CareTech Community Services Limited - 82 Chaucer Road

CareTech Community Services Limited- 82 Chaucer Road is a residential care home providing personal care to eight younger adults living with a learning disability or autism. People had their own bedrooms with en-suite facilities and shared communal areas such as a kitchen, lounges, bathrooms and a garden.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The provider and registered manager had limited oversight of the service and audits were not always effective at identifying where improvements could be made. Staff did not feel supported by the provider and people were not always being supported to achieve good outcomes. Feedback about the service from people was not always actioned in a timely manner.

People were not always kept safe at the service as medicines were not always managed safely. Risks assessments were in place; however, these were not always reflective of people’s current support needs. Some areas of the service needed a deep clean to promote good infection control. There were enough staff to support people safely. However, staff members were not receiving relevant training or frequent supervision to ensure that they were effective in their job roles. We have made a recommendation about the provider’s training programme.

The premises were in need of redecoration and repair in several areas. We have made a recommendation about the environment at the service. People were not always 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 policies and systems in the service did not always support this practice. We have made a recommendation about best practice regarding the Mental Capacity Act.

The service did not 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 were not always supported to follow their interests, have meaningful goals and be a part of their community. We have made a recommendation that the service consult best practice guidance when supporting people living with a learning disability.

People were supported by a kind and compassionate staff team who had gotten to know them as individuals. People’s privacy, dignity and independence was respected and upheld by the staff team. However the provider did not always support staff to do this as they did not keep up to date with best practice guidance.

People were supported to live healthy lives and were supported to eat and drink a varied diet. People had access to a complaints procedure and had been supported to put plans in place for the end of their life.

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 (report published 20 June 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

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, Effective, Responsive 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:

We have identified a breach in relation to the management and governance of the service. 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 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 inspection took place on 10 and 15 May 2017.

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.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service. People had risk assessments in place to enable them to be as independent as they could be whilst remaining safe. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Effective recruitment processes were in place and followed by the service. Staff were not employed until satisfactory checks had been completed. Systems were in place to ensure people’s medicines were managed in a safe way.

Staff received a robust induction programme. They were provided with on-going training to update their skills and knowledge to effectively support people with their care and support needs.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.

People were treated with compassion and kindness by staff. Each person was supported in a way that was individual to them and were encouraged to identify their own support networks in order to improve their independence. Staff supported people to fully engage in discussions about their care and worked proactively to help them to make choices and decisions about their care and lifestyle.

People's needs were comprehensively assessed and care records gave clear guidance on how people were to be supported. Staff were knowledgeable about how to meet people’s needs and understood how people preferred to be supported. There was an effective complaints system in place which was used to drive future improvement within the service.

People and staff were positive about the leadership of the service and the support they were able to provide for people with complex healthcare needs. The service's philosophy demonstrated a true passion and commitment to providing good quality care. We found the service had a positive culture that was person centred, inclusive and empowering. Ideas for change were always welcomed, and used to drive improvements and make positive changes for people.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We found that the staffing ratio facilitated people to participate in activities of their choice and enjoy a good quality of life. One person told us, 'I like living here; staff are kind to me and help me with what I need.' Another person told us how they were looking forward to the time when they cooked for the rest of the house. We found that people were protected from potential abuse because the staff ratios enabled them to effectively attend to people's support needs.

Is the service effective?

We observed staff talking with and assisting people throughout our time in the home, we found that this was done with the people's privacy and dignity in mind and emphasised staff's awareness of people's individual support needs. This was further reinforced in our conversations with staff, which emphasised their knowledge and understanding of people's specific needs. It also reflected the support plans we viewed on the day. We found that staff had a good awareness of people's individual dietary needs and supported them to maintain a healthy dietary intake, whilst enabling them to make independent choices. Within the care files we saw that people or their families, where appropriate, had been involved with, and agreed with the particular care needs that had been identified for them.

Is the service caring?

We found that people were satisfied with the care and support they received. We observed that people were offered support at a level which encouraged independence and assured their individual needs were met. The staff were friendly and courteous in their approach to people and interacted confidently with them. We noted that people were encouraged to express their views about the quality of care in the home. They were also involved in planning their care, making decisions about their support and treatment, and how they spent their time.

Is the service responsive to people's needs?

We found that people received person- centred care and support from appropriate people, when required. We noted that people's wishes were respected by care staff and taken into account when making best interest decisions and planning care and support. Records supported that the service engaged effectively with other professionals in ensuring that all areas of health and well-being were maintained.

Is the service well- led?

We found that the provider monitored the quality of the service provided to people and acted upon the feedback they were given. This showed that the service had an effective management structure and was responsive to concerns, making efforts to drive on-going improvement.

Three people clearly communicated through their body language they were satisfied with the care and support they received. One person told us,"I like living here." Another person said,"I'm hoping to move on to another place but being here has helped me."

We observed that people were offered support that ensured their individual needs were met and independence encouraged. Staff were friendly and respectful in their approach to people and interacted confidently with them, respecting the individual's dignity and knowing how to communicate effectively with them. One member of staff told a person, "You have choices, it's up to you what you do."

We noted people were involved in planning their care and making decisions about their support and how they spent their time. Some people were going to the day centre at the time of our visit, and others were involved in personal development activities.

One person confirmed the different activities and entertainment they participated in and showed us through their gestures that they enjoyed this.