Low Lane House

Low Lane House is a residential care home providing accommodation and personal care for up to six young adults with a learning disability and/or autism. At the time of the inspection there were six people living there. The home has communal lounges and dining areas. Each person has their own bedroom with ensuite facilities.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 and autistic people and providers must have regard to it.

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

Right Support: People were supported by staff who understood their care and support needs. Risks in relation to people’s care and support were assessed and guidance was in place to assist staff with keeping people safe. Plans were personalised for each person and identified how staff should support the person with communicating their needs or when experiencing distress.

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.

There were sufficient staff to meet people’s identified hours of support, and this supported people to access activities both socially and within their home. Medicines were managed safely. Robust infection control measures were in place, people were supported by staff to keep their home safe and clean.

Right Care: Care was person-centred and promoted people’s dignity, privacy, and human rights. Staff showed people kindness and respect during our visits. We observed people interacting positively with staff and seeking support when needed. People were supported to access healthcare services and were supported to eat and drink enough. People were supported by staff to plan their week and access opportunities and activities of their choice.

Relatives spoke positively about the care and support their loved ones received. They told us communication could be improved. This was fedback to the provider who acknowledged this was an area they would seek to improve.

Staff received training on how to recognise and report abuse and said they would feel comfortable raising any concerns with management. People were protected by the provider's recruitment processes. Appropriate checks were completed by the service, ensuring staff were suitable to work with people.

The design and the decoration of the building was adapted to meet people’s needs. Rooms were personalised in line with people’s wishes.

Right Culture: The service was currently being supported by the deputy manager and the area manager. They had recently completed workshops with staff on workplace culture, values, and attitudes to promote a positive culture amongst the staff team.

Staff valued the support from the deputy and area manager, which helped to maintain their wellbeing and positive attitude to supporting people living at the service.

There were systems in place to monitor the quality of service provided and identify improvements. Where audits had identified improvements, these were recorded in the home action plan. The deputy manager and area manager were open and transparent regarding areas they had identified as requiring improvement and the actions they had taken to address them.

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

The last rating for this service was requires improvement (published 27 June 2022).

At the inspection completed 26 October 2021 there was a breach of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. At the inspection on 27 June 2022, we found improvements had been made and the provider was no longer in breach of regulation. However, the service was rated as requires improvement to ensure continued improvements were made and sustained. At this inspection the provider had made the necessary improvements. The service is now rated good.

Why we inspected

We undertook this focused inspection to check they had embedded and sustained the necessary improvements.

The inspection was prompted in part due to concerns received about medicines, staffing, management, and governance. 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 these concerns. The concerns raised had been addressed and the provider had taken action to mitigate the risks which had been effective.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

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.

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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Low Lane House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Low Lane House is a residential care home for up to six young adults living with a learning disability and/or autism. At the time of the inspection, the service was providing personal care to five people.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 and autistic people and providers must have regard to it.

Right Support

People had choice about how to decorate their bedrooms and contributed their design ideas for the communal areas. Ongoing maintenance was in place to ensure the environment was kept to a good standard. The overall quality of the environment had been improved and reflected people’s preferences; it was clean throughout. Staff practices to manage the risks of cross infection needed to improve. People’s art and craft works were displayed. People had access to a sensory area and quiet areas.

People were supported with their independence. Their goals and aspirations were set out and staff supported people with these. Relatives described staff as ‘Excellent’ valuing the care their loved ones received. People had choice in all aspects of their lives, such as how to spend their time, activities they wanted to participate in within the community and their involvement with menu planning, food preparation and cooking. Staff encouraged people to make their own decisions; care records outlined how to do this. Ongoing work was in place to make sure staff consistently followed best practice guidance for decision making.

The service had worked with health professionals to have support plans in place to manage people when they became distressed, to ensure staff did everything they could to avoid using restrictive practices. Staff approach to risk management needed further improvements to ensure all risks were consistently monitored and reviewed. Records were in place to support people with their care. They needed to be reviewed more regularly and updated when people’s needs changed. Medicines were managed safely.

The size of the service was in-line with best practice guidance. It was an adapted house which fitted in with the local community. The service did not contract with the local authority in that area. Each person was placed outside of their local area. People’s funding authorities were actively overseeing their care after we raised concerns with them at the last inspection. The service was no longer suitable for some people and the service were working with people’s funding authorities to find more appropriate placements.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had struggled to maintain safe staffing levels at times. They had proactively tried to manage this. Training and supervision for staff was in place but did not take place regularly.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language) which staff were familiar with. This allowed people to interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them.

Right culture

The improvements which the service had made since the last inspection had ensured the risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. Staff needed to embed their learning to support them to be more consistent with their practices to deliver safe care. Ongoing changes by the service’s culture of improvement and inclusivity had enhanced people’s quality of life.

Staff turnover had been high. The provider had been proactive in addressing this issue. Staff said the changes to their working environment and incentives had supported them to feel valued. Recruitment for staff was ongoing; the service used regular agency staff because they knew it was important for people to have consistency in their care. Staff had got to know people and their needs really well which led to improvements in their care.

People had started to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff had improved. Staff placed people’s wishes, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people’s care. Staff demonstrated kindness and compassion when they worked with people. They were better informed of best practice guidance for supporting people with a learning disability and/or autistic people.

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

The last rating for this service was inadequate (published 26 October 2021) and there were six breaches of regulations. We met with the provider after the last inspection to discuss their action plan to show what they would do and by when to make improvements .

At this 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 October 2021. 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

We used this inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also assessed whether the service is applying the principles of Right support right care right culture.

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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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.

Low Lane House is a residential care home for up to six young adults who live with a learning disability and/or autism. At the time of inspection, six people were living at the service.

Low Lane House is a domestic property which was adapted to become a care home. People were supported across floors in the home.

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

People were not safeguarded from the risks of abuse. Risk was not safely managed. Fire safety actions had not been addressed at the time of inspection. There were insufficient staff on duty to safely care for people. Medicine records did not support the safe administration of medicines. IPC guidance was not followed. The service needed cleaning throughout.

Quality assurance systems were not effective. They had identified some areas for improvement but not all. The overall quality of the service had significantly deteriorated since the last inspection. The registered manager did not have enough oversight of the service; they were no longer based at the service. Staff were supportive of each other and of the manager who was based at the service.

Staff were not effectively supported to carry out their roles. It was unclear how best practice guidance was used to care for people. The support people received for their mental health needed to be improved. The quality of the environment had not been maintained. People received good support with their physical health needs and their nutritional intake

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support 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, effective and well-led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of service did not consistently support people’s choice, control and independence. The way the service was used did not support safe care. People did have regular access to the community. People did not receive individualised care. Their privacy, dignity and human rights were not consistently maintained. The culture of the service did not lead to safe care for people and did not result in positive outcomes for them. We considered these concerns when determining the enforcement and follow up action we needed to take.

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 13 August 2019).

Why we inspected

We received concerns in relation to staffing, training, incidents and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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, 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 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to dignity, the care of people, how people are safeguarded from abuse, the quality of the environment, staffing levels, training and induction and how the quality of the service is monitored.

During the inspection, we sent the provider a letter of serious concern which outlined the key areas of concern. They responded to this letter.

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 meet with the provider to review their action plan following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Low Lane House is a residential care home providing personal care to five people aged 18 and over. The service can support up to six people who are living with learning disabilities and/or autism.

Low Lane House is a large, adapted house situated in a residential area with close links to transport, shops and countryside. It has its own private enclosed gardens which all people can use if they require quiet time or a safe space.

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 observed to be happy and were supported by a staff team who knew them very well and were skilled and knowledgeable. The service provided flexible care and support in line with people's needs and wishes.

The provider ensured people received a safe service with systems and processes in place which helped to minimise risks. Staff effectively reported any safeguarding matters. All incidents were critically analysed, lessons were learnt and used to improve outcomes for people. Medicines were managed safely.

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.

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 gain new skills and become more independent.

The service supported people to access a wide range of activities and hobbies outside of the house and to maintain relationships with their families and friends.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across health and social care sectors. They expand our understanding of both good and poor practice and the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusions and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

People, their legal representatives and health and social care professionals were actively involved in decisions being made about the care people received.

The provider and registered manager monitored quality, acted quickly when change was required, sought people's views and planned ongoing improvements to the services. One relative told us if they had any concerns about they would speak to one of the management team.

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

Rating at last inspection

This service was registered with us on 31/08/2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on our inspection programme.

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.