Hail - Bedford Road

About the service

HAIL- Bedford Road is a 'care home' for people who have a learning disability. The service accommodates a maximum of six people. At the time of our inspection there were six people living in the home. People using the service had been living at the homes for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

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

Right Support:

Not all people were supported in the least restrictive way possible and best interest meetings were not always completed. We found during our inspection that there was a bathroom and a toilet on the first floor locked and 1 person’s wardrobe was also locked. The acting manager informed us that this was due to a person’s support needs. However, this was not recorded on their deprivation of liberty documents or their care plan.

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.

People were safeguarded from the risk of harm and abuse as the provider had systems in place to protect people. Staff supported people to take their prescribed medicines safely. Staff had completed safeguarding training and understood their role and responsibilities in reporting any concerns of abuse.

Right Care:

Staff came across caring and supportive and we saw positive interactions between staff and people. There were sufficient staffing levels to meet people's needs. During the inspection there were music activities taking place and some people were accessing the community with support from staff.

The provider had systems in place to carry out recruitment checks to ensure that staff were recruited safely. Staff received up to date training to meet people’s support needs.

The service needed redecorating, and in some of the communal area’s maintenance was also required as there were cracked tiles in the kitchen. The bathrooms were very dated, and the floors needed replacing. The first-floor shower room needed a deep clean, which was an infection control concern.

At the time of the inspection the provider was having a meeting with the landlord about the housing issues.

During the inspection we noted that 5 bedrooms had locks were placed on the doors the wrong way round, which meant that there were a risk of people being accidentally locked in their rooms and not able to get out, which could also be a fire risk. The manager reported this concern to the landlord at the time of the inspection.

Right Culture:

People’s relative’s spoke positively about the support people received, the acting manager and staff team. There was evidence of positive person-centred care plans in place to meet most people support needs. However, we did identify that 1 person’s care records was missing information regarding environmental restrictions that had been put in place to help manage risks. The acting manager agreed to update this information.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service good (published 05 July 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We have found evidence that the provider needs to make improvements. 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 HAIL- Bedford Road - on our website at www.cqc.org.uk.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, risk assessments and people’s deprivation of liberty, controlling infection, staff supervision and appraisals and the condition of the premises. We have made 2 recommendations in relation to the provider sending feedback questionnaires to people and relatives and ensuring that statutory notifications are completed and sent to CQC.

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.

HAIL- Bedford Road is a ‘care home’ for people who have a learning disability. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates a maximum of six people. At the time of our inspection there were six people living in the home. Most of the people using the service had been living at the homes for many years. Most of the staff team had also been working at the home for some time and everyone knew each other well.

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.

The manager was in the process of registering with the Care Quality Commission but was on annual leave 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 2008 and associated Regulations about how the service is run.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination. Staff knew what to look out for that might indicate a person was being abused. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored appropriately. People were supported to take their medicines as prescribed.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the management team.

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 understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or healthcare needs people had.

People who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements. Staff told us that the management listened to them and acted on their suggestions and wishes.

All parts of the home, including the kitchen, was clean and no malodours were detected. Although care staff were expected to carry out cleaning tasks, they told us they were able to maintain a clean environment as well as support people safely.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

The management team worked in partnership with other organisations to support care provision, service development and joined-up care.

At the time of the inspection Care Quality Commission records showed there was a registered manager in post, however, staff at the service told us this person had not worked at the service since 2015. There was an acting manager overseeing the day to day running of the service and the provider told us they were recruiting to the post of registered manager at the time of the inspection. A registered manager is a person who has registered with the 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.

We last inspected this service in September 2015, and it was found to be breaching the regulation which required the provider to send notifications to the Care Quality Commission. A notification is information about important events which the service is required to send us by law.

At this inspection we found one incident which should have been notified to the CQC and had not been notified.

The atmosphere at the service was friendly and warm. A number of people had lived at the service for many years and staff understood people’s needs and methods of communication.

Although training took place we found a number of staff required refresher training in key areas including epilepsy and communication techniques. Staff had received supervision on a regular basis in recent months, but there was a period between 2015 and 2016 in which no supervision took place. Appraisals had not taken place for the majority of staff in 2016.

Although the service was clean throughout we found an out of date meat product in the fridge which was labelled and sealed, which had been overlooked. We also found that due to issues relating to the behaviour of one person, there was no soap in two toilets or toilet paper in one toilet at the scheme.

Risk assessments were in place for the majority of risks identified and care records were up to date for most people living at the service. We could see that people had access to health care and the service had photo prompts of key health professionals on records to assist staff in communicating with people living at the service.

There was a wide range of food at the service and people chose the menu using pictures at the weekly residents’ meeting.

Staff were kind and we saw they had made the garden attractive and interesting particularly for people with a sensory loss or autism.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff understood the importance of gaining consent before supporting people and the service had in place the relevant paperwork if they were restricting people’s liberty or making decisions on their behalf in their best interest.

Regular checks were completed for fire safety equipment and fire panels, electrical testing, lighting systems and gas safety. The service was in need of refurbishment in a number of areas, including a downstairs bathroom and the living room flooring which was cracked.

We saw that the provider carried out a health and safety audit on an annual basis. The acting manager checked some areas such as medicines and people’s finances on a regular basis, but there were no quality checks by the provider of care records or supervision and training. Also, in the absence of the acting manager supervision, training and quality auditing of care records was not carried out by the provider.

There was a breach of the regulations in relation to the governance of the service and notifying CQC of important events. We are considering our regulatory response to this latter concern.

We have made recommendations in relation to managing behaviours at the service, staff training and risk assessments.

You can see what action we told the provider to take at the back of the report.

During the inspection we spoke with two people who used the service and spoke to a relative by phone. We spent time observing staff engagement with people and we spoke with two care workers, and the registered manager. 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 evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

People who used the service told us they felt safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner. The relative of the person who used the service told us they were confident that people were safe. Staff were clear about their roles and responsibilities and felt supported by management staff. The management team had some systems in place to support workers; however, we found staff appraisals had not been completed for a long time.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to residential homes. Whilst senior staff understood the principle and the process for application was clear we found that the documentation concerning residents with DoLS currently in place was not sufficient and had not been regularly reviewed.

Is the service effective?

Staff told us that there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment had been planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw that people were supported by kind and attentive staff who approached people in a friendly manner. People who used the service were seen to be happy, laughing and chatting with staff. The relatives we spoke to felt that people seemed to be well cared for and were treated with respect by staff.

Staff were knowledgeable regarding the specific care needs of people and respected the choices that people made. Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs. People's privacy and dignity were respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care which was responsive to their interests and preferences. People told us they were listened to and felt involved in decisions about their care. People's care and health were monitored closely. Written notes about people's health and care had been completed by staff.

People's health, safety and welfare was being protected as they received the advice and treatment needed from a range of health and social care professionals. Relatives of people who used the service told us if they had any concerns or complaints, they would feel comfortable raising them with staff. However, we found that there had not been any formal survey of relatives or people using the service.

Is the service well-led?

The registered manager had recently left the home and the deputy manager was acting in this role, we were told that the Care Quality Commission had not been informed of this change. Monitoring checks of the quality of the service had been carried out. These included checks of the care provided to people and the quality of their environment. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

Our observations showed that people were well supported within the home. They were given choices, and had formed good and supportive relationships with staff and management. They were protected from the risk of abuse, and had their medication needs met appropriately.

There were sufficient staff working at the home to meet people's needs, and they were given appropriate training and supervision. Recording procedures within the home were sufficiently robust to ensure that the home was run effectively in the interests of people living there.