Livingstone House

Livingstone House is a residential care home personal care and support for up to six people with a learning disability and autism. At the time of our inspection there were five people living at the service.

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.

Based on our review of the key questions safe, effective, caring, responsive and well led. The service was not able to demonstrate they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support:

People had plans in place to guide staff on how to support them if they became anxious or upset, however, these plans were not always regularly reviewed or updated. Staff were not always provided with clear guidance on how to support people safely. A failure to effectively monitor incidents meant there were missed opportunities to avoid and reduce reoccurrence. People not always supported to have the maximum possible choice, control and independence in their daily lives. People were not always enabled to access specialist health care support in a timely way.

Right Care:

Low staffing levels impacted on people receiving person-centred care. People were not provided with opportunities to try new activities tailored to them that enhanced and enriched their lives. We observed people participated in group activities more often, rather than pursuing their own individual interests or seeking opportunities for volunteering or employment. Poor compliance with training and inconsistent induction processes for staff new to the service meant that people were not always supported by suitably trained, skilled and competent staff. Not all staff could sufficiently demonstrate they knew about the person they were supporting or what was in their care plans.

Right Culture:

The provider failed to develop effective governance and quality assurance systems to assess the quality and safety of the support people received. There were a lack of audits and actions taken when things went wrong. Actions were not always documented, and it was unclear if actions were completed. This meant improvements were not always made to improve the care people received. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not effective. Where checks and audits were carried out, they had not always identified or prevented issues occurring or continuing at the service. Where issues had been identified, the provider had not always ensured actions were taken to maintain or improve the quality and safety of the support being delivered at the service. Some care staff told us they felt unsupported by senior management. Family members told us that until recently, there was insufficient engagement with them. This meant people's families were not sufficiently involved in developing the service. There was limited opportunity for staff to learn from incidents and improve practice.

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 17 November 2021).

Why we inspected

The inspection was prompted in part by a notification of an allegation of abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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 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 breaches in relation to keeping people safe including from risks of harm and potential abuse. Breaches have been found related to staffing and staff training, medicine management, personalised care and governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Livingstone House is a residential care home providing personal care to four people with learning disabilities and associated behaviours which may challenge. The service can support up to six people in a six bedroom house, each with their own bathroom.

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

Risks to people were identified and recorded and staff knew how to respond to these risks in order to keep people safe. There were enough staff to meet people's needs and they were recruited safely. People received the medicines they required. The service was clean and tidy and staff were seen following good infection control practices.

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. Staff were seen to continuously encourage people to share their views and make choices and it was clear people were treated as individuals”.

Staff had the skills and knowledge to meet people's needs and preferences. They received training, regular supervision and attended team meetings to support them in their roles. People's nutritional and hydrational needs were met. There was regular involvement from health and social care professionals, who spoke positively about the support people received.

We observed a kind and caring culture at Livingstone House. Relatives and professionals spoke positively about the support staff gave to people. We observed throughout our inspection that people enjoyed spending time with staff and were confident to be in their company.

People’s care plans were personalised and gave staff the information they needed to support people. Staff received training and support from the provider’s positive behaviour support team which ensured there was a person-centred approach to supporting people. Health care professional input was accessed when required and people’s nutrition and hydration needs were met. We saw people were supported with their communication needs and their preferred activities in accordance with their care plans.

The registered manager looked for ways to improve the service people received. Good governance arrangements were in place to help monitor the service and management acted to address to any shortfalls identified.

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.

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

Right support:

• People in Livingstone House were supported to access local shops and amenities, as well as countryside walks. Staff were observed to enable people to make day to day choices, including around food choices and activities. Access to activities had been impacted by the pandemic, with swimming pools and leisure centres closed. This was no longer the case and people were able to once again access their preferred activities. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• Staff understood people's specific care needs and preferences and supported people in a person-centred way. We saw that people's dignity was respected and any personal care required was done discretely and the person's dignity was not compromised. Staff enabled people to make choices about how they wished to communicate and how to be supported in any given activity. People had been supported to personalise their own rooms and communal areas.

Right culture:

• The leadership team and staff showed commitment and respect to those whom they supported. They spoke with passion and knowledge about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us how the needs and views of those whom they supported were paramount and must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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 06 September 2019 and does not currently have a rating.

Why we inspected

We carried out a targeted inspection of the service in August 2020 following concerns about safeguarding people from the risk of abuse. We only looked at the key questions safe and well-led during that inspection. We found no evidence to substantiate the allegations. However, we could not provide a rating, as we did not look at all five key questions. This was a planned comprehensive inspection to enable us to provide an overall rating for the service.

You can read the report from the targeted inspection, by selecting the ‘all reports’ link for Livingstone House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence 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.

Livingstone House is a residential care home providing personal care to five people with learning disabilities and associated behaviours which may challenge. The service can support up to six people in a six bedroom house, each with their own bathroom.

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

People told us that staff were kind and helped them to keep safe. Family members told us their relatives were safe. Staff understood their roles in safeguarding people from harm. Risks to people were assessed and emerging trends were identified. There was guidance for staff on how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns. Staff followed good infection control practices and government guidance in relation to COVID-19.

The service applied the principles and values of: Right Support, Right Care, Right Culture and other best practice guidance. These ensured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes that included control, choice and independence.

The provider used effective systems of quality assurance and governance which improved people's experience of care. Building safety was regularly audited and regular health and safety checks were completed by staff and by external professionals, who adhered to COVID-19 safety restrictions.

The registered manager openly engaged with external agencies. Family members and a health care professional were complementary about the management and culture of the home. Staff told us they felt supported by the registered manager who encouraged their development and was always available to them for advice and reassurance.

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:

• People in Livingstone House were supported to access local shops and amenities, as well as countryside walks. Staff were observed to enable people to make day to day choices, including around food choices and activities. The provider engaged with local commissioning partnerships in order to strive for continuous improvement.

Right care:

• Staff understood people's specific care needs and preferences and supported people in a person-centred way. We saw that people's dignity was respected and any personal care required was done discretely and the person's dignity was not compromised. Staff enabled people to make choices about how they wished to communicate and how to be supported in any given activity. People had been supported to personalise their own rooms and communal areas.

Right culture:

• The leadership team and staff showed commitment and respect to those whom they supported. They spoke with passion and knowledge about their role, central to which was to empower those whom they supported to live their best life possible. Staff told us how the needs and views of those whom they supported were paramount and must be respected at all times. We observed that people moved around their home with confidence and placed trust in the staff team to support them safely and in the least restrictive way.

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

This service was registered with us on 06 September 2019 and does not currently have a rating.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding people from the risk of abuse. We found no evidence during this inspection that people were at risk of harm in relation to these concerns. Please see the Safe and Well-led sections of this report.

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.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.