Brighton & Hove City Council - 83 Beaconsfield Villas

About the service

Brighton & Hove City Council - 83 Beaconsfield Villas is a residential care home for up to 6 people with a learning disability and/or autism. At the time of the inspection, 6 people were living at the service and receiving support with personal care.

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

Right Support

Governance systems at the service were more robust but still required improvement to ensure shortfalls in the service were identified and actions were taken to address these. Risk assessments were not always fully updated when required. Improvement had been made to specific risks within the home, for example, fire safety.

Staffing levels had improved. Staff were recruited in line with legislation and the provider’s policy. Staff delivered care and support in a safe and clean environment. People's medicines were managed in line with best practice guidance.

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 supported by staff to pursue their interests and to have a fulfilling and meaningful everyday life.

Right Care

People were now supported in a person-centred way as per their needs and wishes. People received kind and compassionate care from staff who knew them well. People's independence was promoted. Staff understood how to protect people from poor care and abuse. Staff training had been a priority and there were enough appropriately skilled staff to meet people's needs.

People could communicate with staff freely because staff supported them consistently and understood their individual communication needs. People's care, treatment and support plans were being updated and reflected their range of needs. People received care focused on their quality of life.

Right Culture

There was a calm and friendly atmosphere at the service. The new management team had created an open and transparent culture where relatives and staff felt comfortable and confident to share concerns and ideas for improvements. Staff placed people's wishes, needs and rights at the heart of everything they did. People and those important to them were involved in planning their care.

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 20 February 2023) and there were breaches of 6 regulations. This service has been in Special Measures since 12 January 2023. 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 carried out an unannounced focused inspection of this service on 27 and 28 October 2022 and breaches of legal requirements were found. CQC took enforcement action and warning notices were issued to the provider. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care; safe care and treatment; safeguarding service users from abuse and improper treatment; premises and equipment; good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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.

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 inadequate to requires improvement. 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 Brighton & Hove City Council – 83 Beaconsfield Villas 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.

About the service

Brighton & Hove City Council - 83 Beaconsfield Villas is a residential care home providing personal care to 6 people with learning disabilities and autistic people at the time of the inspection. The service can support up to 6 people.

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

Right Support

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the systems in the service did not support best practice. Everyone living at the home required specific support and care to keep them safe and happy, there were positive behaviour support approaches for people, recommended by the local psychological support service. Some people had specific restrictive interventions recommended to protect them from harm at times of risk, and in their best interests. However, the service did not always have enough staff who had up to date skills and knowledge to provide the right support at the right time. People's records did not always show how decisions had been made about their support and how risks were reviewed and analysed.

Right Care

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. There were not always enough staff to fully meet people's needs and ensure they had fulfilling lives. People's known interests and activities were not always enabled, this limited their opportunities to go out, exercise and do the things they liked.

Right Culture

Governance approaches were not effective in ensuring good standards of care, a safe environment, or to identify and lead required improvements. Some environmental risks within the home were known by the provider but had not been effectively assessed and responded to in a timely way to ensure people were safe. Audits and checks did not regularly take place to ensure the quality of care and support experienced by people was known and maximised. Staff were not adequately supported in their roles, training was not prioritised and levels of stress were reported to be high.

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 9 May 2019).

Why we inspected

We received concerns in relation to the level of staffing, how risks were being managed and the governance in place. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to failures to reduce risks to people, ensure safe staffing levels and to manage quality and safety, at this inspection.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 6 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.

We found the following examples of good practice.

• Safe arrangements were in place for visitors. This included confirmation of a negative lateral flow test, temperature checks, and the use of personal protective equipment (PPE). Visiting professionals showed evidence of vaccination status or exemption.

• There were adequate supplies of personal protective equipment (PPE) throughout the home. Risk assessments were in place for residents where the use of PPE, other than masks, was not appropriate. Staff were seen appropriately using PPE.

• There were arrangements to admit people safely to the home. This included testing and isolation in line with guidance. Arrangements were in place to undertake individual risk assessments in the event of a new admission.

• People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this was communicated and updated as needed.

• The provider followed relevant COVID-19 testing guidance. This included staff testing requirements as well guidance on testing for people using the service and visitors.

• Maintaining the mental health of people and staff was a priority with proactive support from the service to encourage people’s well-being. This included supported activities within the home and support to maintain contact with family and friends, as well as trips out with one to one support.

• There were clear cleaning schedules in place which included the frequency of cleaning high touch areas. Records showed compliance with the cleaning schedule.

• The home had an up to date infection control policy.

• Staff were trained and knew how to immediately instigate full infection control measures to care for a person who developed symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

About the service:

83 Beaconsfield Villas is registered to provide accommodation and personal care for up to six people. Care is provided to adults with a learning disability. The home is situated in Brighton and is a large detached house. People’s bedrooms are located over four floors and three people each live in a self-contained flat. At the time of inspection six people were living at the home.

Rating at last inspection:

Good (published 11 October 2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People appeared happy and safe. Staff had a good understanding of people’s needs and preferences. Staff listened to what people wanted and acted quickly to support them to achieve their goals and aspirations. Staff were creative and looked to offer people solutions to aid their independence and develop their skills.

People had good community networks which were personal to them. This included college opportunities and therapeutic activities. People were supported to develop and maintain positive relationships with friends and family. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence and access to the community. The emphasis of support was towards enabling people to learn essential life skills. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life.

Families described the staff as caring, kind, compassionate and friendly and the atmosphere of the houses as relaxed and engaging. 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 and was in line with national guidance.

Leadership was visible and promoted good teamwork. Professionals, families and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, management and staff teams worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the management team was keen to make changes that would impact positively on people's lives.

The service met the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support'. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A full description of our findings can be found in the sections below.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

83 Beaconsfield Villas provides accommodation and personal care for up to five younger adults with a learning disability or autistic spectrum disorder. The service specialises in working with people whose behaviour is complex and can be challenging. The service is situated in Brighton and is in a large detached house near the town centre. People’s bedrooms are located over four floors and there are two one person self-contained flats within the building. Communal areas include a kitchen/dining room and two lounges. There is a large garden for people to use. One of the self-contained flats also has its own private garden. Five people were living in the service at the time of our inspection.

The service had 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 registered manager was not present during the inspection, however we contacted them after the inspection for clarification and further information.

The last inspection was carried out on 3 and 8 July 2015. We found a breach to the Regulations. This was in relation to safe storage and recording of medicines. We also found areas which required improvement in relation to where people had ‘as and when required’ (PRN) medicines the guidance for care staff to follow had not been updated. The regular checks of the fire equipment in between checks made by the external contractors had not been maintained. Staff training records had been updated and this highlighted care staff had not received updates of their training to meet the timescales of the provider. Where bank staff worked in the service there was not a record of the training they had completed. So it could not be assured that they had the necessary training to meet peoples care and support needs. The hot water checks had not been maintained to ensure the delivery of hot water at a safe temperature. People were supported to eat a healthy diet. However, records of what people had eaten and fluids consumed to inform care staff had not been maintained. Recruitment documents were not fully available for senior staff to access. Feedback and quality assurance systems were not fully in place. The provider provided the CQC with an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and the regulations were now being met.

Relatives and the visiting healthcare professional told us they felt people were safe. One relative told us, “He is very safe. We are very pleased he gets his care there.” People were supported by care staff who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager. There were systems in place to assess and manage risks and to provide safe and effective care. People were supported through a risk management framework to access a range of activities. One member of staff told us, “We keep the guys safe. All five people are incredibly vulnerable, so we have to be vigilant as they could get into trouble. We give them a good quality of life, to be able to enjoy life and get new experiences. We are always thinking about new experiences for them all.”

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. All appointments with, or visits by, health care professionals were recorded in individual care plans. Medicines were managed safely and people received the support they required from care staff. There were systems in place to ensure that medicines were administered and reviewed appropriately.

The premises were well maintained. The environment was clean and spacious which allowed people to move around freely without risk of harm. Equipment and services such as gas and electric supplies and the fire alarm system had been checked by external contractors.

Consent was sought from people with regard to the care that was delivered. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care and support provided was personalised and based on the identified needs of each individual. Where people were unable to make decisions for themselves staff had taken appropriate action to arrange meetings to make a decision in their best interests.

People were supported by kind and caring staff. People were treated with respect and dignity by the care staff. They were spoken with and supported in a sensitive, respectful and professional manner. There were robust recruitment procedures in place. There were sufficient numbers of suitable care staff to keep people safe and meet their care and support needs. Care staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively.

There was a clear management structure with identified leadership roles. The registered manager told us that they operated an 'open door policy' so people, their representatives could discuss any concerns. Systems were in place to audit and quality assure the care provided. There was a detailed complaints procedure, and relatives told us they knew who to talk to if they had any concerns. Feedback was sought on how to improve the service, through the reviews of people’s care, and the completion of a satisfaction questionnaire to help identify any areas for improvement. There was evidence as to how any feedback was acted upon and improvements made to the service provided. Care staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable. One member of staff told us, “It’s a really, really good team. Everyone one is here because they want to do the job. We all pull together and help each other.” Another member of staff told us, “I really love it here.”

This told us that the people who used the service or their representatives had been involved in making decisions about their care and treatment and where they were able to, gave consent to the care. People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording of medicines.

People's care had been provided by care workers who understood their care needs. There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service.

Records relevant to the management of the service was accurate and fit for purpose. However, staff training records were not consolidated and did not fully demonstrate all the training staff had completed.

This told us people or their representatives had been able to express their views about the care provided if they wished to, and where possible people who used the service had been involved in making decisions about their care and treatment.

People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. One comment received was 'My relative is completely correctly placed,' 'I'ts a happy and content place,' 'They look after him well,' and 'The home is extremely well managed and the team work well together.'

The service's own care workers and regular bank staff had a good understanding of people's care needs.

People knew who to talk with if they had any concerns about the care provided.

The provider had systems in place to quality assure the care provided.