Archived: Life Opportunities Trust - 329 Martindale Road

Life Opportunities Trust - 329 Martindale Road is a care home situated in a residential street in Hounslow. It is registered to provide personal care for people aged 18 and over. It supports adults with multiple or complex needs such as profound learning and physical disabilities and who are living with additional conditions, including epilepsy and dementia. People had their own bedrooms. They shared the kitchen, dining room, living room, bathing and laundry facilities, a sensory room and garden. A team of staff supported people during the day and overnight.

The service has been developed and designed in line with the principles and values that underpin

Registering the Right Support (RRS) and other best practice guidance in relation to environmental

considerations. The service was registered to provide support to up to seven people and there were four people using the service at the time of our inspection.

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

There had been a number of improvements to the care people received. People were treated with dignity and respect. People's support and risk management plans set out how to avoid the risk of skin damage and discomfort. There was a planned approach to offering people support to regularly try activities that were meaningful to them.

The provider had a number of systems in place to monitor the quality of the service and had implemented an action plan to make sure the service was compliant with regulations. However, ongoing improvement was still required to ensure the quality assurance systems were properly embedded and reliable, and improvements were sustained.

At the time of the inspection the service applied the principles and values of Registering the Right Support. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to try activities that were meaningful to them and gain new skills and become more independent.

People using the service and staff experienced a challenging time as a result of the COVID-19 pandemic. Staff had supported people to shield based on health professionals' advice and this meant some people had not been able to access their community as much as would have been preferred.

There were appropriate procedures for infection prevention and control.

The service worked with other agencies to make sure people received joined up care.

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 supported this practice.

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 27 February 2020) and there were multiple breaches of regulations. These were in relation to treating people with dignity and respect; providing care to meet people's needs and reflect their preferences; managing risks to people's safety; and having effective systems in place to monitor the quality of the service. This service has been in 'special measures' since 31 January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

We undertook this unannounced targeted inspection to check if the provider had met regulations 9 (Person-centred care), 10 (Dignity and respect), 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which they were breaching at our last inspection in January 2020. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices, breaches of regulations 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 found there were improvements regarding the provider having effective systems in place to monitor the quality of the service, so we widened the scope of the inspection to include the whole of the well-led key question and to award it a rating.

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.

Follow up

We will request an action plan for the provider to understand what they will do to continue 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.

Life Opportunities Trust - 329 Martindale Road is a care home situated in a residential street in Hounslow. It is registered to provide personal care for up to seven people aged 18 and over. It supports adults with multiple or complex needs such as profound learning and physical disabilities and who are living with additional conditions, including epilepsy and dementia. At the time of the inspection four people were living at the home. People had their own bedrooms. They shared the kitchen, dining room, living room, laundry facilities, a sensory room and garden. A team of staff supported people during the day and overnight.

Services for people with learning disabilities and/or autism should be developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values are to ensure people who use the service can live as full a life as possible and achieve the best possible outcomes. They reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the services should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The provider had made some improvements to how the service was managed and the care people experienced. These included staff treating people in a more attentive manner, improved medicines support, the home environment, safe staff recruitment and staff support.

However, a number of improvements were still required. People were not always treated with dignity or respect. People’s support and risk management plans did not set out how to avoid people experiencing the risk of skin damage and discomfort. People did not always receive personalised support to help them regularly enjoy in activities that were meaningful to them. People did not always experience a planned approach to meet their communication needs.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. This is because people were sometimes not treated with dignity and respect. People did not always receive person-centred support that helped them to have good, meaningful everyday lives.

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.

The provider’s arrangements to monitor the quality of the service and identify and take action when improvements were required not been operated effectively. While there had been some improvements, the provider had not addressed the ongoing issues we found at this inspection.

Safe staff recruitment procedures made sure only suitable staff were recruited to work at the service. Staff leadership, support and supervision had improved. Staff were inducted to the service, completed a range of training and felt supported by the organisation.

People were supported to be healthy and to access healthcare services. People received their medicines and as prescribed.

People were supported to eat and drink appropriately. There was an organised approach to providing food for people to ensure they received a variety of appropriate meals.

The home was clean and well-maintained. The provider had continued to make improvements to the home environment, including redecorating bathrooms and communal areas and purchasing new furniture. Most people’s bedrooms were personalised.

People's support and risk management plans described how to meet their care needs. Plans included some personalised information about them, including their personal histories, their likes and dislikes and their food preferences.

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 inadequate (published 23 August 2019) and there were multiple breaches of regulations. These were in relation to treating people with dignity and respect; providing care to meet people’s needs and reflect their preferences; safe staff recruitment and providing appropriate training and supervision; managing medicines and risks to people’s safety; and having effective systems in place to monitor the quality of the service. This service has been in ‘special measures’ since 31 January 2019. Following the last inspection we took action against the provider in respect of the breaches we identified. We have not yet published details of this action.

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches of regulations at this inspection. These were in relation to treating people with dignity and respect; providing care to meet people’s needs and reflect their preferences; managing risks to people’s safety; and having effective systems in place to monitor the quality of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Requires improvement'. However, we are continuing to place the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Life Opportunities Trust - 329 Martindale Road is a care home situated in a residential street in Hounslow. It is registered to provide personal care for up to seven people aged 18 and over. It supports adults with multiple or complex needs such as profound learning and physical disabilities and who are living with additional conditions, including epilepsy and dementia. At the time of the inspection five people were living at the home. People had their own bedrooms. They shared the kitchen, dining room, living room, laundry facilities, sensory room and garden. A team of staff supported people during the day and overnight.

Services for people with learning disabilities and/or autism should be developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values are to ensure people who use the service can live as full a life as possible and achieve the best possible outcomes. They reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the services should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. This is because people were not always treated with dignity and respect. People did not always receive person-centred support that helped them to be safe and have good, meaningful everyday lives.

People were not always supported in a caring and respectful way. Staff did not always demonstrate empathy for people using the service.

People were not supported to participate in regular, varied and meaningful activities they could enjoy at home or in the community. People were not supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice.

Medicines were not being managed safely.

People had complex needs and were not always able to verbally communicate with others. There were not planned approaches in place for how staff should communicate positively with people to meet their communication needs

The provider’s systems to monitor and improve the quality of the service had not been operated effectively. They had not made improvements following the areas of concern which we identified at the last inspection despite submitting action plans and stating they would make the necessary improvements. Furthermore, they had failed to identify areas for improvement through their own monitoring.

Safe staff recruitment procedures were not always followed to ensure only suitable staff were recruited to work at the service. Staff did not always benefit from inductions, training and supervision to develop and be competent in their roles. Staff did not always feel supported by the organisation.

The home environment was not always clean and well-maintained. The provider had made some improvements to the home environment, but more work was still required to improve areas like the bathrooms and to redecorate and personalise people’s rooms.

People were supported to eat and drink. There wasn’t always an organised approach in place to provide food for or with people to ensure they received a range of nutritious and appropriate meals that reflected their preferences.

People's support and risk management plans set out what their care needs were and described daily routines for how to support people with these. People’s plans included some person-centred information about them, including their personal histories, their likes and dislikes and their food preferences.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Rating at last inspection and update

The last rating for this service was inadequate (published 1 February 2019) and there were multiple breaches of regulations. This service has been in ‘special measures’ since 31 January 2019. 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 enough improvement had not been made and the provider was still in breach of regulations.

Enforcement

We identified six breaches of regulations at this inspection. These were in relation to treating people with dignity and respect; providing care to meet people’s needs and reflect their preferences; safe staff recruitment and providing appropriate training and supervision; managing medicines and risks to people’s safety; and having effective systems in place to monitor the quality of the service.

We took action in line with our enforcement procedures to begin the amendment of the provider’s registration to prevent them from lawfully operating the service at Life Opportunities Trust - 329 Martindale Road. Following this we found the provider then made sufficient improvements to the quality and safety of the service and subsequently we withdrew our enforcement action.

Follow up

The overall rating for this service is inadequate and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The last comprehensive inspection took place on 15 June 2016. At this inspection we rated the service requires improvement for the key question, 'is the service well-led?' and found breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009 because the provider did not always notify us about significant events. We carried out a focussed inspection on 2 March 2017. At this inspection we found that the provider had made improvements but these improvements had not been consistent and we continued to rate the key question, 'is the service well-led?' as requires improvement. The overall rating of the service was good.

Life Opportunities Trust - 329 Martindale Road is a care home situated in a residential street in Hounslow. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People using the service had multiple or complex needs such as profound learning and physical disabilities and were living with additional conditions, including epilepsy and dementia. People required varying degrees of support from staff throughout the day, ranging from verbal prompting and intensive one-to-one support to interact with others, to full assistance to eat and one or two staff to support them with personal care and to use their wheelchairs. People had very limited or no ability to verbally communicate with others. The service was managed by the Life Opportunities Trust, a registered charity which also ran six other care homes and one personal care service for people with learning disabilities in north-west London and Hertfordshire.

There was a registered manager who has been in post since the last 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.

The care service has not 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 were not supported to live a good and meaningful lives just as other citizens expect to.

Staff did not always treat people with dignity and respect. Some of the staff's approaches were not always appropriate and demonstrated a lack of empathy for people using the service. Some of the staff interactions with people were task-based and communication was sometimes limited to a word or two at a time. Staff did not respond to people appropriately when people communicated with them.

People's independence was not always respected and promoted.

The way in which care was provided was not always person centred and did not reflect nationally recognised good practice guidance. People had some opportunities to access the community and some planned activities, but did not regularly benefit from meaningful activities or positive interactions with the staff team while they were at home.

Risks to people's safety and wellbeing were not always being reasonably mitigated.

The service was not supporting people in line with the principles of the Mental Capacity Act 2005.

Quality assurance and audit systems had not always been effective as they had not identified or addressed issues of the quality and safety of the service.

The provider did not display a CQC rating for this service on its website as required by law.

The provider did not have an effective management process for ensuring that it submitted information to the CQC when required in that they had not completed and sent the Provider Information Return in a timely manner when this was requested.

People’s care and risk management plans set out what their care needs were and how these should be met. They also prescribed a daily routine for each person. The plans included person-centred information about individuals' personal histories, their likes and dislikes and preferences, and end of life care planning.

The environment was clean and appropriately maintained and there were regular environmental checks. The provider had updated communal areas and some furnishing and had plans to replace flooring. The provider made sure equipment was safe to use. The staff followed procedures to minimise the risks of infection.

Staff recruitment procedures were in place and being followed to ensure only suitable staff were recruited to work at the service. There was a programme of training for staff to enable them to carry out their roles. The staff felt supported by the manager and told us they had the training and support they needed.

There were enough staff deployed to keep people safe, but people sometimes had to wait for care and support. We have made a recommendation regarding the provider determining appropriate staffing levels to meet people’s assessed needs.

The service was supporting people to have their healthcare needs met.

The provider had systems in place to ensure they responded appropriately to allegations of harm and abuse. They were working in partnership with external agencies and stakeholders.

The provider had systems for handling complaints and responding to incidents and accidents. We have made a recommendation about the service’s complaints procedures.

We found the service to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care, dignity and respect, safe care and treatment, safeguarding people who use the service from abuse and improper treatment, and good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we checked that notifications were being submitted to the Care Quality Commission (CQC). We found improvements had been made in the reporting of notifiable changes, events and incidents to the CQC and we found the provider and the manager were now reporting appropriately to meet the requirements of the Care Quality Commission (Registration) Regulations 2009.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Life Opportunities Trust – 329 Martindale Road’ on our website at www.cqc.org.uk.

329 Martindale Road is a care home providing personal care for up to 7 adults. People living at the service have a range of needs including learning and physical disabilities.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 was a manager in post and they had commenced the process of applying to register with the CQC.

329 Martindale Road is a care home providing personal care for up to 7 adults. People living at the service have a range of needs including learning and physical disabilities.

The service is required to have 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. The service had a registered manager who had been in post since 2013, however although they still worked for the provider they were no longer managing the service. There was an acting manager in post at the time of inspection.

The Care Quality Commission had not received notification of events that the provider was required to inform us of.

Systems were in place to safeguard people against the risk of abuse and staff understood these.

Staff recruitment procedures were in place and being followed. There were enough staff available to meet the needs of people using the service.

Risk assessments were in place for maintaining people’s safety and were being followed. Servicing of equipment was carried out to keep the service safe.

People were receiving their medicines safely.

Staff received training to provide them with the skills and knowledge to care for people effectively.

Staff understood people’s rights to make choices about their care and the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), so they acted in people’s best interests. This is where the provider must ensure that people’s freedom is not unduly restricted.

People’s dietary needs and preferences had been identified and were being met.

People’s healthcare needs were identified and they were supported to receive the input they needed from healthcare professionals.

Support plans were in place for people’s identified needs and interests to provide staff with the information they needed to meet these. People’s needs were reviewed to ensure changes were identified and could be met.

Activities took place and people’s individual interests were identified and responded to.

There was a complaints procedure in place and relatives said they would feel able to raise any concerns they might have so they could be addressed.

The service had an acting manager and relatives, staff and healthcare professionals said she was approachable and supportive.

There were systems in place to assess and monitor the quality of the service.

We found two breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

At this visit we talked with two staff members and the manager. We also carried out observations, as due to people's individual communication needs they were not able to talk with us about their experiences of the home. We also viewed three people's care records.

We observed people were relaxed with staff and staff regularly engaged with people, talking with them, explaining tasks to them and checking that people were ok. We saw staff responding quickly to people's needs and considered people's well being if they did not seem well.

Overall people's care records had improved and detailed people's current needs using words and pictures and photographs. Where we noted some information was missing, such as two people's weight for June 2014 had not been recorded, the manager addressed this the day of the visit. Health appointments had been recorded along with the outcome so that staff could support people appropriately. One person's support plan stated they would see a chiropodist every six months, however, the records showed they had not seen a chiropodist since September 2012. The manager informed us the day after the visit that he had arranged a chiropody appointment on 19 July 2014.

Explanations were now in place to inform staff about how risks were assessed and scored. This information enabled staff to know if the risks to the person and/or others was high or low and therefore inform them on how to support the person safely.

Below is a summary of what we found. The summary describes what a family member thought about the service and what staff told us, what we observed and the records we looked at. The manager was not working on the day of inspection.

Is the service safe?

Due to people's complex needs we could not directly speak with them to obtain their views. The family member told us they felt their relative was safe in the care of staff. All three staff we spoke with understood about the safeguarding procedures required to protect the people they supported. Staff received safeguarding training.

The senior member of staff was aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had been submitted. We saw people living in the home needed continuous supervision and support. People were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required.

We saw systems were in place to protect people against the risks associated with medicines.

Is the service effective?

People's health and care needs were assessed. Staff told us care plans assisted them to meet people's needs.

Is the service caring?

Staff showed patience and gave encouragement when supporting people. We asked the family member their views on the staff. They said staff were, 'Alright.'

People's preferences and diverse needs had been recorded in their support plans.

Is the service responsive?

We saw evidence of systems which had been put in place to ensure staff learnt from events such as accidents and incidents which were discussed at staff meetings. There were shortfalls in accurate record keeping. We saw people's risks were not fully considered and acted upon.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing people's needs accurately to reflect their risk assessments and care plans.

Is the service well-led?

We saw that the service was well-led. For example, processes were in place to support staff with regular supervision.

This small service has started to introduce quality assurance systems to identify areas for improvements and address issues. All members of staff we spoke with told us they were clear about their roles and responsibilities.

During this visit on the 30th April 2013 we spoke with the manager and six members of staff. We also received feedback from a regular visitor to the home. Due to people's complex needs we could not directly speak with them to obtain their views. However we observed interactions between staff and people who use the service. We also viewed two people's care records.

At this visit we found improvements had been made and interactions between staff and people using the service were professional and caring.

Care records reflected people's needs and had been reviewed and included people's preferences and abilities.

The systems for managing medicines in the home protected people and ensured they received their prescribed medicines. Staff attended training on medicine management.

New staff had been recruited to the team since the last visit and staff confirmed to us that enough staff worked on each shift. There was a daily planner in place which informed each member of staff of their roles and responsibilities.

One professional said the staff were competent whilst another professional told us that people appeared well presented and that health appointments were followed up.

Staff explained that they watched people's body language to see if they were happy or sad. They said people communicated in different ways, such as making sounds and noises, such as screaming or saying 'no'. We observed staff interactions during the visit and staff sometimes used inappropriate language when supporting and encouraging people.

There were some inconsistencies in the information seen on two people's files, some information had been reviewed, such as support plans and risk assessments, whilst other information was either inaccurate, missing or had no date to evidence the documents had been checked. This meant that people's needs might not be effectively met if the information was not relevant or available.

Staff received training and support however there were insufficient numbers of staff working to meet the needs of the people living in the home. We observed that staff were not engaging people in activities in the home as they were busy carrying out other tasks, such as cooking and providing personal care support.