Albert Road

About the service

Albert Road provides a supported living service to people living in their own flats or shared accommodation within seven ‘supported living’ schemes. The aim is for people to live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. Each supported living scheme had a manager in post, and a registered manager oversaw the seven schemes.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Right Support

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.

Although the provider worked well with professionals to assess and mitigate risks, and this had been successful with most of the people who used the service, they had been unable to manage and reduce some of the risks to people’s safety and wellbeing.

The provider had made improvements to help ensure people were protected from the risk of abuse. They ensured safeguarding procedures were followed appropriately. Staff followed the procedure for the safe administration and recording of medicines. The service used positive behaviour support principles and worked with behaviour support specialists to support people.

Right Culture

The culture at the service had not always been positive and had not always achieved good outcomes for people who used the service. However, the provider had taken appropriate action to improve this.

Staff appeared responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. However, in one of the supported living settings, we saw the staff were not always responsive to people’s individual needs. They did not spend time with people, did not support them to engage in activities of their choice and did not consult them about what they wanted to do or eat. In the other supported living setting, people were supported to engage in activities of their choice. They were consulted about what they wanted to do and were listened to.

Staff received the training, support and information they needed to provide effective care. The provider had procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

Right Care

People were supported to attend day centre services where they could gain new skills and become more independent. We saw staff supported people in a person-centred way and respected their privacy, dignity and human rights.

Records indicated people’s needs were met in a personalised way and they, and their representatives, had been involved in planning and reviewing their care. The operations manager told us the staff were kind, caring and respectful and had developed good relationships with people who used the service.

The provider worked closely with other professionals to help make sure people had access to health care services.

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 December 2021).

Why we inspected

We received information of concerns in relation to staffing, inappropriate restraint of people, safeguarding allegations and poor management practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well 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 and Recommendations

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 a breach in relation to safe care and treatment at this inspection. We have also made a recommendation in relation to good governance.

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 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.

Albert Road provides a supported living service to people living in their own flats or shared accommodation within seven ‘supported living’ schemes. The aim is for people to live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. A manager who was applying to be registered with Care Quality Commission (CQC) oversaw the seven schemes.

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

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. Policies and systems in the service supported this practice.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, responsive and well led

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Right care:

• People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The staff supported people in a person-centred way and respected their privacy, dignity and human rights.

Right culture:

• Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual. People were engaged in meaningful activities of their choice. They were consulted about what they wanted to do and were listened to.

There were systems and processes in place to protect people from the risk of harm. Risks to their safety and wellbeing were appropriately assessed and mitigated. The environment was clean and hazard-free. There were robust systems in place for the prevention and control of infection and the staff followed these. People received their medicines safely and as prescribed.

People who used the service were happy with the service they received. Their needs were met in a personalised way and they had been involved in planning and reviewing their care. People said the staff were kind, caring and respectful and they had developed good relationships with them.

People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing care plans. There were systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements. The provider worked closely with other professionals to make sure people had access to health care services.

Staff were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

Rating at last inspection

The last rating for this service was Good (published 22 May 2019). At this inspection, the service remains Good.

Why we inspected

The inspection was prompted in part due to whistleblowing concerns received indicating the possibility of a closed culture in two of the supported living schemes. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 not changed. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service.

¿ Albert road provides a supported living service to people living in their own flats or shared accommodation within seven ‘supported living’ schemes. The aim is for people to live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements.

¿ Not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, 27 people were receiving personal care.

¿ Each supported living scheme had a manager in post, and a registered manager oversaw the seven schemes.

¿ 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 mental health needs using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

¿ At the last inspection, we found that the provider did not have effective arrangements to protect people against the risks associated with the management of medicines. However, at this inspection, the provider had made improvements and people were receiving their medicines safely and as prescribed.

¿ There were systems and processes to help protect people from the risk of harm. There were enough staff on duty to meet people's needs and there were contingency plans in the event of staff absence. Employment checks were in place to obtain information about new staff before they could support people.

¿ Care plans and risk assessments were reviewed and updated whenever people's needs changed. People and relatives told us they were involved in the planning and reviewing of their care and support and felt valued.

¿ The risks to people's safety and wellbeing were assessed and regularly reviewed. People were supported to manage their own safety and remain as independent as they could be. The provider had processes in place for the recording and investigation of incidents and accidents and lessons were learnt when things went wrong.

¿ 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 had undertaken training in the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Act. The provider had liaised with the local authority when people required Court of Protection decisions about being deprived of their liberty in the receipt of care and treatment. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

¿ People were protected by the provider’s arrangements in relation to the prevention and control of infection. The provider had a procedure regarding infection control and the staff had specific training in this area.

¿ People’s health and nutritional needs were recorded and met. Where possible, people using the service were supported to shop for ingredients and cooked their own food. Staff supported people to attend medical appointments where support was required.

¿ People were supported by staff who were sufficiently trained, supervised and appraised.

¿ A range of activities were arranged that met people’s individual interests and people were consulted about what they wanted to do.

¿ Staff were caring and treated people with dignity, compassion and respect. Support plans were clear and comprehensive and included people's individual needs, detailed what was important to them, how they made decisions and how they wanted their care to be provided.

¿ People told us, and we saw staff supported them in a way that considered their diversity, values and human rights. People confirmed they were supported and encouraged to be involved in the running of the service and felt valued.

¿ Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed by the management.

¿ People, relatives and staff told us that the registered manager was supportive, approachable and hands on. Staff were supported to raise concerns and make suggestions about where improvements could be made.

¿ The provider had some systems in place to monitor the quality of the service and where issues were identified, these were addressed promptly.

Rating at last inspection:

¿ At the first inspection of the service on 27, 28 and 29 March 2018 the service was rated requires improvement in the key questions of ‘safe’, ‘well led’ and overall. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good and they sent us this. During this inspection we found the service had made the required improvements and met all the Regulations.

Why we inspected:

¿ This was a planned inspection based on the previous rating.

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 any concerning information is received, we may inspect sooner.

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

This service provides care and support to people living in five ‘supported living’ schemes, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Each setting was a large house which accommodated up to five people and these were located in north and south London. In total, there were 21 people using the service at the time of our inspection.

Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. Each setting had a manager in post, and the registered manager overlooked the five settings. 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 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.

Our findings during the inspection show that the provider did not have effective arrangements to protect people against the risks associated with the management of medicines. We saw that appropriate action was taken to rectify this before the end of our inspection.

There were systems in place to assess and monitor the quality of the service, but these had not always been effective and had not identified the issues we found during our inspection.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe care and treatment and Good governance. You can see what action we have told the provider to take at the back of the full version of this report.

Notwithstanding the above, there were other systems and processes in place to help protect people from the risk of harm. There were enough staff on duty to meet people's needs and there were contingency plans in the event of staff absence. Employment checks were in place to obtain information about new staff before they were allowed to support people.

Care plans and risk assessments were reviewed and updated whenever people's needs changed. People and relatives told us they were involved in the planning and reviewing of their care and support, and felt valued.

The risks to people's safety and wellbeing were assessed and regularly reviewed. People were supported to manage their own safety and remain as independent as they could be. The provider had processes in place for the recording and investigation of incidents and accidents.

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 had undertaken training in the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Act. The provider had liaised with the local authority when people required Court of Protection decisions with regard to being deprived of their liberty in the receipt of care and treatment.

People lived in a comfortable environment which was clean and free of hazards. People were protected by the provider’s arrangements in relation to the prevention and control of infection. The provider had a procedure regarding infection control and the staff had specific training in this area.

The provider ensured people's nutritional needs were met. Some of the people using the service shopped for ingredients and cooked their own food.

People were supported by staff who were sufficiently trained, supervised and appraised.

People’s healthcare needs were met and staff supported them to attend medical appointments where support was required.

People's care plans were comprehensive and detailed people’s individual needs. They were personalised to reflect people’s wishes and what was important to them.

A range of activities were arranged that met people’s individual interests and people were consulted about what they wanted to do.

Staff were caring and treated people with dignity, compassion and respect. Support plans were clear and comprehensive and included people's individual needs, detailed what was important to them, how they made decisions and how they wanted their care to be provided.

Throughout the inspection, we observed staff supporting people in a way that took into account their diversity, values and human rights. People confirmed they were supported to make decisions about their activities.

Information about how to make a complaint was available to people and their families, and they felt confident that any complaint would be addressed by the management.

People, relatives and staff told us that the registered manager was supportive, approachable and hands on. Staff were supported to raise concerns and make suggestions about where improvements could be made.

The provider had effective systems in place to monitor the quality of the service and where issues were identified, these were addressed promptly.