Flat C 291 Harrow Road

About the service

Flat C 291 Harrow Road is a residential care home providing personal care to four people at the time of the inspection. The service can support up to five people.

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

Right support

• The service supported people to have the maximum possible choice, control and independence.

• Staff supported people to achieve their aspirations and goals.

• Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right care

• Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

• People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

• People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

• People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

• Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

Why we inspected

We carried out an unannounced comprehensive inspection of this service from 9-24 June 2021. Breaches of legal requirements were found in relation to safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led.

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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Flat C 291 Harrow Road 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.

Flat C 291 Harrow Road is a care home for people with learning disabilities. It provides accommodation and support for up to five people. At the time of our inspection there were five people using the service.

People’s experience of using this service

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.

People had not always been safeguarded from improper treatment. Some staff told us that they had not felt their concerns had been listened to by managers, however there were effective systems for staff to report concerns higher up in the organisation.

Risks to people’s care needs and wellbeing were not always managed effectively. Sometimes risk assessments had not been completed when people were at risk of developing pressure ulcers, although risk management systems were in place. However, in other cases information from risk assessments and specialist guidance was not recorded in peoples’ support plans. Sometimes this resulted in unsafe practice.

Medicines were safely managed and checked by managers to ensure good practice. Staffing levels were sufficient to keep people safe, but at times staff congregated in communal areas, meaning people were not always supervised when they needed to be. The provider had worked with the local authority and commissioning bodies to review staffing levels.

Aspects of infection control were not always safe. Although measures were in place to protect staff and visitors, there was a lack of comprehensive assessment of the premises which may have identified areas such as enhanced cleaning that could make the service safer. The service did not maintain sufficient records to ensure that staff testing for COVID-19 took place in line with government guidance.

The service did not always promote person centred care, and there was a lack of meaningful activities for people to do whilst they were unable to go out. We saw that this was beginning to improve, with more person centred systems in place and people starting to access the community again with staff support. Although some staff communicated positively with people and engaged well, this was not consistent across the staff team.

Following concerns about a deterioration of the service, the provider had met with stakeholders to review the management and oversight of the service. A new interim manager had identified several key areas for development, including improved systems for planning and recording people’s care and documenting their choices and setting clearer expectations for staff.

Staff told us they had not always felt supported, but that this was beginning to improve. People’s family members told us they had been kept well informed by managers and felt their family member received a good service. Families we spoke with were not always aware of the concerns within the services or the changes in management or management systems

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

Rating at last inspection:

The last rating for this service was good (published 21 August 2018).

Why we inspected

We received concerns in relation to the management of safeguarding and the management of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe, Responsive and Well-led only.

We reviewed the information we held about the service. 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.

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

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care, good governance and person centred care at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.”

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.

At our previous inspection of Flat C, 291 Harrow Road in October 2017, we rated the service as 'Requires improvement' overall. You can read the report from our previous inspections, by selecting the 'all reports' link for Flat C, 291 Harrow Road on our website at www.cqc.org.uk.

At this inspection, improvements had been sustained and we found evidence that supported the rating of ‘Good’ overall.

The service had a registered manager in post who was supported by a deputy manager. She was visible within the service and spent time engaging with people using the service, staff members and visiting healthcare professionals.

Individual care and support plans had been developed for each person using the service and contained a good level of detail around people's individual needs, life histories and personal preferences.

People were protected from avoidable harm because any potential risks to people and/or others had been identified and management guidelines were in place to ensure people were supported in a safe and appropriate manner. Staff knew people well and were aware of the risks to individuals and how these could be managed.

The provider was operating effective procedures to ensure the safe storage, management and administration of medicines. Staff completed appropriate medicines training and competency assessments before carrying out medicines related tasks and were confident supporting people with their medicines.

Staff references were taken up and verified before staff started work, and the provider obtained sufficient proof of identification and carried out Disclosure and Barring (DBS) checks. The DBS provides information on people's background, including convictions, in order to help providers make safer recruitment decisions. There were enough staff deployed to support people with their needs.

Records showed that staff had up to date training in essential areas such as moving and positioning, safeguarding adults, first aid, mental health legislation, fire safety and food safety and hygiene. Some staff members had completed specialist training in diabetes and epilepsy. People were supported by staff whose performance was appraised on an annual basis. Supervision sessions were delivered by the management team in line with the provider's policies and procedures.

People's health and well-being was being promoted. Systems in place ensured that people were seen by the appropriate healthcare professionals at the appropriate time. People were supported to attend annual health checks with their GPs. Where people had complex healthcare needs, staff sought relevant guidance from a range of healthcare professionals such a wheelchair specialists, occupational therapists, dietitians, dentists and opticians.

People were supported to eat and drink enough to maintain healthy, balanced diets. People's weight was monitored regularly and action taken to address any specific diet and weight issues. Guidelines relating to weight management plans were available in people’s care records.

People were treated with dignity and respect and we saw evidence of caring relationships between staff and people using the service. Staff used communication passports, pictorial aids, objects of reference, simple language, song and touch to interact and engage with the people they supported.

The premises were well maintained but in need of some refurbishment and redecoration in certain areas. Health and safety checks were carried out regularly and were sufficient to ensure the building was safe.

We saw that accidents and incidents were monitored and reviewed by members of the management team. Staff told us that incidents and accidents were discussed at team meetings and in supervision sessions with a view to promoting understanding and learning.

People's experience of using the service was assessed and monitored on a regular basis. We looked at records of quality assurance checks, quality observation visits, medicines records and health and safety environmental checks.

The provider had a policy in place for managing and responding to complaints.

After the comprehensive inspection, we asked the we asked the provider to write to us by July 2017 to say what they would do to meet legal requirements in relation to the breach. We did not receive an action plan despite our request.

We undertook a focused inspection on the 11 October to check that appropriate and safe systems and procedures were in place in relation to medicines.

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 ‘291 Harrow Road Flat C' on our website at www.cqc.org.uk’

291 Harrow Road Flat C, consists of five separate bedrooms, a communal lounge/dining area and a kitchen. The service is registered to provide support with personal care to people with learning disabilities. There were five people living in the flat at the time of our visit although one person was absent due to a hospital admission.

The manager had completed the application process to become the registered manager of the service. 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 and associated Regulations about how the service is run.

At our focused inspection on the 11 October 2017, we found that the provider had adequate systems in place in relation to the safe storage and administration of medicines and legal requirements had been met.

During this inspection, we found that medicines were stored safely. A GP had reviewed people's use of emergency medicines and following a clinical decision these were no longer being prescribed or used by people using the service. Medicines were stored in a cupboard that was kept locked when not in use. Controlled drugs were stored appropriately and all medicines were checked and counted in to the service when delivered.

Auditing systems were in use and we saw no discrepancies in medicine's quantities. Medicines administration records were signed appropriately when medicines were administered and we observed no omissions or errors in the completion of this task. Keys to the medicines cupboard were held by the shift leader and therefore easy to locate. This meant the provider was operating effective procedures to ensure the proper and safe management and storage of medicines.

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. The registered manager was well regarded by relatives and the wider staff team.

Relatives and health professionals were involved in planning people’s care. Care plans were split into person-centred plans, health assessments, health action plans and risk assessments. However, staff were not always aware of specific details relating to people’s health conditions, care needs and preferences and as a result people's human rights were not always being protected in accordance with the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff were trained in the safe administration of medicines and kept relevant and accurate records. However, people's medicines were not always being stored safely and securely.

People’s risk assessments covered a range of issues including guidance around accessing the community, personal care, moving and positioning and safety within the home environment. However, risk assessments were not always being reviewed when people’s health status changed or when new circumstances created potential risks to people’s health and well-being.

There were sufficient numbers of staff deployed to the service. Recruitment procedures ensured that only staff who were suitable worked within the service. Staff files contained appropriate references and identity checks with the Disclosure and Barring Service.

New staff completed an induction programme which included shadowing more experience staff and completing elements of the care certificate which prepared them for their role and duties. Staff were given opportunities to develop professionally through regular training opportunities and ongoing supervision sessions. Staff told us they felt supported by the management team.

Staff received training in safeguarding adults and understood the procedures to follow should they have any concerns. The registered manager ensured that action was taken after incidents and accidents occurred.

People were cared for by motivated staff and positive relationships had been established between people using the service and staff. Staff interacted with people in a kind and caring manner and respected people's privacy and dignity.

There were activities in place which people enjoyed. However, one person was not able to access the community due to a faulty wheelchair and repair delays.

People had sufficient amounts to eat and drink and were offered choices at mealtimes. Staff were aware of people’s specific needs in relation to specialist diets and food preparation and had completed safe food handling training.

There was a complaints procedure in place and the provider listened to the views of staff, relatives and visitors. The manager understood the requirements of CQC and sent in appropriate notifications. Relatives told us they felt that the management was approachable and responsive.

There were procedures in place to monitor, evaluate and improve the quality of care provided though these systems were not always effectively identifying and addressing the shortfalls we found during our inspection.

Below is a summary of what we found. The summary describes what people using the service and their relatives/friends told us, the records we looked at and what staff we spoke with also told us.

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

We looked at two care records and saw that these contained a variety of risk assessments which included those in relation to the environment, personal care and fire safety.

The service had a safeguarding policy and procedure in place. All staff we spoke with were aware of their responsibilities to report any concerns they had about potential safeguarding issues and were able to describe potential signs of abuse.

Appropriate checks were undertaken before staff began work. All staff were required to undergo a Disclosure and Barring Service check (previously a Criminal Records Bureau check) before commencing employment.

There were arrangements in place to deal with foreseeable emergencies. All staff had received first aid training which was repeated annually. There was a policy in place for dealing with accidents and incidents and we were told that a senior staff member was always on call in case of an emergency. We spoke with three members of staff and each person correctly explained the policy for handling an accident or incident.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with three members of staff about how they obtained consent from people using the service on a daily basis. We were given detailed examples of the routines of each person as well as the general likes and dislikes of people.

CQC monitors the operation of the Deprivation of Liberty safeguards (DoLS) which applies to care homes. Staff were aware of the policies and procedures relating to the Mental Capacity Act 2005 (MCA 2005) and DoLS and understood when an application should be made and how to submit one. No applications had been submitted at the time of our visit.

Is the service caring?

One of the people who used the service told us that "the staff are really nice." We carried out observations using the Short Observational Framework for Inspection (SOFI) and observed positive interactions between staff and people using the service.

There were a range of activities available for people who used the service. This included an art group, going out to the park and pampering sessions for example massage.

Is the service responsive?

Staff told us that they organised resident's meetings where issues such as the range of activities, food choices, the home environment, staffing and well-being were addressed.

Is the service well-led?

The service had a registered manager in post. Staff we spoke with told us that the manager operated an open door policy.

Staff meetings took place every month and a separate residents meeting took place once a month. We saw that an annual audit took place every year and monthly compliance audits were also conducted.

People were assessed regularly by staff to ensure that all their care needs were being met. This included assessing their nutritional status on a monthly basis.

All people's risk assessments and care plans were up to date.

The service had procedures in place to prevent abuse from happening and provided annual training to staff in safeguarding vulnerable adults.

People were cared for in a clean, hygienic environment by staff that had been trained, supervised and supported to undertake their duties appropriately. Staff had received training in infection control and there was a policy and procedure in place.

People were cared for in safe, accessible surroundings which promoted peoples' wellbeing. However, some areas of the home were in need of repainting.

There was a complaints policy in place and people were given information on how to make a complaint.

We found that the service was not consistently monitoring a person's care and staff could not always locate records that we asked to see as part of our inspection.