We carried out a review of the data available to us about London Road on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about London Road, you can give feedback on this service.
London Road is a residential care home providing accommodation and personal care to up to 10 people. The service also provides personal care to 3 people in 1 ‘supported living’ setting. The service supports people living with acquired brain injury. At the time of our inspection there were 12 people using the service.
London road is a large adapted building with 10 bedsit-like ‘flats’ with ensuite bathrooms. Communal facilities included an adapted kitchen, living room and adapted bathroom. There was a passenger lift to the first floor, allowing wheelchair access, a laundry, activity and storage rooms. People in supported living had their own bedrooms and shared the kitchen, dining, bathroom and living rooms. There was a staff office/sleep-in room within the house.
People’s experience of using this service and what we found
People’s risks had been assessed and their support plans detailed the actions staff should take to keep them safe. Individual risk assessments and support plans were reviewed regularly, and timely action was taken when people’s needs changed. Staff followed advice from professionals when managing risks in relation to choking, pressure care, seizures and medicines. People’s medicines were reviewed regularly to ensure they remained suitable. The registered manager had ensured the equipment people needed was available and appropriately maintained. Provider policies were followed to manage environmental risks including fire and control of infection.
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.
When people were unable to consent to any restrictions needed to keep them safe, capacity assessments had been completed and applications to deprive them of their liberty had been submitted. Each person had a named staff member [keyworker] who supported them with planning and decision-making. Improvements had been made to staff recruitment, employment conditions and training to address staffing challenges and ensure staffs’ approach maximised people’s choice, control and independence.
The provider and registered manager were committed to ensuring improvements underway at the service were completed. Increased investment, oversight and leadership, recruitment changes, staff training and support were all having a positive impact on the service's culture. Effective working relationships had been established with health and social care professionals. Feedback from people and their relatives had been acted upon. People’s comments included, “I love it here” and “It is cool so far”. A relative said, “I am grateful.”
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 06 May 2022) and there were 3 breaches of regulation. 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
We carried out an unannounced inspection of this service on 23 and 24 February 2022 and 01 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.
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 London Road 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.
London Road is a residential care home specialising in care for people with traumatic brain injury. This care home provides care to up to 10 people of varying ages in one adapted building. At the time of our inspection, the service was providing personal care to eight people.
People’s experience of using this service and what we found
We received mixed feedback from staff, relatives and professionals about management and oversight of the service. The provider told us about ongoing issues with recruiting senior staff to support the registered manager to make the improvements needed at the service. We found shortfalls identified by the provider had not been always been addressed in a timely way to ensure the quality and safety of the service remained good. This meant people had not always been protected from the risk of harm. At the time of the inspection, the provider had committed resources to making the improvements needed. Work was progressing at pace to ensure people’s needs and risks were assessed and managed safely.
People were positive about the service they received. Their comments included, “I love it” and “It is a good place to live, I am quite happy”. People told us they felt safe and respected and they had enough to eat and drink. People described staff as “kind”, “polite and respectful”. One person said they valued being able to have as much independence as possible, staff only supported them with things they wanted support with.
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. However, we found the policies and systems in place had not always been followed to ensure legal requirements relating to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were met.
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 4 April 2020).
Why we inspected
We received concerns in relation to the management of people’s money, neglect of people’s needs, poor staff culture and cleanliness at the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We also 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.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
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 and will take further action if needed.
We have identified breaches in relation to safe care and treatment, safeguarding and 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
London Road is a residential care home specialising in care for people with traumatic brain injury. This care home provides personal care to people of varying ages in one adapted building. At the time of our inspection, the service was providing personal care to 10 people, this is the maximum number of people this service is registered to support.
People’s experience of using this service and what we found
Medicines were administered safely; however, medicines were not always stored in line with best practice guidance.
There were systems in place to safeguard people from abuse. Staff were knowledgeable about safeguarding and there were clear whistleblowing policies in place. Relevant health and safety checks were completed. Risks were assessed and there were risk management measures in place. Infection control was managed safely.
People's needs and choices were assessed and recorded in their care plan. People were cared for by staff who received ongoing and relevant training. People were supported to maintain a balanced diet. The service design was adapted to meet people's needs. People's flats were personalised and homely.
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.
People were treated kindly and respectfully. People's right to privacy and dignity was respected and staff supported people to be as independent as possible. People and their families spoke warmly of the family atmosphere at the service.
People were supported to maintain social networks and take active roles in their local communities. There were regular activities and daily trips that people told us they enjoyed.
The service was well-led and staff told us they felt supported by the registered manager. Relatives told us they were happy with the way the home was run and felt the positive culture at the home was led by management.
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 19 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
London Road is registered to provide two regulated activities; accommodation for persons who require nursing or personal care and personal care. The care home is registered to provide long and short-term care to 10 people with acquired brain injuries. At the time of the inspection there were 10 people living there. The service does not employ nurses so people’s health needs were met by visiting health care professionals, for example, community nurses. The accommodation had been adapted to meet the needs of people who live with a physical disability. People’s private accommodation comprised of a bed-sit arrangement with washing and toilet facilities and a small kitchenette. The second service supports people with their personal care. They live as a small group in the community. At the time of the inspection three people lived together.
A registered manager manages both services with the support of their senior staff team. 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.
Monitoring processes were in place which ensured care and support was provided in both services, safely and to a high standard. We have however, made a recommendation in relation to the service’s audits.
There were arrangements in place to keep people safe. There were enough staff in both services to ensure people’s care needs were met and to support them with other daily activities. Safe staff recruitment practice protected people from those who may not be suitable to care for them. People in both services received the support they needed to take their medicines safely.
Staff had been provided with appropriate training and support to meet people’s diverse needs. 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 both services supported this practice. People who lacked the mental capacity to make decisions and provide consent for their care, treatment and accommodation were protected. This was because staff adhered to the principles of the Mental Capacity Act 2005. People were supported to maintain their nutritional well-being.
People’s individual choices and preferences were met. People had a voice and were listened to. People therefore received care which was tailored to their individual needs. People were treated with respect and their privacy and dignity maintained. They were supported to maintain relationships with those who mattered to them. There were no unnecessary restrictions applied to when relatives and friends could visit or to people’s social lives. People were supported to take part in activities they enjoyed.
People’s care was planned and reviewed with the involvement of the person (where possible) and relatives and representatives (where appropriate) were fully involved. Care and treatment records were well maintained and gave staff and visiting professionals the information they needed in order to support people’s needs. People’s goals and aspirations were incorporated into these plans and supported.
There were arrangements in place for people to be able to raise a complaint or concern although the registered manager informed us they had not received any. Communication with people, their relatives/representatives and staff was good so this ensured that any queries or worries were addressed and resolved quickly. People’s views and suggestions were sought as were those of their relatives/representatives. These were acted on to improve the overall service.
We carried out an unannounced inspection of London Road on 11 and 12 November 2014. London Road is a purpose built care home for 10 people with an acquired brain injury. People are accommodated in self-contained flats with additional shared living areas. 10 people were living at the home when we visited. The 10 people living at the home had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.
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 and associated Regulations about how the service is run.
People were supported by a caring staff team who knew them well and treated them as individuals. For example, staff understood the ways each person communicated their needs and preferences. People were supported to stay active at home and in the community. Particular consideration was given to finding activities that would help rehabilitate people following the brain injuries they had sustained.
People were encouraged to make choices and to do things for themselves as far as possible. In order to achieve this, a balance was struck between keeping people safe and supporting them to take risks and develop their independence. People’s legal rights to make decisions were respected and the least restrictive options were sought when a decision was made on behalf of a person lacking mental capacity to make that decision.
Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. Staff understood what they needed to do if they had concerns about the way a person was being treated. Staff were prepared to challenge and address poor care to keep people safe and happy.
Learning took place following any incidents to prevent them happening again. People and their relatives were encouraged to provide feedback which was used to enhance the service.
We saw evidence that people were involved in the development of their support plans along with their relatives, staff and relevant health care professionals. We looked at daily activities planners which showed the time and types of activities people had engaged in each day. One person told us they enjoyed music therapy, completing crosswords and accessing the internet in order to choose and plan holidays. We spoke to a relative who told us that people 'always seemed to be having a lot of fun.'
There were a sufficient number of qualified, skilled and experienced staff to deliver care and treatment safely and to an appropriate standard.
The provider had made arrangements to ensure the prevention and control the spread of infection and an agreed standard of cleanliness was maintained in the home.
People were asked for their views about the quality of support provided and activities offered. We found that the provider had systems and processes in place for identifying, assessing, monitoring and reviewing risks posed to people living in the home.
At the time of our visit, the provider was not offering a domiciliary care service.This meant that we did not look at this regulated activity .
We completed this review because when we carried out our inspection on 3 July 2012 the report did not show the outcomes for management of medicines, safety and suitability of premises and records. All these three outcomes had outstanding compliance actions from our inspection in June 2011, where we had asked the provider to make improvements. When we inspected the service in July 2012 we found the provider to be compliant in these outcomes.
We gathered evidence of people's experience by speaking with two relatives and a health care professional who visited the home on the day of our visit.
The health care profession told us, 'The home has an open and flexible way of working and puts the service users' needs first'.
Relatives of people living in the home told us that they were very happy with the staff and the facilities in the home. One relative told us, 'The home is very good and my son is so happy here'.
Staff were observed interacting with people in a respectful manner that showed that they understood each individual's needs and how best to communicate with them.
'Love it here.' 'Food is good'. 'Staff are ok.'
This person confirmed that he had no concerns and indicated that he would talk to staff if he had any.
Another person confirmed that he enjoyed activities, and that he does lots in Gloucester with staff support. He also confirmed that he would talk to staff if he had any worries, and that staff would listen to him and deal with issues.
When questioned about staff he said they were 'very good'
He nodded that he had a key worker and indicated that care plans were in the office. He confirmed that he was involved in the review of his care plans and again indicated that he would talk to staff if he had concerns. About concerns he said,' No'- don't have any.
We talked to a third person. He said that staff were 'good.' We talked about care plans and key workers. He indicated that care plans were kept in the office, confirmed individual goals were in place and that staff supported him to achieve these goals. He indicated that if he had any concerns he would talk to staff, confirmed they would listen 'good' and would deal with problems. He indicated that he didn't have any concerns or worries. He confirmed that he knew about advocacy and could have an independent advocate if he wished. He was enthusiastic about the range of activities available and indicated that he really enjoyed skittles, bowling and cinema.
A fourth person did not wish to interact with us but said - 'Ok here.' 'Staff alright'