road is a 'care home' providing accommodation and support for people living with complex needs and learning disabilities. The service can support up to seven people. At the time of our inspection there were seven people living in the home.

We found the following examples of good practice:

People were supported to see their family and friends. If this was not possible staff were using technology to keep family members updated.

There were safe arrangements in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and the provision of new personal protective equipment (PPE).

The service was clean and maintained. There was regular monitoring completed by the registered manager to ensure staff were cleaning high touch surfaces.

The provider was completing regular infection control audits and concerns actions were followed up when required.

The provider had sufficient stock of appropriate PPE and there were designated notice boards available to remind staff about correct guidelines and handwashing techniques.

7, Hall Road is a 'care home' providing accommodation and support for people living with complex needs and learning disabilities. The service can support up to seven people. At the time of our inspection there were seven people living in the home.

We found the following examples of good practice.

People were in contact with their families. Relatives could visit their family members by pre- arrangement. Only one visitor was allowed at any one time. Visitors had to complete a rapid flow test together with a negative result before the visit was authorised. They were also required to wear appropriate PPE. Rooms were fully cleaned after each visit to reduce the risk of possible infection. Families were provided with information about the safety procedures visitors should follow to ensure their safety and the safety of residents and staff. When relatives were not able to visit, they kept in touch with people through video and telephone calls.

Residents and staff were tested for COVID-19 in line with current government guidance.

All staff were trained in infection prevention and control (IPC) and the use of personal protective equipment (PPE). There were designated areas for staff to don and doff PPE and hand sanitising and washing facilities were easily accessible to people, staff and visitors. There were COVID-19 and hand washing information signs throughout the home. We observed staff followed current IPC guidance and practice throughout our visit.

The service's IPC policy was up to date and in line with current guidance.

The service had plans in place to respond immediately and appropriately to an outbreak of infection to ensure the safety of people and staff.

Further information is in the detailed findings below.

Independence Homes Limited - 7 Hall Road accommodates seven people with a learning disability in one adapted building. The service specialises in supporting people with epilepsy. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were six people using the service.

This inspection took place on 24 April 2018. At our last inspection of the service in January 2016 we rated the service ‘good’. At this inspection we found the evidence not only continued to support the rating of good, we also found for the key question ‘is the service effective?’ the service had improved to ‘outstanding’. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Relatives told us the care and support their family members received from the service with their healthcare needs and conditions had led to demonstrable improvements in the quality of their life. People’s care and support was planned and delivered by staff to help them experience the best possible outcomes in relation to their healthcare needs. To support them to do this staff took a holistic approach when planning how people's needs should be met and accessed a wide range of resources to ensure the planning and delivery of care and support adhered to current best practice and evidence based guidance, legislation and standards.

People were supported to access the services they needed to manage their healthcare conditions effectively to help them live healthier lives. Staff used their good links with the health care services involved in people’s lives to ensure people got appropriate support when they needed this. Staff followed the advice and support provided by professionals so that people experienced positive improvements in their health. People were encouraged to eat and drink enough to meet their needs and had meal plans that catered for their specific needs. Staff monitored what people ate and drank and responded quickly to any concerns about this so that people had access to the appropriate support when required. Creative methods were used to support people who were experiencing difficulty in eating which had achieved positive outcomes for people.

Technology and equipment was used to support the delivery of highly effective care and had led to people experiencing positive health related benefits and improvements in their overall wellbeing and quality of life. The provider’s bespoke epilepsy alarm system ensured people received timely support from staff when required.

People were safe living at Independence Homes Limited – 7 Hall Road and staff knew how to safeguard them from the risk of abuse. Staff had access to up to date guidance on how to minimise identified risks to people to keep them safe from injury or harm. Risks posed to people by the premises were in the main appropriately managed. However, the assessment process used to identify environmental risks posed to people was not fully effective as one of the measures identified by the provider to reduce the risk of burns and scalds to people in the premises was not appropriate to this service. The registered manager was already aware this risk assessment needed to be updated and amended and was taking action after this inspection to do this. Notwithstanding this issue the provider had maintained a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. The premises was clean and clear of slip and trip hazards. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care, cleaning the premises and when preparing and storing food. Medicines were stored safely and securely and people received them as prescribed.

Staff followed best practice and acted appropriately when managing behaviour that challenged the service. Senior staff closely monitored and reviewed all incidents when this type of support and intervention was used to check this had been appropriate and in line with best practice. The provider had systems in place to review and investigate incidents or safety concerns about people so that appropriate action could be taken to protect people when required. We noted no formal analysis was done of all incidents that occurred at the service to identify any themes or trends relating to the safety of all of the people using the service. The registered manager said they would look again at current systems for reviewing incidents and safety concerns about people.

There were sufficient numbers of staff to keep people safe and the provider maintained recruitment checks to assure themselves of staff's suitability and fitness to support people.

People and their relatives remained involved in planning and making decisions about their care and support needs so that they would continue to receive personalised care and support. We noted that for two people when setting care goals for tasks and activities intended outcomes needed to be clearer and better documented and records needed to be updated to show that decisions made had fully involved the person and was relevant to their personal preferences and choices.

People were also involved in discussions and making decisions about the design and layout of the premises so that this reflected their choices and preferences for what this should look like. People had a choice of spaces to spend time in when at home and were supported to move freely around the premises with no restrictions. People were encouraged to participate in a wide range of personalised and group activities and events to meet their social and physical needs and to build and maintain friendships and relationships with others. They also had access to education opportunities to develop skills and promote their independence.

The provider had clear values and vision for the service focussed on people experiencing good quality care and support. Staff received regular and relevant training to help them to meet people's needs. They kept their skills and knowledge up to date with current best practice in their respective fields. Staff had work objectives which reflected the values and vision of the service. These were monitored and reviewed through supervision meetings and appraisal. Staff were well supported through this process and motivated to perform well to ensure people experienced a good quality of life at the service.

Staff were caring and attentive to people’s needs. Staff knew people well and what was important to them in terms of their day to day support. They knew how to ensure people’s right to privacy and to be treated with dignity was respected. Staff supported people to be as independent as they wished to be. They were warm and welcoming towards people’s relatives when they visited the service.

People were asked for their consent before care was provided and prompted to make choices. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

People, relatives and staff were asked for their views about how the quality of care and support could be improved. They said senior staff demonstrated good leadership and were approachable, supportive and responsive. Senior staff monitored the quality of care and support provided. They undertook surveys, regular audits and unannounced spot checks of the service and took appropriate action to remedy and shortfalls identified. Some aspects of the spot checks needed to be improved so that these consistently gave senior staff meaningful information about the quality of interactions between people and staff. If people and/or their relatives were unhappy and wished to make a complaint, the provider had arrangements in place to deal with their concerns appropriately.

Records relating to people, staff and to the management of the service were secure, accurate and well maintained. The provider supported the service to continuously improve and worked in partnership with others to develop and improve the delivery of care to people.

The service had a registered manager in post who was aware of their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.

Further information is in the detailed findings below.

7 Hall Road provides accommodation, care and support to up to seven adults with epilepsy and learning disabilities, some of whom also have physical disabilities. At the time of our inspection seven people were using the service. Each person had additional communication needs, including supporting non-verbal communication.

The service had a registered manager who was available on the day of the inspection. 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.

People received a highly individualised and personalised service. Staff were knowledgeable about people’s support needs and their preferences as to how they wished to be supported. Support was tailored to meet people’s needs and staff had in-depth knowledge of the people they were supporting. People’s relatives were extremely positive about the service their family member received and felt they received high quality care that met their needs.

People’s health needs were reviewed to ensure they received the support they required. This included regular review of their epilepsy and supporting them with seizure management. People were also supported to access specialist support from a range of therapists, including physiotherapy, occupational therapy, and speech and language therapy. This supported people to maintain their health needs, and ensure they had the equipment and support they required to promote good health. Safe medicines management was in place and people received their medicines as prescribed. The provider’s medical team reviewed people’s medicines and monitored them to identify any side effects.

A nutritionist worked with staff to ensure people had their dietary requirements met. Staff were aware of people’s individual nutritional needs and provided them with the support they required. Staff supported them to develop their eating and drinking skills, and supported people as necessary to ensure their nutritional and hydration needs were met in line with their preferences.

Staff had developed trusting relationships with people. They were aware of people’s preferences, wishes and interests. They were aware of people’s communication methods and how they expressed themselves. Staff supported people to develop their communication skills and used their knowledge of people’s interests to aid communication.

People were supported to make decisions about their care and choices about how they spent their time. Staff used various methods to support people to make decisions, including supporting them to develop pictorial memory aids and activity plans.

Staff supported people to develop their skills and to progress towards the goals they wanted to achieve. This included supporting them to develop their independence in the community, supporting them to participate in new hobbies and to attend college courses.

Relatives told us staff were highly skilled and trained. Staff felt the training at the service was to a high quality and provided them with the skills they needed to support people. This was particularly in regards to epilepsy and managing people’s health needs. Staff’s competency and performance was regularly reviewed during supervision and appraisals. Staff were supported and encouraged to develop their skills and implement these within service delivery. A staff recognition scheme was in place to acknowledge staff that had ‘gone above and beyond’ and a member of staff had recently won the provider’s employee of the month award due to the consistently high quality support they provided.

People’s relatives and staff felt comfortable speaking with the registered manager. They felt the service was well-led and they felt their views and opinions were listened to. Any concerns raised by people’s relatives were dealt with promptly and used to improve service delivery.

The registered manager and the provider’s operational team reviewed the quality of service provision. New processes were put in place to address improvements required. The service used relatives of people from a sister service as ‘family checkers’, as well as management ‘walk rounds’ and ‘service user observation’ reviews to help improve the quality of the support provided.

One relative said 'There has always been good communication with the home and they always let us know what's going on. We work in partnership with them to meet my daughter's needs'. The other relative said 'The standard of care provided at the home is very good. Staff are good, they receive a lot of training and I am really, really pleased with the home'.

Both relatives told us they were aware of the homes complaints procedure. Both said they would contact the registered manager if they needed to make a complaint.

People were cared for in a clean, hygienic environment. People were protected from the risks of inadequate nutrition and dehydration.

There were effective recruitment and selection processes in place.

The provider had effective systems in place to assess and monitor the quality of service that people received.

We saw bedrooms had been personalised to each person's taste with pictures, photographs and belongings. People who use the service were supported to maintain important family links.

Staff said they "enjoy working here", "I like working here", "we get the training and support we need to carry out our role" and "we have time to be with people, doing what they want and like to do".

Quality assurance systems in place across the organisation included regular checks being made on care plans and other personal records, medication administration, storage and records and staff training and support. Staff at the home completed similar checks each week and were familiar with the systems in place to monitor the services provided.