London Care (Bristol Court)

London Care (Bristol Court) is an extra care scheme which opened in 2019. This is purpose-built accommodation which has 94 flats in total comprising of one and two bedrooms. There were 12 homes which provided specialist dementia support and 15 homes providing specialist support for people with a learning disability. Assisted living (also known as extra-care housing) is a type of 'housing with care' which means you retain independence while you're assisted with tasks such as washing, dressing, going to the toilet or taking medicines.

At the time of our inspection, 87 people were using the service. This included older people, people living with the experience of dementia, people with physical disabilities and people with learning disabilities. Everyone living at the scheme required some degree of support with personal care.

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

People were generally happy with the service they received from London Care (Bristol Court). They liked the staff who supported them and felt their needs were being met. People raised some concerns about the building and catering arrangements, but these were not provided by London Care and did not form part of our inspection.

There were times of staff shortages and these impacted on people's experience. People still received visits from staff to provide personal care and make sure they had their medicines, but these did not always happen at the time people expected or for as long as people expected. This was the result of short notice staff absences rather than the norm. However, people told us that during these times some staff complained of feeling rushed and this added to the negative experience people had. The provider was aware of these issues and was trying to address staff shortages and give staff opportunities to voice their frustrations to management rather than people using the service.

People felt safe with the service. They received their medicines as prescribed and risks to their safety and wellbeing were assessed. There were systems to help protect people from abuse and to investigate any allegations, incidents or accidents. The provider had learnt from these to improve the service.

Systems for recruiting staff helped to ensure they were suitable. Staff were well trained and supported and had opportunities to learn about people's needs and develop their skills so they were able to meet these needs.

People were involved in making decisions about their care. They told us the staff treated them with respect and supported them to be independent where they were able. Some people were supported to access the local community and the provider was working with other organisations to improve group activities.

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 was appropriately managed. The management team had worked closely with others to continually review and improve quality at the service. They sought feedback from people using the service and other stakeholders and listened to their views.

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.

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

Right support:

The model of care was designed to meet people's needs. People lived in their own flats within a secure building. They were able to live independently, and their privacy was respected. They had opportunities to use communal facilities and be part of a wider community, where people with different needs, abilities and skills lived.

People had individual care packages which were designed to meet their needs. These included different levels of support to learn independent living skills and access the local community. Sometimes, staffing shortages impacted on their experience, although people received essential care and their safety was maintained.

People were able to make choices about their care and take risks.

Right care:

People received personalised care from familiar staff who treated them well. The staff received training to understand equality and diversity and the registered manager was able to give examples of how people's protected characteristics had been respected and valued.

People were supported to access other services, such as health and social care services.

Right culture:

There was a positive culture and ethos. The management team reviewed and monitored the quality of the service, asking people for feedback and listening to their views. They worked closely with other external organisations to continuously improve the service and develop this to help empower and support 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 rating at the last inspection (Published 17 December 2020) was requires improvement. We found the provider was breaching legal requirements relating to person-centred care, dignity and respect, safe care and treatment, responding to complaints and good governance. The provider completed an action plan to show what they would do and by when to improve the service.

At this inspection we found improvements had been made and the provider was no longer in breach of 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 we receive any concerning information we may inspect sooner.

London Care (Bristol Court) is an extra care scheme which opened in 2019. This is purpose-built accommodation which has 94 flats in total comprising of one and two bedrooms. There were 12 homes which provided specialist dementia support and 15 homes providing specialist support for people with a learning disability. Assisted living (also known as extra-care housing) is a type of 'housing with care' which means you retain independence while you're assisted with tasks such as washing, dressing, going to the toilet or taking medication.

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

Medicines were not always administered safely. Risk management plans were not always in place when a specific risk had been identified. Risk management plans are plans which provide care workers with guidance as to how they could reduce possible risks. The provider did not have clear systems in place for dealing with infection control practices.

The provider had systems in place to record accidents and incidents, but we were not able to see evidence of the learning being embedded into the service. The provider did not always have safe recruitment practices in place.

People were assessed prior to moving into the service. Care plans did not always record important information to guide care workers to respond to people’s needs.

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's dignity and privacy was not always maintained and at times people felt their care was rushed. People did not always know who was going to provide their care and support. However, people enjoyed living at the service and relatives felt their loved ones received good care.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People told us they were not always told when their care workers were running late. The care people received was not always person centred and people wanted to participate in more activities. When people raised concerns and complaints, they were not always responded to in line with the providers policy.

There were systems in place to monitor the quality of the service and identify when improvements were required. These were not sufficiently robust to have identified the issues we found during the inspection.

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 12 September 2019 and this was the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and management of medicines. A decision was made for us to inspect and examine the service.

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 identified breaches of five of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, person-centred care, dignity and respect, manging complaints and concerns and good governance. Please see the 'action we have told the provider to take' section towards the end of the 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.