Archived: East View Housing Management Limited - 24 Tower Road West

We found the following examples of good practice.

People were supported to go out safely. People attended the hairdresser, shopping for essentials and walks with the support of staff. The home was set up to receive visitors and there were safe procedures in place for visiting. Visitors were required to complete a lateral flow test and have their temperatures checked before coming into the home. Visitors were asked to wear personal protective equipment and sign a health check form. The registered manager had discussed visiting with each person and their relative. Relatives had chosen not to come into the home for the time being and chose to see their loved ones through window and garden visits. People were also supported to keep in touch with their loved ones through phone and video calls.

People had been supported with a range of activities throughout the pandemic. One person told us about the new activities they had tried during lockdown and was proud to show us a photobook of what they had done. Activities included arts and crafts, baking, gardening and games. The registered manager told us they had used electronic devices to connect to the provider’s other homes to support people to participate in quizzes.

The registered manager had plans to support people in the event of a COVID-19 outbreak. An area of the home had been designated to be used to support someone to isolate safely with their own bathroom. Staff had discussed what would happen in the event of an outbreak. A group of staff had agreed to move into the home in the event of a COVID-19 outbreak. It would be difficult for people to understand the need to self-isolate in the event of an outbreak and the registered manager had discussed that some people may need one to one support during this time to help them to keep safe.

The home had plenty of personal protective equipment (PPE). Staff were following government guidelines for safe use of PPE. The storage had been considered based on people’s needs and preferences. Staff had received training in safely putting on and taking off PPE as well as infection prevention and control (IPC). Part of the registered manager’s Infection control audit involved meeting with staff and completing spot checks for donning and doffing of PPE. People were not upset by staff wearing masks and some people enjoyed wearing masks themselves.

The home was clean and tidy. Cleaning schedules were in place and high touch areas were cleaned at least four times a day. Windows were opened frequently to increase ventilation in the home.

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.

24 Tower Road West provides accommodation and personal care for up to five people who have learning disabilities and some associated physical and/or sensory disabilities. There were five people using the service at the time of inspection. The building was situated over two floors, with people's bedrooms located on both. Some people had their own bathrooms attached to their bedrooms and there were communal facilities for those that did not. There was a kitchen, dining-room and a large lounge for people to relax in. One person had their own self-contained flat with their own lounge, bathroom and kitchenette. People also had access to outside space. There was a large decking area with table and chairs which we saw people accessing during the inspection and garden space beyond that.

At our last inspection in November 2014, the service was rated 'Requires Improvement' with five breaches to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

The service had a registered manager. 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.

Since their previous inspection, significant improvements had been made to the quality and quantity of audits. However, we still found some inconsistencies within people’s care documentation which suggested quality assurance systems required some improvements. We have made a recommendation regarding this.

People were supported to be safe with person centred risk assessments. Safety checks were completed regularly by the management team and external professionals on equipment and the building. There were suitable numbers of staff to meet the needs of people and absences were covered by other staff who knew people well. People received their medicines safely from suitably trained and competent staff. Staff had a good understanding of how to protect people from potential harm and any incidents were responded to in a timely way, with actions taken to minimalize reoccurrence.

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

Staff had the skills and knowledge to support people and meet all their needs. They received a thorough induction and training that ensured they were up to date with current good practise. Staff also told us they had regular supervision and appraisals to support them in their roles.

People's nutritional needs were met and they were encouraged to be as independent as possible with preparing food. People had regular support from a variety of health and social care professionals to promote their mental health and well-being.

People, their relatives and professionals spoke positively about the caring nature of staff. People's dignity, independence and privacy was promoted and encouraged. Staff knew people, their preferences and support needs well.

Care plans were detailed and person centred with an emphasis on people’s preferences and independence. Some people had specific communication needs and staff were very knowledgeable of these. People and their relatives were aware of the complaints procedure and confident any concerns would be addressed by the registered manager or provider. People had choice and control over the activities they wanted to participate in each day.

Although there were areas for improvement in records, people, staff, relatives and professionals told us they felt the service was well-led. The registered manager sought feedback from those involved with the service and used this to improve quality of care. Staff spoke highly of the support they received from the registered manager and felt that an open, transparent and supportive culture was promoted.

Further information is in the detailed findings below.

The people we met were happy with where they lived. They enjoyed the activities they did during the day and in the evenings. They made decisions whether they wanted to attend structured day care activities or not. They had opportunities to discuss with the manager and key work staff any concerns they might have regarding their support and care. They were consulted about how their care was delivered and decisions about their future.

People had access to routine and specialist healthcare support. Any nutritional risks or dietary concerns were assessed and measures implemented to minimise risks of harm from poor nutrition.

A system was in place for the management of medicines but this was under review to improve safety.

We found that the house provided a comfortable homely environment for people to live in. It was clean and well maintained. Furnishings were of good quality. Health and safety and property checks were undertaken to ensure people lived in a safe environment.

People's concerns were listened to and actions taken to resolve them. Where necessary the service sought the involvement of other stakeholders.

At this visit we viewed all communal areas, including toilet and bathing facilities where particular infection control issues were highlighted previously. We found the cleanliness of these much improved. We met four people who lived in the home/service but their feedback did not relate to the outcomes assessed. We spoke with staff who confirmed that following our previous inspection, cleaning schedules had been reviewed and staff awareness of infection control had been raised at team meeting discussions. We saw evidence that the manager was introducing new monitoring systems and that an infection control audit had recently been conducted.

Staff told us that safeguarding had been discussed with staff at recent team meetings, and this was evidenced in meeting minutes viewed. The manager reported that safeguarding featured as a regular agenda item and this was evidenced in an agenda plan viewed for the next meeting. The manager reported that staff safeguarding training frequencies had been increased to annually. When we spoke with staff they confirmed that safeguarding training was happening.

Care plans viewed were comprehensive and informed staff how to support each person. People told us they participated in a range of daytime and evening activities that they liked.

Staff demonstrated an awareness of safeguarding vulnerable adults and had received training. Systems were in place for the reporting of accidents and incidents. However, we noted several incidents where it was unclear if they had been reported or acted upon, and we were concerned that people could be placed at risk from under reporting.

People were provided with a comfortable homely and generally well maintained home, they were encouraged to be involved in household tasks. We noted shortfalls in the infection control practice in the house that placed people at risk of harm from cross infection.

Staff records demonstrated that there was a satisfactory recruitment system in place. Staff told us that they received good support through supervision and staff meetings and were provided with a programme of training.

We saw that a range of audits were in place to monitor aspects of service quality, and that the views of people living there and their representatives were sought to inform this.