Brighton & Hove City Council - 19 Leicester Villas

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. Care and support is provided for up to five for people with a learning disability or autistic spectrum disorder. At the time of the

inspection two people were living in the service. The service is situated in a residential area with easy access to local amenities and transport links.

We found the following examples of good practice.

• Safe arrangements were in place for visitors. This included confirmation of a negative lateral flow test, temperature checks, and the use of personal protective equipment (PPE). Visiting professionals showed evidence of vaccination status or exemption.

• There were adequate supplies of personal protective equipment (PPE) throughout the home. Risk assessments were in place for residents where the use of PPE, other than masks, was not appropriate. Staff were seen appropriately using PPE.

• There were arrangements to admit people safely to the home. This included testing and isolation in line with guidance. Arrangements were in place to undertake individual risk assessments in the event of a new admission.

• People were supported to understand and comply with visiting and social restrictions in line with all best practice guidance and this was communicated and updated as needed.

• The provider followed relevant COVID-19 testing guidance. This included staff testing requirements as well guidance on testing for people using the service and visitors.

• Maintaining the mental health of people and staff was a priority with proactive support from the service to encourage people’s well-being. This included supported activities within the home and support to maintain contact with family and friends, as well as trips out with one to one support, including supported walks with friends and family members.

• There were clear cleaning schedules in place which included the frequency of cleaning high touch areas. Records showed compliance with the cleaning schedule.

• The home had an up to date infection control policy and carried out regular infection control audits.

• Staff were trained and knew how to immediately instigate full infection control measures to care for a person who developed symptoms, who tests positive or who has been exposed to the virus to avoid the virus spreading to other people and staff.

19 Leicester Villas is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 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. Care and support is provided for up to five for people with a learning disability or autistic spectrum disorder. At the time of the inspection three people were living in the service. The service is situated in a residential area with easy access to local amenities and transport links.

At our last inspection on 25 April 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff spoke of a difficult period over the last year where they had been supporting one person to remain in the service with end of life care. At this inspection we found some audit systems, building checks, staff training updates and paperwork had not been fully maintained. To maintain the right level of staff support and a safe service support to maintain staffing levels there was a high use of the provider’s bank staff. However, the bank staff had worked in the service for a long time and knew people well. These were areas in need of improvement. However, these shortfalls had been identified and an action plan drawn up which staff were following to address the identified issues.

People remained protected from the risk of abuse because staff understood how to identify and report it. A relative told us they had continued to feel involved and listened to. The culture of the service was open and inclusive and encouraged staff to see beyond each person's support needs. The registered manager worked with care staff to develop the service with people at the heart of the service. Care staff had received regular supervision and appraisal.

People continued to live in a service with a relaxed and homely feel. They were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

Medicines continued to be stored correctly and there were systems to manage medicine safely.

All three people had lived in the service a long time, and care staff knew them well. The registered manager monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Care and support was person centred and the wellbeing of people supported through purposeful activity and involvement in the service, such as helping with housework and rubbish recycling. People could join in a range of meaningful activities outside of the service.

People continued to be supported with their food and drink and this was monitored regularly. People were supported to maintain good health and access healthcare professionals when needed.

Staff told us the registered manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. Procedures were in place for people and their relatives and their representatives to raise any concerns. People and their relatives were regularly consulted about the care provided through reviews and by using quality assurance questionnaires. A relative told us staff kept in touch with them.

19 Leicester Villas has up to five people with a learning disability living in the service. At the time of the inspection there were four people living in the service whose behaviour could be complex. People have single bedroom accommodation and a range of communal facilities they can use. The service is situated near Portslade railway station, in a residential area with easy access to local amenities, transport links and the city centre.

The service had a registered manager, who was present throughout the inspection, they had been in their current post for a number of years and knew the service well. 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 service was going through a significant period of review, where the provider and local stakeholders were looking at the service provision and what was needed and how the service would best be provided in the future.

Relatives told us people were safe in the service. People were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans and risk assessments were detailed, up-to-date, and reviewed regularly. One relative told us, “(Persons name) has done so much better there. The staff have motivated them to get the best out of them. (Person’s name) looks so much more contented. I can’t praise them enough.”

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans.

Care staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People were supported by kind caring staff. One relative told us the staff were, “Excellent. Very caring.”

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the registered manager. One member of staff told us, ”It’s the best here. The atmosphere here, the manager and staff are supportive. The staff are doing their best for the service users.”

People and their representatives were asked to complete a satisfaction questionnaire to help identify any improvements to the care provided. There was a detailed complaints procedures should people wish to raise any concerns. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

Our inspection team was made up of one adult social care inspector. We answered our question; Is the service safe? Below is a summary of what we have found. The summary is based on our observations during the inspection. Four people were resident in the service at the time of our inspection. We looked at staff records and records relating to the management of the service. We spoke individually with the registered manager (who is referred to as manager in the report), and a care worker.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was safe, clean and hygienic. Policies and procedures had been updated, shared with staff and implemented in the service.

Below is a summary of what we have found. The summary is based on our observations during the inspection. There were four people who used the service at the time of our inspection who had complex needs which meant they were not able to tell us about their experiences. We observed the care provided, looked at supporting care documentation. We spoke with the registered manager who is referred to as manager in the report, two care workers, and two relatives of two of the people who used the service.

Is the service safe?

People were treated with respect and dignity by the care workers. People told us their relative was safe. The relatives commented, 'I do. It's a small home, and it's like a family,' and "I think XXX (name) is very happy. I don't see any dangers.' Staff had received training and had an understanding of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They knew who to contact should further guidance and support be required to ensure people's best interests. Where possible, people had been asked for their consent for any care or treatment.

There was a system in place to make sure that the provider, manager and care workers learnt from events such as incidents and accidents, complaints, and concerns.

There were systems in place to ensure maintenance of the building was carried out and regular health and safety checks were carried out. Relatives told us that the service was clean. However, systems were not demonstrated to be fully in place to ensure that people were protected from the risk of infection. The organisations policies and procedures were not all in place to protect people.

Staff had been provided with training to undertake their roles in the service, systems developed and recording and monitoring systems put in place. This helped to ensure people were not put at any unnecessary risk.

A staff rota was set, which had taken into account people's care needs when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs had been reviewed and where possible people and their representatives had been involved in the writing and review of the care documentation. Their specialist care needs such as dietary requirements and behavioural support needs had been identified and guidance for staff to follow was in place. People were able to move around the service freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and offered encouragement when supporting people. The relatives we spoke with told us, 'They just do the very best job that they can. Very caring and hardworking. XXX (name) is lucky to be there,' 'They have always been excellent. XXX (name) always gets excellent care,' and 'The staff are lovely. They are all very helpful, kind and friendly to everyone.'

The relatives told us had been involved with the service and had been ask to complete regular quality assurance satisfaction surveys.

People's preferences, interests, aspirations and diverse needs had been recorded. Both the relatives told us care and support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside of the service.

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider. No complaints had been received since the last inspection. The relatives told us they had not had to raise any concerns, and they were aware who to speak with if they had any concerns. One commented, 'I do feel I can approach them.' People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well lead?

The service had quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all time.

We looked at records and systems in the service. We spoke with the registered manager

who is referred to as manager in the report. We found care workers had received the required training to protect people who used the service.

People or their representatives had been able to express their views about the care provided, and where possible people who used the service had been involved in making decisions about their care and treatment. People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. We spoke with one relative who told us "We are really happy with my relative being in the home. They support my relative's care needs very well. I am happy that they have a lovely room."

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

People's care had been provided by care workers who understood their care needs. However, they had not all received the training or updates of training as required by the organisation.

The records for the management of the service were accurate and complete.