Durham Street

Durham Street and Endymion Street is a residential care home that provides accommodation and personal care to young people who have a learning disability, autistic spectrum disorder, physical disability or sensory impairment. The service can support up to seven people. At the time of our inspection visit there were three people living at the service.

49 - 53 Durham Street is registered to provide care and accommodation for up to five adults with a learning disability. 48 Endymion Street is a terraced property which is registered to provide care and accommodation for two adults who have a learning disability. They are both part of the Avocet Trust organisation, which is a registered charity.

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

The service was not always well-led. The provider's quality assurance systems were not effective in identifying and addressing issues.

Risks associated with people's care had not always been clearly recorded in their care plan or risk assessments, and there was a lack of detail about the measures in place to reduce the risk of harm.

People's care plans did not always contain sufficient information to ensure staff were fully aware of people’s needs.

The principles of the Mental Capacity Act (MCA) 2005 were not always followed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were recruited safely. There were enough staff to meet people's care needs. Staff had received training for their roles.

The home was clean and tidy and additional cleaning ensured people were safe from the risk of infection.

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

The model of care and setting maximised people's choice, control and independence. People's dignity, privacy and human rights were promoted, but improvements were required to MCA practices to ensure that people’s human rights were always fully promoted. The ethos, values, attitudes and behaviours of care staff ensured people using the service led confident and inclusive lives.

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 good (published 11 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and risk management associated with incidents and accidents. A decision was made for us to inspect and examine those risks.

Due to the concerns received, we undertook a focused inspection to review the key questions of Safe and Well-led'. When we arrived, we also had concerns about areas covered by the 'effective' domain. We decided to include this 'effective' domain in our inspection. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Durham Street and Endymion Street on our website at www.cqc.org.uk.

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 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included a breach of regulation 12 (safe care and treatment), regulation 11 (consent) and regulation 17 (good governance).

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Durham and Endymion is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

49 - 53 Durham Street is registered to provide care and accommodation for up to five adults with a learning disability. 48 Endymion Street is a terraced property which is registered to provide care and accommodation for two adults who have a learning disability. They are both part of the Avocet Trust organisation, which is a registered charity.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were sufficient staff to meet people's needs and staff recruitment processes and procedures were robust.

Staff received appropriate induction, supervision and training to provide safe and effective care. The registered manager worked in partnership with healthcare professionals and other organisations to meet people’s needs.

Observations showed staff were compassionate, kind and caring and had developed good relationships with people using the service. Staff knew people well and promoted their dignity and respected their privacy. Care plans detailed and provided staff with guidance on how to meet people's individual needs. People using the service were provided with the care, support and equipment they needed to maintain their independence.

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

Medicines were managed safely and people’s individual nutritional needs were met. A range of activities were available for people to participate in. People using the service were supported to maintain relationships that were important to them.

The registered provider had a procedure for receiving and responding to complaints about the service. Staff spoken with were fully aware of their responsibilities in supporting people if they needed to complain about the service they received. People using the service had access to an advocate.

The provider and registered manager consistently monitored the quality of the service and made changes to improve and develop the service, considering people’s needs and views. People knew the registered manager and were comfortable and confident in approaching them. Staff told us the registered manager was approachable and supportive.

Further information is in the detailed findings below.

We undertook this unannounced inspection on the 21 March 2016. At the last inspection on 11 November 2013, the registered provider was compliant with the regulations we assessed. Four people were using the service at 49 -53 Durham Street and 48 Endymion Street was unoccupied.

Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff and those people using the service who were able to speak with us.

The service had 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 registered manager informed us they would be moving to manage another service within the organisation and another manager would be taking over responsibility for the service. They told us that a date for these changes had not yet been confirmed.

We found improvements were required with the quality assurance system in place this needed further improvements as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys. A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. However we found that the system had not identified the need for one person’s mealtime prescription, (this is a document which identifies people's nutritional needs and the support they need with eating and drinking) required updating.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions. People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

People’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Meals provided to people were varied and in line with risk management plans produced by speech and language therapists and dieticians. We observed drinks and snacks were served between meals. People who used the service received care in a person centred way, the care plans described their preferences for care and staff followed this guidance.

We found staff were recruited safely and were employed in sufficient numbers to meet people’s needs. Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on outings. Staff also supported people to maintain relationships with their families and friends.

People who used the service received continuous support from staff and needed to be supervised whenever they went out. We observed that support was provided on an individual basis and people’s needs were understood by staff delivering their care. We saw people had assessments of their needs and plans of care were produced; these showed people and their relatives had been involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

There was a complaints procedure in place which was available in a suitable format which enabled people who used the service to access this if needed. People we spoke with knew how to make complaints and told us they had no concerns about raising issues with the staff team.

We saw people's preferences and choices were made clear in their care files and there was use of pictorial representations to aid communication and understanding.

Detailed support plans had been developed that staff followed to make sure people's needs were met. We observed the people who used the service were happy with the service provided. They appeared relaxed and satisfied that their needs were being met in the way they wanted. We found the staff were very caring. One person we spoke with described the staff member looking after them as, 'Nice.' Another person said, 'Staff are good."

People who used the service were provided with a balanced and varied diet. One person told us, 'I like pork chops best and I like crisps.'

We found suitable arrangements were in place to manage people's medication to ensure they received any medication they needed.

Appropriate background checks were carried out to ensure new staff were safe to work with vulnerable people.

We saw the complaints procedure was available to people who used and visited the service. Staff told us how they would support people to raise concerns if they could not do so themselves. People who used the service named staff they would talk to if they were worried or upset.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people's needs and provided reassurance and guidance when needed.

We saw that people were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw that staff had received adequate training which helped them to care for the people who used the service and to meet their needs.