Archived: Catherine House

About the service

Catherine House provides care and accommodation for up to five people who have Learning disabilities or autistic spectrum disorders. At the time of the inspection three people were living at the service and one person staying for a period of respite. The service was based in a large town house in the market town of Taunton with close access to local amenities.

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

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

Right support:

People were supported to have choice and control over their own lives. 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 did support this practice.

Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

Staff supported people to take part in home-based activities, for example cooking and playing pool. People were also supported to pursue interests in their local area. This included going bowling and to the cinema. One person attended college and undertook work experience, and another attended a day service. On the day of our inspection two people were going to town shopping.

Staff supported people safely with their medicines and worked with health professionals to achieve good health outcomes.

Environmental risks to people were managed safely. People’s rooms were personalised with their personal possessions. The main communal area was bright and clean, and people had access to a rear enclosed garden.

Right Care

People received care, which was personalised, and the service was responsive to the needs of the people. Care plans and risk assessments were in place, which provided staff with guidance on how to meet people's needs and manage identified risks.

People were protected from risks associated with their health, safety and welfare.

People were kept safe from avoidable harm because staff knew how to recognise and report abuse or poor care.

People were supported to maintain good health and were referred to appropriate health professionals as required.

People were supported to eat and drink in accordance with their preferences and choices.

People were supported to receive their medicines safely and as prescribed.

Right culture

There was a relaxed and happy atmosphere in the home, staff were friendly and supportive.

The management team was were very open and said they had recognised improvements of the service were needed to improve things for people living there. This included improved quality monitoring and more robust documentation regarding concerns.

People received care and support from a consistent staffing team who had been recruited safely and in sufficient numbers to meet their needs. They had received training and support which enabled them to support people to meet their needs.

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

Rating at last inspection

The rating at the last inspection was Good. (Published December 2020)

Why we inspected

The inspection was prompted due to concerns raised by the local authority in relation to poor provider communication and concerns raised by a relative of a person who used the service and a relative of a person who had used the service. A decision was made for us to inspect and examine the risks raised with us. We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

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.

Catherine House is registered to provide accommodation and nursing and personal care for up to five people with learning disabilities and/or autism. The service is in a large detached building located in the market town of Taunton. There were three people living at the service at the time of the inspection.

This targeted inspection took place on 28 October 2020.

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

Prior to the inspection concerns had been raised about staffing levels at the home not being enough to ensure people’s needs were safely met. We found that there were enough staff allocated on the rota to meet people’s needs.

People were supported by staff who had undergone a robust recruitment process.

People received good quality food which they were involved in choosing.

This service is registered by an individual provider who is not required to have a registered manager. The provider does not manage the day to day operation of the service, they delegate responsibilities to the manager and the health and safety and maintenance co-ordinator. We found the provider had systems in place to ensure they had a good oversight of the service. The provider was reviewing their on-call arrangements to ensure staff had support when needed.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our thematic review of infection control and prevention in care homes. At the inspection we found that staff were not following up to date infection prevention and control guidance to help people to stay safe. We raised this with the provider, and they put in place new infection control measures to keep people safe. We have made a recommendation that the provider keep up to date with current infection prevention and control guidance from the government.

Rating at last inspection

The last rating for this service was Good (published 12 September 2018).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about staffing levels, food quality and choice, emergency on call arrangements and the provider’s oversight and delegation of responsibility. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. We found the provider had taken action to mitigate most of these risks and were taking action to address the other concerns. The overall rating for the service has not changed following this targeted inspection and remains Good.

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 coronavirus and other infection outbreaks effectively.

Please see the safe, effective and well led section of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Catherine House on our website at www.cqc.org.uk.

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.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Following our last inspection in March 2017 we rated the service as Requires Improvement.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

We found the provider had taken action and improvements had been made to all issues raised in the report. People’s independence was being promoted more effectively within the home and their local community. Specifically people were now able to access the kitchen freely.

There was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns.

At this inspection we found the service was Good.

People received care and support that was safe and personalised to their specific needs and wishes. People took part in a variety of activities according to their interests and abilities.

There was a warm and friendly relationship between people and staff who lived and worked at the home. Staff encouraged people to make choices and understood how to support people to make decisions for themselves

The provider had systems and processes in place to keep people safe and minimise the risk of abuse. People were supported by sufficient numbers of staff to meet their needs in a relaxed manner. Staff levels were flexible according to the people living in the home and the activities and social outings taking place.

People received effective care and support from staff who had the skills and knowledge to meet their needs. Staff were offered opportunities to review and up-date good practice in line with current guide-lines.

People had access to health care professionals to make sure their health care needs were assessed and met.

People were supported to have choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People's privacy was respected and everyone had access to their private rooms if they wished to spend time alone.

People lived in a home which was well managed by a competent registered manager and staff team that had a commitment to continuous improvement. Staff felt well supported and their morale was good which created a happy place for people to live.

Further information is in the detailed findings below

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The provider is also the registered manager of the service. There was a manager who had the responsibility of the day to day running of the service, and who was available on the day of the inspection. The registered manager joined the inspection at a later stage in the day.

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.

At the last inspection in November 2014, the service was rated Good. At this inspection people and relatives told us they felt safe however we found areas that required improvement. For example, although medicines were safely administered and stored by staff who had received specific training and supervision to carry out the tasks, we found when medication errors occurred the outcomes of investigations had not always been recorded. The registered manager reviewed their policy following the inspection.

Care plans contained risk assessments. However some risk assessments did not identify ways of supporting people to remain as independent as possible within the home and their local community.

People who lived at the home were able to make decisions about what care or treatment they received. However we found they had not been fully consulted about restrictions relating to access to areas of their home, staff were able to demonstrate knowledge and understanding about their responsibilities to follow the principles of the Mental Capacity Act (MCA) when making decisions for people in their best interests.

We recommend the least restrictive option is reviewed and discussions held with individual people regarding the management of the risks in regards the least restrictive practice.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. People living at Catherine House told us they were happy with the care and support provided.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people safely. In addition to completing induction training new staff had opportunities to shadow more experienced staff. This enabled them to get to know people and how they liked to be cared for. People told us they felt safe at the home and with the staff who supported them.

People accessed various activities in the local community. People were supported to maintain contact with the important people in their lives. A relative told us, “The staff all seem nice and have a chat when we visit”. People confirmed they received visits from family and friends.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

We met and spoke with all the people living at the home, also with five members of staff. Everyone said they liked living at the home and one person said 'it's brilliant here'. We were accompanied by two service users to look at their rooms, which were individual and had been personalised with all sorts of personal possessions which indicated their interests and preferences.

The house was well maintained, tidy and cosy. We were told by one person that they were going to a Halloween party the following night and by another that they were going out to buy a fancy dress costume for the party.

We saw that people were encouraged to live as independently as possible with support from staff, and were given lots of examples of people's involvement within the home and in local community activities. One person had been encouraged and supported to pursue an interest in getting a job. This had resulted in a part time opportunity for a trial period, which had increased the person's confidence in their own ability.

People living at the home told us that their care, support and treatment had been discussed and agreed with them. Procedures were in place which gained consent for the support and care needed. Everyone said that they were happy about the support they received and that they had agreed to what was provided.

Staff were knowledgeable in their understanding of medication and in the processes followed in the event of refusal, which acknowledged potential risks of refusal, at the same time respecting human rights. The staff worked well as a team and all told us they enjoyed their work and were provided with 'lots of training opportunities'.

No formal complaints were received during the year. Any informal concerns or niggles were resolved as quickly as possible. People told us they would have no hesitation in raising any concern in the confidence that the matter would be listened to and addressed. One person said, 'I would just tell them what was wrong, and I do'.

We found that the home had been through a disruptive period following the Registered Managers resignation. There was an interim manager in post, initially contracted to conduct a needs assessment for the home. The interim manager and provider worked closely, to ensure continuity and consistency of care for people living at the home.

We spoke with the provider who lived locally and was active within the home. They told us their priority was to provide a homely community environment which recognised and understood the needs of people within their care which, encouraged independence and integration within the community.

Throughout our visit we observed that staff and people living in the home interacted in a cheerful, friendly and respectful way. One person told us the staff were very good at explaining things to them.

We observed that people felt comfortable to approach staff, who responded promptly and in a friendly manner.

People said there were always enough staff on duty that understood their needs and were able to support them and their activities. Some people told us they had been involved in staff recruitment, and that their opinion was listened to and taken into account. People told us there were at least two staff on duty each day and at least one person sleeping in at night. People told us there were more staff on duty at different times of the day and evening depending on the level and number of activities going on. For example, we were told there were often more staff on duty in the evenings to support different outings. Some people attended college, others went to pubs, and discos. Others went out shopping or for walks. One person had been supported to see their favourite band play live.