Athol House - Care Home Physical Disabilities

Athol House is a care home for people with learning disabilities. Athol House accommodates 21 people living with a physical or learning disability. At the time of our inspection 15 people were living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: The provider delivered care in a way that maximised people’s choice, control and independence. However, although the provider delivered an individualised level of care, we found the layout of the building did not optimise people’s independence. The building was a large home and we could not see evidence that the home met the needs of people living with a learning disability. The provider considered risks to people’s health and safety and had appropriate risk management guidelines in place to mitigate these. Lessons were learned when things went wrong. Accidents and incidents were recorded and investigated as required. The provider managed people’s medicines safely. Records of administration were kept when the provider administered both oral and topical medicines and care staff had a good level of understanding of their responsibilities in all areas.

Right Care: The provider delivered care in a way that was person-centred and promoted people’s dignity, privacy and human rights. People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider had appropriate systems in place to protect people from the risk of abuse. The provider ensured there were enough suitably qualified and experienced staff in place to support people. The provider had appropriate infection control systems and processes in place.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives. The provider engaged people in the running of the service and had effective systems of audit in place. The provider understood their obligation to be open and honest and promoted a positive culture that achieved good outcomes for people. The provider worked in partnership with other multi- disciplinary professionals.

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 requires improvement (published 21 April 2021) and there were breaches of regulation 12 (Safe Care and Treatment) and regulation 19 (Good Governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Athol House - Care Home Physical Disabilities on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Athol House is a care home for people with learning disabilities. Athol House accommodates 21 people living with a physical disability. The service is situated in a large building with a large communal area, bedrooms and bathrooms located on all floors. The home has recently added the service user band of learning disabilities. At the time of our inspection 20 people were living at the service.

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

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the principles of Right support, right care, right culture.

• Right support: The model of care and the setting did not maximise people's choice, control and independence. For example, the building was a large home and we could not see evidence that the home met the needs of people living with a learning disability. The building was not purpose built and the layout was at times hard to navigate. The corridors were narrow and whilst they accommodated wheelchairs, people told us it was challenging at times to use their wheelchairs.

• Right care: On the whole care was person-centred, but at times we saw examples when care given to people did not always promote people's dignity, privacy and human rights. For example, during our inspection we saw two people who needed very specific reassurance and staff did not have the time to provide this level of care. Another person wanted to speak up about the care they were receiving but they felt they were not always listened to by staff. One person we spoke with felt they were not always given the opportunity to make suggestions regarding the care they were receiving. We raised this with the registered manager during the inspection and they addressed the issues promptly.

• Right culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives. For example, we were not reassured that staff had the appropriate training to support people’s individual needs. For example, since the service user band of learning disabilities had been added to the home, staff had not received appropriate training to support people. Within people’s support plans there was an option to record individual goals, but we found in some people’s care plans they were blank.

Medicines were not always administered or managed in a safe way. Risk management plans were not detailed, and they were not updated when people's needs changed.

The provider did not always have effective quality assurance systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

The premises were clean and tidy. Infection prevention and control measures and practices were in place to keep people safe and prevent the spread of COVID-19 and other infections.

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

Rating at last inspection

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

Why we inspected

The inspection was prompted in part due to concerns we received regarding another service which the registered manager was managing. A decision was made for us to inspect and examine those risks at this service. 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.

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 monitor the service. 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 in relation to safe care 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 continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

At our last inspection we rated the service Good. At this inspection we found the service continued to meet the standards and the rating for the service remained Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Athol House has 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.

There are established safeguarding processes in place at the service. Staff understood abuse and the actions to take to protect people from harm and abuse.

Staff assessed risks to people’s health and wellbeing. Risk management plans were developed to help staff understand those risks and the actions they should take to reduce them.

People’s medicines continued to be managed in a safe way. Staff used the systems in place for the safe administration, ordering and storage of medicines.

Infection control processes were in place at the service. Staff used personal protective equipment to help reduce the risk of infection for people. The service was clean, well maintained and adapted for people’s use.

There were enough members of staff on duty to care for people effectively. People had support from staff to attend social events when necessary. Staff had support through training, appraisal and supervision in their jobs.

People had support to have maximum choice and control of their life and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had sufficient information so they could give staff consent to the care and support they received.

There was an onsite cook who prepared meals for people. People had choice in the meals they had and their individual nutritional needs and personal meal preferences were met.

People had access to health care services when their health care needs changed and when this was routinely required. Staff went with people to hospital appointments when needed.

People told us staff showed them compassion, kindness and were respectful. Staff spoke and cared for people in a dignified way that ensured their privacy was respected whilst they delivered care.

Assessments were completed with people and their relatives. These assessments placed people at the centre of their care and support, were person centred and used to record people’s needs. Assessments were used to develop a plan of care to ensure people’s needs continued to be met. Care plans detailed the support people required to meet their individual needs. People discussed their end of life care plans and their views and wishes were recorded.

People had access to a complaints system so they could make a complaint about any aspect of the service. The registered manager followed the registered provider’s complaints policy to ensure these were handled correctly.

The registered manager continued to ensure the service was regularly monitored and reviewed so it provided good quality care. Staff enjoyed working at the service and understood their role. The registered manager had an ‘open door’ policy and staff felt the registered manager was helpful and approachable. CQC were kept informed of incidents and events that occurred promptly.

The service has 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.

We found that people who live at Athol House experienced a good quality of life as they were encouraged and supported to take part in activities they enjoyed. They had opportunities to meet people in the local area by going to community events and visiting local facilities. There were links with community groups and the home received visits from people who assisted by volunteering with activities.

There were good arrangements to keep people safe from harm at Athol House. Risks were managed well and people were protected from abuse. There were safe arrangements for dealing with emergencies. People received medicines as prescribed and they were managed safely.

Staff were trained and supported to do their work. They knew how to support people in line with the requirements of the Mental Capacity Act 2005 and ‘best interests’ meetings were held when people did not have the capacity to make their own decisions.

Staff were caring towards the people living at the home and they respected their privacy and dignity. Staff spent time getting to know people and agreeing how they could best support them in the way they wished.

People were supported to have their health needs met through contact with health care professionals and their advice was included in people’s care routines. Meals were prepared in line with people’s preferences and reflected the guidance given by health specialists.

People had opportunities to make their views known about the service and the staff made improvements in response.

There were effective management arrangements in the home. The provider monitored the service to make sure the care provided was high quality and shared good practice amongst services so standards developed and improved.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with four people who used the service and three family members. We spoke with two senior care supervisors, two care workers, the activities coordinator, the health and safety officer and the maintenance supervisor. We also spoke to a speech and language therapist from the local Clinical Commissioning Group and a music therapist. We looked at five care records and six staff records.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A person who used the service told us that 'I feel safe here. Staff are good.' A care supervisor told us how 'we monitor response rates to (call) bells very closely.' We subsequently noted that a bell was answered in less than one minute. We saw evidence that all staff had received safeguarding training and those with to whom we spoke with demonstrated a good understanding of the signs of abuse and were familiar with the safeguarding policy of the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place to provide staff with guidance about legal requirements. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One care worker told us how 'I like to find a way to enable a person, rather than to see their disability as an obstacle.' A person who used the service showed us photographs and told us how they were supported by care staff to undertake a life changing event. They told us that 'this made me the happiest person alive.' We saw on their records that staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. A family member told us how "staff have a genuine desire to do as much as possible for those who live here'. We observed how a care worker was mindful of a person's dignity and discreetly asked them about their personal needs at that time. A senior care supervisor told us that the service was a home for life and that 'if it is peoples' wish to die here then we respect that and support them in whatever way possible.'

Is the service responsive?

A senior care supervisor told us that people's needs had been assessed before they moved into the home unless it was an emergency admission. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. A person who used the service told us how 'it is all about staff knowing what to do for us and they all know that here.'

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received though they could not recall completing a customer satisfaction survey. A family member told us how 'I look forward to coming here; it is a very well-run home.' Staff told us they were clear about their roles and responsibilities. They also told us that management support was very good and there was a manager on call 24 hours a day.

A visitor told us that they were pleased with the service their relative received at Athol House.

A professional involved with the service told us their client was 'very happy at Athol House' and said they had benefitted from the help they had received from speech therapy and physiotherapy arranged by the service.

Staff told us they enjoyed their work and felt the service had improved over the time they had worked there.

People participated in activities they enjoyed. These included gardening, visiting art galleries, going to the cinema and to concerts. People's religious and cultural needs were supported. We heard that one person was assisted to make contact with a religious leader. One person told us that the meals include items that reflected their cultural background.

We observed that there was relaxed and warm interaction between people at the service and with staff.

People were asked for their consent for care and treatment.

Care planning systems were in place but one person did not have an effective care plan.

The complaints system was effective and concerns were investigated fully, but one person had not received a copy of the procedure.

The people we spoke with told us they felt they could approach staff if they that any concerns. They had opportunities to make suggestions about how the service was run. They were able to follow their own interests and to participate in group or individual activities in the home or in the local community.

Care planning records had detailed information about health care needs and medication, in addition to social care needs and individual goals. People had access to physiotherapy and other healthcare services to meet their needs.

We found staff were well trained in supporting people with their medicines and there were good systems in place to make sure that risks associated with medicines were minimised.

The people we spoke with said staff were responsive and provided good care and support. Staff had access to a variety of training courses and the members of staff we spoke with said they felt well supported.

There were good systems in place to check the quality of the service and the home listened to the views of people using the service.