Homewards Limited - 51 Leonard Road

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 guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people

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

The service could show how they met the principles of Right support, right care, right culture.

Right support:

The model of care and setting maximised people’s choice, control and independence. People’s support was provided in a safe environment which met people's sensory and physical needs. Improvements had been made in response to previous concerns and managers had focused on minimising risks to people living at the service. People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice.

Right care:

Care was person-centred. People were supported to be independent and had the freedom to make their own decisions. Their human rights were upheld. Staff respected their cultural needs. People received kind and compassionate care from staff who respected their privacy and dignity. People were supported to maintain links with their family and friends. People took part in meaningful activities which were part of their planned care and support.

Right culture:

There was a calm, enabling atmosphere, where people felt safe. A person said to us, “I am happy, I like it here it’s peaceful.” The ethos, values, attitudes and behaviours of the management and staff ensured people’s needs and quality of life formed the basis of the culture at the service. Managers were visible and communicated well with people, those important to them and staff. The leadership had worked hard to create an open culture where feedback and learning was encouraged.

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 protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People had their communication needs met and information was shared in a way they could understand.

• People’s risks were assessed regularly in a person-centred way, people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

• People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People’s care and support plans reflected their sensory, cognitive and functioning needs. Staff regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

• People received care and support from trained staff able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Managers supported staff to meet their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• People were supported by staff who understood best practice in relation to learning disability and/or autism.

• Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve the service.

Rating at last inspection (and update)

The last rating for this service was inadequate (published 24 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after this inspection to show what they would do and by when to improve.

We carried out an unrated targeted inspection (published 19 September 2020) due to concerns raised by a whistle-blower about lack of activities, reporting of accidents and incidents and food and nutrition. We found no evidence at this time that people were at risk of harm from these concerns.

At this comprehensive inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 24 October 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this inspection to provide assurance that the service is applying the principles of Right support right care right culture.

At this inspection 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homewards Limited – 51 Leonard 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.

Homewards Limited – 51 Leonard Road provides accommodation with personal care for up to three people with learning disabilities or autism spectrum disorder. At the time of this inspection there were three people using the service.

People’s experience of using this service

A relative told us they had seen positive changes in the cleanliness in the service and they felt their relative was safe.

Staff confirmed they were provided with adequate amounts of personal protective equipment such as masks and gloves.

Staff understood what action to take if they suspected somebody was being harmed or abused.

Staff knew how to report accidents and incidents.

People had risk assessments to keep them safe from the risks they may face.

Relatives and staff spoke positively about the management of the service.

The provider carried out quality checks such as infection control.

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 inadequate (published 24/10/2019) .

Why we inspected

This was a targeted inspection based on concerns raised with the local authority in relation to staffing, risk management, safeguarding and incident and accident reporting, .

CQC have introduced targeted inspections to follow up on Warning Notices 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 no evidence during this inspection that people were at risk of harm from these concerns.

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.

Please see the safe, and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homewards Limited - 51 Leonard 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.

Homewards Limited - 51 Leonard Road is a residential care home registered to provided personal care support to up to three people with learning disabilities and/or autistic spectrum disorders. At the time of the inspection, three people were using the service.

The service had not been fully developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always 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

People were not supported by staff who were appropriately recruited. Staff rotas were not clear and accurate to confirm staff on duty. Risks to people were identified. However, the risk assessments did not always include actions staff were required to take to reduce the risks to people.

People were exposed to risk of harm due to health and safety issues with the garden. People were not safeguarded from the risk of infection. The provider lacked effective systems to learn lessons from accidents and incidents, and when things went wrong.

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 service didn't always consistently 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 as people did not receive safe personalised care.

The provider lacked effective systems to ensure the safety and quality of the service. During and following the inspection, although requested, we were not provided with evidence of the provider’s quality audits and assurance systems.

Whilst staff knew signs and types of abuse, they did not know the whistleblowing procedure. We could not be confident people were appropriately safeguarded. We have made a recommendation in relation to the whistleblowing procedure. People received appropriate medicines management support.

Staff told us they felt supported and found the management approachable. Staff said they liked working with the provider. The provider worked with other healthcare professionals to enhance people’s experiences.

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 November 2018).

Why we inspected

We received concerns in relation to the management of medicines and staffing. As a result, we undertook a focused inspection to review the Key Questions of Safe 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 Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homewards Limited – 51 Leonard Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and good governance 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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Homewards Limited - 51 Leonard Road is a 'care home'. 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. Homewards Limited - 51 Leonard Road provides care and support for up to three people with learning disabilities and/or autistic spectrum disorders. At the time of our inspection there were three people using the service.

There was a registered manager at the service at the time of our 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 and associated Regulations about how the service is run.

People and a relative told us they felt safe with staff and there were enough staff to meet their needs. Staff were trained in safeguarding and knew how to safeguard people against harm and abuse. People’s risk assessments were completed, regularly reviewed and gave sufficient information to staff on how to provide safe care. Staff kept detailed records of people’s accidents and incidents. Staff wore appropriate protection equipment to prevent the risk of spread of infection. Medicines were stored and administered safely. The home environment was clean.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their best interest. We saw people were able to choose what they ate and drank. People told us they enjoyed the food. The home was well decorated and adapted to meet the needs of people using the service.

People told us that they were well treated and the staff were caring. We found that care records were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. People had access to a wide variety of activities. The service had a complaints procedure in place. People’s end of life wishes were explored.

Staff told us the registered manager was approachable and supportive. The home had various quality assurance and monitoring mechanisms in place.

The service is registered with the Care Quality Commission to provide accommodation support with personal care and to up to three adults with learning disabilities or autistic spectrum disorder. Three people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

Although medicines were mostly managed in a safe manner, we found that correction fluid had been used on some medicines records. The service did not always have clear records of medical appointments. We have made recommendations about these issues within the report.

The service had appropriate safeguarding adults procedures in place. There were enough staff working at the service to support people in a safe manner and checks were carried out on staff before they began working at the service. Risk assessments were in place which included information about how to mitigate risks people faced.

Staff were well supported and received regular training and supervision. The service was operating within the Mental Capacity Act 2005 and people were able to make choices about their daily lives. This included choices about what they ate and drank. People had routine access to health care professionals.

People told us they were treated with respect and in a caring manner by staff. The service promoted people’s independence and privacy.

People’s needs were assessed before they moved into the service. Care plans were in place which set out how to meet people’s individual needs. The service had a complaints procedure in place and people knew how to make a complaint.

People and staff told us they found the registered manager to be approachable and helpful. The service had various quality assurance and monitoring systems in place. Some of these included seeking the views of people that used the service.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they were happy and safe. We spoke with one person about their views of the service. They smiled and gave positive responses. When asked if they liked living at the home, they replied, "Yes I do."

Systems were in place to make sure managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. We found risk assessments had been undertaken to identify any potential risk and the actions required to manage and minimise the risk had been put in place. This meant people were not put at unnecessary risk.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The manager told us that no applications had been made to deprive people of their liberty but staff understood how to submit one and follow the correct process. This meant people would be safeguarded from any potential abuse.

The service liaised with the emergency services and arrangements were in place to deal with foreseeable emergencies.

Is the service effective?

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind manner and there was a relaxed and friendly atmosphere.

Care files we checked confirmed that initial assessments had been carried out by the staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Managers' were accessible to staff for advice and support and we saw people being able to access the manager as needed.

All the records we looked at were fit for purpose. They were easily accessible throughout the inspection.

Is the service caring?

One relative in the quality survey said, "The care and facilities provided by the home is excellent." During our observation we saw friendly interactions between staff and people who used the service and there was kindness in the staff's tone of voice when speaking with people who were excitable. Interactions between staff and people who used the service were relaxed and unrushed. We found staff understood the need to recognise and respect the diversity and human rights of people who used the service.

Is the service responsive?

Staff told us the care and support provided was flexible to the person's individual needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed and updated in the care plan. People knew how to make a complaint if they were unhappy and the manager and staff spoke with relatives on a regular basis and would deal with any issues promptly.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had regular meetings and were kept updated about any information during the daily handover sessions. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information. Feedback was sought by way of relative/friend satisfaction surveys, staff surveys and 1:1 sessions with people who used the service. This showed people had the opportunity to put their views across.

The service had a quality assurance system in place. Daily and monthly audits were completed such as a premises check and cleanliness of the home. This ensured a timely response could be given to any issues and the service could maintain and improve quality at all times.

We spoke to one relative who told us that everything is fine and they have no concerns about the care provided.

We looked at three care plans and found them to be person centred and focused on people's needs. All aspects of support and different tasks were shown in picture format which ensured people at the home were involved in their care.

We looked at pictures from a recent gardening class that the home had provided in the back garden. The people we spoke to confirmed they did this and enjoyed it. People were also booked on Drama sessions which showed the home supported new activities people wanted to try.

The home was clean and tidy and people at the home were wearing clean clothes. The registered manager told us that it is very important that people at the home are always presentable and that the home is clean at all times. We saw that people at the home were doing their own laundry which encouraged the maintenance of a hygienic environment.

Staff went through appropriate checks and the home ensured that they were suitably qualified to care for the people at the home.

There was a complaints policy which was clear and available in different formats. No complaints had been made at the home.

One staff member told us that they did have regular individual meetings with their manager, theses sessions included an appraisal, reviewed thier performance and identified appropriate training needs.

Following the last inspection the provider had to undertake minor repairs. This was being acted upon and redecoration of some of the rooms had been carried out.