Archived: College View

College View is a residential unit providing accommodation and care to young adults aged 19 to 25, who have a wide range of complex learning disabilities, such as autism and related autistic spectrum conditions

(ASC) and who have special needs resulting from behavioural, emotional and social difficulties (BESD). College View is based on the St. Johns School and College campus and is a 52 week a year service, meaning

that people can live at the service all year round. The service is registered to provide accommodation for up to 10 people and at the time of our inspection, there were five people living there.

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

People and their relatives told us they felt safe being supported by staff and that staff had the skills and experience to support them appropriately. One relative told us, “We are very happy with the staff that look after our [relative]. He has only been there since September and the transition was handled beautifully with short notice. All information was passed on with social stories, via videos and school staff. During August we were given the opportunity to visit, to enable him to see his accommodation at his own pace and he’s been allowed to decorate his room. He loves the tea parties and socialising with friends. He calls every morning to say hello and is being helped by the staff to use the telephone himself.”

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.

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: Model of care and setting maximises people’s choice, control and Independence

People were supported by staff to work towards their individual goals and objectives. One relative said, “We’re happy with communication and feel very reassured. There seems to be enough staff and we know who to contact with any issues should they arise. [Our relative] comes home at weekends, but is happy to go back and seems to have settled in well. The staff are aiming for increased independence with lots of small things, but all are critical.” During their stay at College View, staff encouraged and supported people to live as independently as possible and to have control over their lives. People were encouraged to express their views using a variety of communication methods and staff actively sought feedback which was discussed with individuals.

Right Care: Care was person-centred and promotes people’s dignity, privacy and human rights

People who used the service and their relatives told us they felt supported by kind and caring staff. Staff knew people well and ensured they were supported with their social and care needs in a person-centred way.

Right Culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The culture of the service was open, inclusive and empowered individuals to express their views on how the service was run. People and relatives told us they felt confident and were supported to manage potential risks, for example when they accessed the local community. People and their relatives were complimentary of staff and the leadership of the service.

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 was for this service was Good (report published 30 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and care delivery. 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.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 remained Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for College View 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.

Follow up

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

College View is a residential unit providing accommodation and care to young adults aged 19 to 25, who have a wide range of complex learning disabilities, such as autism and related autistic spectrum conditions

(ASC) and who have special needs resulting from behavioural, emotional and social difficulties (BESD). College View is based on the St. Johns School and College campus and is a 52 week a year service, meaning

that people can live at the service all year round. The service is registered to provide accommodation for up to 11 people and at the time of our inspection, there were six people living there.

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 and physical 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.

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.

People’s experience of using this service:

Staff knew people extremely well and tailored their support accordingly. We observed strong relationships between staff and people due to the continuity of staffing and their approach. Systems supported people to stay safe and reduce the risks to them. Staff knew how to recognise signs of abuse and what action to take to keep people safe. There was enough staff to support people safely and the registered manager had safe recruitment procedures and processes in place.

Staff were trained in administering medicines. People were protected by the prevention and control of infection and we observed staff wearing gloves and aprons when supporting people.

People received high-quality person-centred care that exceeded their expectations. The management and staff team went above and beyond to ensure that people’s care and preferences met their expectations, with their wellbeing and independence being at the heart of the service. Activities were innovative and highly regarded by people and relatives. The service ensured people were involved in their community and empowered in the planning of activities to reduce social isolation and improve well-being. A relative told us, “They treat people with respect and make an effort to think of things which will enhance their life.”

People were supported to maintain their health and had support to access health care services when they needed to. 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.

People were fully involved in the service and had opportunities to give feedback. Feedback about the registered manager was very positive and staff felt very well supported. Staff were well motivated and very proud of the service, and morale was very high. Systems were in place to monitor the service and drive improvement.

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

Rating at last inspection: Requires Improvement (report published on 9 January 2019).

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care.

Follow up: We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

College View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

College View is a residential unit providing accommodation and care to young adults aged 19 to 25, who have a wide range of complex learning disabilities, such as autism and related autistic spectrum conditions (ASC) and who have special needs resulting from behavioural, emotional and social difficulties (BESD). College View is based on the St. Johns School and College campus and is a 52 week a year service, meaning that people can live at the service all year round. The service is registered to provide accommodation for up to 11 people and at the time of our inspection, there were seven people living there. The provider refers to people using the service as learners, which they will be referred as in this report.

The learners who live at College View attend the provider’s specialist education college during weekdays between 9am and 4pm. While attending this, learners are supported by staff who work at the College. The learners living at College View require high levels of support with managing their behaviours that may challenge and had 2:1 or 1:1 support when they were not attending College and in their home.

College View had been built and registered before Registering the Right Support (RRS) had been published. These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen. The provider did have a Statement of Purpose that reflected the values that underpin the RRS and other best practice guidance. However, the provider had not fully developed the service in response to the values that underpin RRS. We found that the service was geographically isolated and that the provider had not had clear oversight of their systems and staff training plans, to prevent and respond to crisis situations and safe use of restrictive interventions. Therefore, it is unlikely that a request to register College View today would be granted.

At the time of inspection there was no registered manager. However, a new manager had been appointed and was in the process of registering with the CQC. Since April 2018 there had been three changes in leadership and management. The most recent registered manager had left the organisation at the beginning of October 2018 and so had many of the senior support staff team. 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.

College View was last inspected in April 2016. At the last inspection we found that the service was Good overall with Outstanding elements of care in Responsive. This inspection was prompted following concerns we received about medication errors, which led to a safeguarding concern and the lack of staff to support learners safely. We also received information that staff had been restraining learners without appropriate training and restraining them unnecessarily. We were told there was a high turnover of staff leading to staff shortages, general poor management and support for staff. At this inspection we found the concerns were substantiated. Whilst the provider and new manager have acted to improve the delivery of care and support and developed action plans at the beginning of October 2018 to address these issues. These changes need to be embedded to demonstrate sustained improvement across these areas of concern.

Systems for safe ordering and administration of medicines were not always in place and followed. For example, the College and the home had different protocol’s and guidance for learners who required medication as and when needed (PRN). This meant that the College and the home had different instructions and guidance for administering medication to learners.

Risk assessments identified risks and protected learners from harm. However, learners with behaviours that can challenge were not always managed safely. This lead to a high level of restrictive holds being used on learners to manage behaviours.

There has not always been sufficient staff on shift to meet learners needs and keep them safe. We reviewed the rota and the number of staff on duty, this showed that the numbers recorded on the rota did not always match with who worked and it was not always clear who had worked on certain shifts. For example, when we discussed staffing records, the team leader was not able to confirm if certain members of staff were on shift and the rotas showed that there was not enough staff to support learners.

Agency staff had not always received appropriate training to ensure that they had to skills and competencies to meet learners needs. This was at a time when the service relied on a high level of agency staff to cover shifts.

Oversight of audits were not always used robustly by management to identify and manage risks to the quality of service and drive improvement.

Staff and relatives told us that the service was not always well-led. However, they spoke positively about the new manager and said there was now an open-door policy.

Learners had not always been treated with kindness and compassion and the provider had not supported staff and monitored their actions, to ensure the learner’s dignity and wellbeing was cared for.

Activities had not always been person-centred and the activities available to learners had been restricted to within the service and college campus due to learners challenging behaviour.

Premises, equipment and safety checks were carried out regularly to ensure that learners were living in a safe setting.

Staff were aware of their safeguarding responsibilities in relation to keeping learners safe and knew who to contact externally should they feel their concerns had not been dealt with appropriately.

The service was kept clean and we found infection control policies and procedures in place for staff to follow, should there be an infection outbreak such as diarrhoea and vomiting.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and learners were encouraged to make decisions about their care and treatment. Learners were supported to have choice and control of their lives.

Learners can only be deprived of their liberty so that they can receive care and treatment when this is in line with their best interests and legally authorised under the MCA. The authorisation procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

Learners were supported to maintain good health and had support to access health professionals. Dietary needs and nutritional requirements had been assessed and recorded.

Complaints were listened to and managed in line with the services policy and procedures.

College View is a residential unit providing accommodation and care to young adults who attend St John’s School and College. St. John’s is a special educational needs (SEN) school and specialist college that provides education, care and medical therapy to young people aged 7 to 25, who have a wide range of complex learning disabilities, such as autism and related autistic spectrum conditions (ASC) and young people who have special needs resulting from behavioural, emotional and social difficulties (BESD). College View is based on the college campus and is a 52 weeks a year service, meaning that people can live at the service all year round, rather than only during term time. The provider has five separate residential locations in the Brighton and Hove area. This report relates to College View, and at the time of our inspection, there were eight people living at the service. The provider refers to people using the service as learners, which they will be referred to in this report.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Learners living at College View were supported with exceptional care, dedication and understanding. Transitions for learners to and from their care setting at college was bespoke and planned thoroughly. For learners with very complex physical or emotional needs a great deal of planning and preparation was involved. By liaising and co-ordinating with relatives, other professionals and authorities, staff and the environment were prepared to reflect each individual learner’s preferences and routines. When changes were needed these were done as quickly as possible, such as recognising group living wasn’t right for one learner, leading to a flat being developed for this learner to have their own space. Staff worked closely and co-operatively through partnership working to make sure learners had access to ongoing support, to remain at college if they wished and to make sure when they moved on the appropriate arrangements had been made for them.

Learner’s experience of their care and support was overwhelmingly positive. They were involved in the planning and reviewing of their care records and were able to direct their care, and were assisted innovatively to learn how to manage their anxieties and emotions. They discussed and shaped the activities they wished to take part in and were listened to. They took part in socially inclusive activities in their local communities and well as at the college. Learners had work experience and work placement opportunities as well as working in college departments. Learners benefitted from new and creative methods of communication and staff worked proactively to help learners to make choices and decisions about their care and lifestyle. Learners were supported to be as independent as possible, taking responsibility for their medicines, and learning new skills.

Outstanding training resources equipped staff with the skills, knowledge and understanding to meet the challenges of supporting learners with diverse and complex needs. They said the learners were “at the centre” of everything they did. Staff were supported to develop individually, to voice concerns which they were confident would be listened to. Bespoke training had been developed to ensure that learners remained safe and had their health and wellbeing protected at all times. Staff were passionate, committed and motivated to make sure the learners journey through college was a positive experience.

Learners were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One learner told us, “I feel safe and I can talk to the staff if I need to”. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Learners were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and staff knew what to do.

Learners were encouraged and supported to eat and drink well. There was a varied daily choice of meals and learners were able to give feedback and have choice in what they ate and drank. One learner told us, “I like the food and I can choose something else if I don’t like it”. Special dietary requirements were met, and weight was monitored, with permission. Health care was accessible for learners and appointments were made for regular check-ups as needed.

Learners were encouraged to express their views and had completed surveys. Feedback received showed they were satisfied overall, and felt staff were friendly and helpful. Learners and their relatives also said they felt listened to and any concerns or issues they raised were addressed.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. One member of staff told us, “St John’s is incredibly supportive and understanding around staff”. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.