Real Life Options - 90 Capel Gardens

Real Life Options - 90 Capel Gardens is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Real Life Options - 90 Capel Gardens provides care and support for up to six people who have learning disabilities, some of whom live with mental health conditions and may have sensory impairments. At the time of our inspection five people were using the service. Public transport and a range of shops and other amenities are located close to the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support (RRS) 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 who had recently left the service. A registered manager is a person who has registered with the 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. At the time of the inspection the service was being managed by an interim manager. The provider was in the process of recruiting a permanent manager who would apply to register with us.

At our previous comprehensive inspection on the 12 July 2016 we rated the service 'Requires Improvement' in the area of Safe. This was because we identified one breach of legal requirement as arrangements for looking after people's money did not ensure that they were protected from the risk of financial abuse. During a follow-up focused unannounced inspection on the 22 November 2016 we found that the provider had taken action to minimise the risk of financial abuse and therefore had addressed our concerns. Whilst improvements had been made, we did not revise the rating for the key question Safe, because to improve the rating to Good we required a longer-term track record of consistent good practice.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, and we rated the service overall as Good.

Staff were knowledgeable about people’s needs and engaged with them in a respectful, sensitive and encouraging manner. Staff had a caring approach to their work and understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights.

People’s relatives told us that they felt people using the service received the care that they needed, were safe and happy living in the home.

People's care plans were up to date and personalised. They included details about people’s individual needs and preferences, and guidance for staff to follow so people received the care and support that they needed and wanted.

People had the opportunity to take part in a range of activities that met their interests and needs.

Staff recruitment procedures supported the employment by the service of suitable staff with appropriate skills and abilities to carry out their roles. Staffing levels were flexible so that people received the care and support that they needed.

Staff received the training and support that they required to carry out their roles in meeting people’s individual needs and supporting their independence.

People’s medicines were managed safely. Staff liaised with healthcare and social care professionals to ensure that people’s health, medical and care needs were met by the service.

People using the service were supported and encouraged to choose their meals. Their dietary needs and preferences were accommodated by the service.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s relatives knew how to raise a complaint and were confident that any concerns would be addressed.

Arrangements to monitor and improve the quality of the service were in place.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 22 November 2016 to check they had followed their plan and to confirm that they now met legal requirements.

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 Real Life Options-90 Capel Gardens on our website at www.cqc.org.uk

Real Life Options-90 Capel Gardens provides accommodation and personal care for up to six people who have learning disabilities including autism. There were five people living at the home at the time of our inspection.

At the time of our inspection the home had 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.

At our focused inspection on the 22 November 2016, we found that the provider had followed their plan and legal requirements had been met. The provider had made improvements to the systems for supporting people with the management of their monies to prevent theft, misuse or misappropriation of money or property belonging to people using the service.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

Real Life Options –90 Capel Gardens is registered to provide accommodation and personal care for six people. The home provides care and support for people who have a learning disability, some of whom have mental health needs. The home is owned and managed by Real Life Options who provide a similar service in two other care homes in North West London and a range of services in other areas. On the day of our visit there were five people living in the home.

The service currently does not have a registered manager. However, a manager is in post and has made an application to register with us. 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.

People were cared for by staff who knew their needs well including people’s individual ways of communicating. People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. Staff respected people’s privacy and dignity and understood the importance of confidentiality. People were supported to choose and take part in a range of activities of their choice.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. However, arrangements for looking after people’s money did not ensure financial abuse could not take place.

Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. Accidents and incidents were addressed appropriately.

People were supported by staff to be as independent as possible and were provided with the support they needed to maintain links with their family and friends.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People were supported and encouraged to choose what they wanted to eat and drink.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were encouraged and supported to make decisions for themselves whenever possible. Staff knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives. However, this was not evident when supporting people with their finances.

There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we spoke with all the people who used the service. People had varied communication needs. They communicated with us by making gestures, facial expressions signs and sounds. Two people who used the service provided one and two word answers to our questions. We spent time observing care in the lounge, kitchen and dining room. We also used the short observational framework (SOFI), which is a specific way of observing care to help us understand the experience of people who could not talk with us. We also spoke with two care workers, a senior care worker, the team co-ordinator, the manager and two relatives of people who used the service.

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.

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

This is a summary of what we found:

Is the service safe?

People who used the service were unable to tell us whether they felt safe. However, we spent a significant part of the inspection observing people and staff. We found that people who used the service approached staff without hesitation, and we saw that staff respected people's rights and dignity.

Relatives of people who used the service told us that they felt confident that people were safe. They spoke about the relaxed and welcoming atmosphere of the home and commented that they were 'very happy' with the service. One relative told us that they felt that a person who used the service was 'relaxed, safe and happy.'

Safeguarding procedures were robust. Staff understood their role in safeguarding people that they supported and understood the whistleblowing policy.

The service had systems in place to identify assess and manage risks relating to the health welfare and safety of people who used the service. Care records contained risk assessments which provided guidance to staff on action to take to keep people safe. Staff we spoke with had knowledge and understanding of this information.

The Care Quality Commission monitors the procedures for the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff had received training with regard to DoLS. The manager told us that no applications for deprivation of liberty have needed to be submitted. However, we saw people living in the home needed continuous supervision and control, and staff told us that due to risk to their safety people were not free to leave without staff or family members accompanying them. This may mean deprivation of liberty authorisations were required. The manager agreed that he would contact the local authority with regard to this issue.

People's care and support needs were taken into account when senior staff made decisions about the numbers, qualifications, skills and experience of staff required. There were systems in place so staff and people who used the service could contact management staff for advice and support at any time.

Is the service effective?

People's health and care needs were assessed. People were central to their plan of care and support. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Staff had received appropriate training to meet the needs of the people living in the home.

Staff, family members, healthcare and social care professionals were involved in decisions about people's care. Relatives of people who used the service told us that they were kept informed about people's progress. Comments from relatives included 'They always let me know when X is unwell,' 'They keep me informed about Y's progress,' and 'They involve me in reviews of X's care plan.'

Is the service caring?

We saw that people were supported by kind, attentive staff. We saw that care workers were patient and praised and encouraged people who used the service. People were supported to make decisions which included what they wanted to drink and do. Those choices were respected by staff. People who used the service were able to do things at their own pace and were not rushed. People's privacy and dignity were respected. Arrangements were in place to ensure that people's religious and cultural needs were met. People completed a range of activities in and outside the home.

People's preferences, interests, aspirations and diverse needs had been included in their care plans. Staff were aware of each person's individual needs and worked as a team with others including family members to provide the care and support that people needed. Relatives of people who used the service described the staff as 'brilliant,' 'kind and competent,' and 'I really appreciate all they have done for X.'

Is the service responsive?

People's progress was monitored closely. People's care and support needs were discussed by staff during each shift and during staff meetings, so staff were aware of people's progress and of any change in people's needs. Written notes about people's behaviour, mood, health and care were completed by staff during each day and night shifts. Monthly reports completed by staff included a review of each person's needs. People's care plans and their health needs were also regularly reviewed with each person, family, staff and significant others. One relative told us 'I always go to the review meetings.'

Relatives and significant others including advocates of people who used the service completed feedback satisfaction surveys. Relatives of people told us that they felt staff listened to them and responded appropriately to their feedback about the service. A relative of a person who used the service told us that 'I have been sent questionnaires to feedback about the service.' Another relative told us that 'staff always answer any questions that I have about X, are very helpful and listen to me.'

Is the service well-led?

The manager started work managing the home on the 23rd December 2013 and has made a registered manager's application to CQC. There was a team co-ordinator who has worked in the home for several years who assisted in the management of the home. There were arrangements in place to ensure that the service was monitored closely by the management team. Checks that had been carried out by management staff included checks of incidents, accidents and complaints.

Staff had a good understanding of the ethos of the home and quality assurance processes. They were fully involved in monitoring the quality of a number of areas of the service. These included carrying out daily checks of people's monies and medication. Weekly audits included checks that people's support plans had been updated, menus completed and maintenance issues resolved.

The divisional manager and the regional director of the organisation regularly visited the home to check on the condition of the home and the care of people.

The service worked well with other agencies and services to make sure people received their care and support in a joined up way. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities. Staff training and supervision records showed that staff received appropriate training and support.

Comments from relatives included 'I am kept informed,' 'I give on-going feedback,' 'I am extremely happy with the service,' and 'I can talk to any of the staff.'

We saw people who used the service approach staff without hesitation and accessed their bedrooms and the communal areas freely within the home. People who used the service had signs of well being. They smiled, laughed and were well dressed. People were supported to make choices about their care and their lives, which included decisions about what they wanted to eat, what they wanted to do. Staff interacted with people who used the service in a respectful manner.

Each person who used the service had a plan of care that had been regularly reviewed and included information about the individual support and care that they needed. There were enough skilled and experienced staff to meet people's needs and appropriate systems were in place to manage people's medication.

Records were well maintained, accurate and kept securely. Staff had consulted with people who used the service and their representatives to ensure that the care provided was appropriate and their preferences were respected. Where people did not have capacity to consent the provider acted in accordance with legal requirements.