We carried out a review of the data available to us about Orient St Adult Respite Unit 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 Orient St Adult Respite Unit, you can give feedback on this service.
About the service
Orient St Respite Service is a residential care home which operates as a respite service. It provides short stays and emergency accommodation where required for people with a learning disability and autistic people. The service is registered to accommodate up to four people at a time and we met six people during our three visits. Part of the premises provides services for children and is registered by Ofsted. The services for adults and children was clearly divided by locked doors internally and the rear garden has a fence and gate to ensure guests from each side do not have access.
People's experience of using this service and what we found
Right Support
People were provided with a clean and comfortable living environment that had been adapted to meet their individual needs. People told us they were happy at the service and relatives commented on how their family members were supported to have good outcomes and a good quality of life during their stays at the service. Staff supported people to achieve their aspirations and goals. People benefitted from the stimulating facilities at the service and were supported to take part in activities of their choice in the local area. People received care and support from safely recruited staff who had appropriate skills and backgrounds for their roles. People were supported by staff to communicate their wishes, preferences and choices. People were supported to meet their healthcare needs and the provider liaised well with relevant health and social care professionals to ensure people achieved good outcomes for their health. 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.
Right Care
People were protected from abuse by staff who had appropriate training and knew how to apply it. The service deployed sufficient staff with suitable training and experience to safely meet people's needs. People's cultural needs were understood and supported by staff. People who had individual ways of communicating were supported by staff with training and guidance to enable them to understand and interact with individuals. People's care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People were treated with kindness and respect by staff. One person told us, "It's fun here, it's good."
Right culture
People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.
People and those important to them, including advocates where applicable, were involved in planning their care. Staff knew and understood people well and were responsive to their choices and wishes for how they spent their time during their stays. Staff placed people's needs and aspirations at the centre of how the service operated. People’s quality of life was enhanced by the service’s culture of ongoing improvement and inclusivity, which included acting on the feedback from people and their relatives about the quality of care and support.
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
At the last inspection, the service was rated as requires improvement (report published 11 December 2019) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve systems for monitoring the quality of the service. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this unannounced focused inspection to check the provider had followed their action plan and to confirm that the service was applying the principles of right support, right care and right culture. This report only covers our findings in relation to the key questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from ‘requires Improvement’ to ‘good’ based on the findings of 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 Orient St Adult Respite Unit 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.
The service shares a building with another respite service for children, but this is separated through the use of pin coded doors. This service is not registered with the Care Quality Commission and therefore did not form part of this inspection.
The service has been 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 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 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 systems in the service did not support this practice, because they were not always assessing people’s capacity to consent to their care. The provider was therefore not consistently meeting legislation and current guidance with regard to the mental capacity assessments and could not demonstrate they were effectively monitoring the quality of the service.
The provider did not ensure care staff consistently received up to date training, but did ensure they received an induction and ongoing supervisions and training. Audits were not being completed to assess the quality of the service, so the issues we found were not identified.
Improvements had been made to staffing levels and the provider was no longer accepting emergency admissions. Risks to people’s health and safety were properly assessed before they used the service. People’s medicines were being managed safely and the provider reduced the risk of infection by maintaining good levels of cleanliness within the home. Lessons were learned when things went wrong and the provider had clear systems in place to prevent the risk of abuse. The provider conducted appropriate checks before staff started working at the service.
People were given appropriate support with their nutritional needs and were supported to access healthcare services when needed. The home was appropriately designed to meet their needs.
The provider ensured people received the support they needed and their equality and diversity was respected and promoted. People’s privacy and dignity was respected and people were supported to express their views. The provider assessed people’s needs before they used the service and communicated effectively with them. People were supported to take part in activities they enjoyed and complaints were responded to as needed. Due to the nature of the service, the provider was not supporting anyone with end of life care needs, but they had the necessary information to support people in accordance with their preferences in the event of a sudden death.
Staff were aware of their roles and responsibilities and the provider was open and honest when things went wrong. Staff and people’s relatives told us there was a positive culture within the service and their views were sought. The provider worked with other professionals when needed.
The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to become more independent.
We have made a recommendation about compliance with the MCA 2005.
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 requires improvement (published 12 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the effective 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 Good 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 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.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support 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.
At the time of our inspection, Orient St Adult Respite Unit was providing support to four people.
At the last inspection on 13 May 2016, the overall rating for the service was Good.
There was a registered manager in post. 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.
We carried out this unannounced inspection of the service on 3 July 2018. At this inspection, we rated the service Requires Improvement overall for the first time. This was because aspects of the service were not safe and well led. Staff felt that there were not always sufficient numbers of them deployed to care and support for people. Staff worked under pressure to meet people’s needs and there were not effective systems in place to manage emergency admissions. The provider had started recruiting additional staff to resolve the staffing level concerns. Checks and audits were carried on the quality of care. However, improvements were not always done in a timely manner.
People received their medicines when needed. However, staff did not have sufficient guidance on how to manage ‘when required’ medicines. Staff underwent medicines management training and a competency assessment.
Risk assessments and management plans were appropriate for people who used respite services on a regular basis. However, risk assessments for emergency admissions at the service did not always reflect people’s needs and the support they required.
Staff understood safeguarding procedures to follow to identify and report abuse to protect people from harm. The provider’s recruitment procedures were appropriate in ensuring that only staff deemed suitable delivered care to people.
Staff received support, training and supervision to enable them to deliver care. The registered manager monitored staff performance and development needs.
People were treated with kindness and compassion. Staff respected people’s dignity and privacy. People enjoyed positive caring relationships with the staff who provided their care.
People had access to healthcare services and the support they required to maintain their health and well-being. Staff involved people in menu planning, meal preparation and maintaining a healthy diet. People were encouraged to develop their daily living skills and to do as much as possible for themselves.
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. Staff continued to deliver care and support in line with the requirements of the Mental Capacity Act 2005. People received the support they required to consent to care. Staff acted in people’s best interests when they were unable to make decisions for themselves.
People’s care delivery met their individual needs, preferences and choices. People using the service and their relatives took part in making decisions about their care. Staff undertook regular reviews of people’s needs and the support they required. Care plans showed staff delivered support that reflected people’s needs.
People had the support they required in taking part in activities and interests of their choosing. People had received a copy of the complaints procedure and knew how to raise concerns about any aspect of their care. People’s views and ideas about the service were sought and their feedback was acted on to improve care delivery.
The registered manager and staff were focussed on delivering person centred care. The registered manager worked closely with other agencies. However, some clarity in the processes was required to ensure that emergency admissions resulted in people receiving good care.
We have made a recommendation on medicines management.
We last inspected the service on 29 May 2014 where the service met all the regulations inspected.
At the time of our inspection the service had one person using the service and three people were referred for respite care at the service later that day. People stayed at the service for three days to one week, but could stay more or less depending on their needs. Respite stays were booked in advance but emergency and short notice stays could be arranged when necessary. Some people using the respite service continued to attend day services during their stay which meant there were sometimes less people at the service during the day.
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 home is run.
People, their relatives and healthcare professionals told us the service was safe. Staff understood the types of abuse that could happen to people and their responsibility to report any concerns and take action to protect them from harm.
People told us staff listened to them and respected their privacy. Staff had complied with the law in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) when people lacked mental capacity. Staff knew how to protect people’s rights.
Staff were supported in their roles through regular supervision and appraisal. People received their support from staff who had received relevant training and had the knowledge to deliver their care effectively.
People told us they enjoyed their stay at the service because staff met their needs. There were sufficient staff to meet people’s needs effectively. Staff knew people well and provided their care and support in a caring manner. People received sufficient food to eat and drink and had a choice over what they wanted to eat, how they wanted to spend their time and which staff supported them. People were involved in the local community and enjoyed a range of activities.
People were supported by suitable staff who had been recruited using a robust procedure. People received the support they required with their medicines from staff who were assessed as competent to administer medicines safely. Staff had identified risks to people’s health and wellbeing. Support plans were in place for staff on how to manage the identified risks and the action to take to minimise those risks whilst enabling people to be as independent as possible.
People enjoyed good relationships with staff. Staff ensured people, their relatives and friends were made welcome at the service. People looked forward to coming back to the service again for their break. People received care which took into account their choices and preferences. Staff encouraged people to be as independent as possible.
People’s needs were thoroughly assessed and their support was reviewed before they returned to the service for another stay. Staff had up to date information about people’s needs and the support they required. People’s needs were met and relatives were happy about how responsive the service was, particularly when managing emergencies at the service. People knew how to make a complaint and felt able to use the complaints procedure in place.
People, staff and healthcare professionals told us the registered manager led the service effectively. The registered manager used effectively the audit systems in place to monitor the quality of the service and support provided to people and drive improvement where necessary.
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 the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
Staff were knowledgeable in recognising signs of potential abuse and the relevant reporting processes. There were processes in place to ensure people's safety whilst using facilities shared with the provider's children's service. There were systems for protecting people from financial abuse.
All activities were risk assessed to ensure they were safe for people to do. Individual risk assessments were undertaken and management plans were in place about how to minimise the risk from occurring.
People's needs, interests and abilities were identified and taken into consideration during group bookings to ensure there were appropriate staffing numbers to ensure the safety of people who used the service.
Is the service effective?
People who used the service told us they enjoyed going to the service and that it 'gives me a break and my family.' Relatives of people who used the service described the service as 'a fantastic place,' 'a wonderful service,' and 'the staff are great.'
Staff were knowledgeable about people's support needs, their interests and preferences. Staff spoke with people who used the service and their relatives before they stayed at the service to identify any changes in people's health and support needs.
People were asked about what they wanted to eat at the start of their stay and this was catered for. People were provided with additional support and adaptive crockery and cutlery as required enabling them to eat and drink independently.
Is the service caring?
People who used the service told us they liked the staff and enjoyed going to the service.
People were involved in decisions about their care and their views were listened to. People were given choice about what they wanted to do whilst at the service. Meetings were held at the beginning of their stay to identify what they wanted to do during their time at the service and they were supported by staff as required.
Staff were knowledgeable on people's cultural and religious needs and staff supported people to meet those needs.
Is the service responsive to people's needs?
One staff member told us, 'It's great being able to respond to people's needs and help them with activities when they want it.' People were supported to access the community and to undertake activities in line with their wishes. Staff encouraged people to be independent. It was identified before people's stay if they were in the process of learning new skills to increase their independence and staff supported them to continue developing their skills, for example, learning how to make a cup of tea.
There were systems in place for people who used the service and their relatives to feedback on service provision. At the time of our inspection there had been no complaints received and the relatives we spoke with told us they had not needed to complain or raise any concerns regarding the quality of service provision.
Is the service well-led?
There were systems in place to monitor the quality of service provision. The most recent checks did not identify any concerns with the quality of service provision. This included checking health and safety processes, emergency procedures such as fire evacuation drills, and identifying any concerns or training requirements within the staff team.
There was a process for recording incidents. However, for low level incidents there was not the process in place to record the action taken to ensure the safety and welfare of people who used the service. The manager was in process of reviewing this system and implementing a new recording tool.
People were able to make choices about how they spent their time at the unit. Decisions about care and support were made in people's best interest and were described in care plans that were developed with the person and their family carers.
Staff we spoke with felt well supported by other staff and their manager, and had access to good quality training.
We found there were arrangements in place for the safe storage and administration of medicines. Records were well kept and fit for purpose.