Oxford Road

Oxford Road is part of Arden College that provides specialist further education for young people aged 16-25 years of age with learning disabilities. There were support staff present in the home 24 hours per day. Accommodation can be term time only and outside of term time if required. At the time of our inspection there were two people living at the home, and one person receiving respite care two days a week.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 16 people but had been adapted to provide individual accommodation for five young adults aged over 18 who attend the college. There was additional classroom space on the ground floor of the property. The size of the service having a negative impact on people was partially mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs. However, the presence of an industrial bin and minibuses in the car park identified the building was not in use as a domestic dwelling.

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.

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 the health and social care sectors. They expand our understanding of both good and poor practice and of 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, seclusion 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’s experience of using this service

Staff were not always deployed safely in accordance with people’s needs. Staff from other services did not always receive a thorough induction before undertaking their duties. Some staff had not completed essential training.

Risk was not always managed in accordance with best-practice guidance. Changes were not always made to reduce risk following incidents. The service did not have the resources to respond to complex behaviours in a timely manner. We made a recommendation regarding this.

Medicines were managed safely in accordance with best-practice guidance. Staff had been trained in adult safeguarding and understood their role in relation to keeping people safe. The service sought support from other social and healthcare professionals to improve practice.

Staff did not always understand their roles and how to safely manage some risks. People living at the home were involved in discussions about their care wherever possible. Staff used alternative forms of communication to help people understand important information.

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.

Rating at last inspection and update

The last rating for this service was Good (published 14 May 2019).

Why we inspected

We received concerns in relation to the safe deployment of staff and the management of medicines. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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 Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oxford Road on our website at www.cqc.org.uk.

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.

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

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:

There was a person-centred culture and staff knew the needs and preferences of people living in the home well. Staff had developed positive relationships with people and were seen to display kind and respectful support to people.

People received care and support which was in line with their support plan. People's privacy and dignity was respected and independence promoted. The service had developed community links to reflect the needs of people. It worked with Arden college as well as health and social care professionals to deliver improved outcomes and experiences for people.

People were supported to ensure that the home was clean, personalised and the environment was well maintained.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm.

Medicines were managed safely and people received their prescribed medicines at the right time. Health needs were understood and met.

There were sufficient numbers of safely recruited and suitably qualified and skilled staff in place to meet people's individual needs.

Staff received a range of training and support appropriate to their role and people's needs.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people's right to make their own decisions where possible and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements.

People knew how to make a complaint and they were confident about complaining should they need to.

The registered manager demonstrated a good understanding of their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

Rating at last inspection: At the last inspection (16 October 2016) the service was rated good.

Why we inspected: This was a planned comprehensive inspection based on the ratings at the last inspection.

Follow up: We will continue to monitor this service and plan to re-inspect as part of our inspection schedule. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We gave the provider 48 hours’ notice that we would be coming as service is a small home for adults with adults with learning disabilities and we wanted to be sure someone would be in.

Oxford Road is part of Arden College that provides specialist further education for young people aged 16-25 years of age with learning disabilities. Oxford Road can provide accommodation for three young adults aged over 18 who attend the college. There are support staff present in the home 24 hours per day. Accommodation can be term time only and outside of term time if required. At the time of our inspection there was one person living at the home, and one person attending a few days a week for respite care.

The inspection was conducted by an adult social care inspector.

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 2008 and associated Regulations about how the service is run.

We spoke to family members of people living at the home who told us they felt their relative was safe and well cared for.

There was a procedure in place to ensure staff were recruited and checked to ensure they were able to work with vulnerable adults.

Procedures relating to the safe storage and administration of medication were in place in the home and checked regularly to ensure no errors had occurred.

Arrangements were in place to check the safety of the building by external contractors and a log of these were kept on file for us to check.

People we spoke with told us they felt safe and staff knew what actions to take if they thought anyone had been harmed in any way.

Staff understood the need to respect people’s choices and decisions if they had the capacity to do so. Assessments had been carried out and reviewed regarding people’s individual capacity to make care decisions. Where people did not have capacity, this was documented appropriately and decisions were made in their best interest with the involvement of family members where appropriate and relevant health care professionals. This showed the provider understood and was adhering to the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005).

The person who lived there permanently had decorated their bedroom to their own tastes. The person could not communicate verbally, but was encouraged to express their views in a variety of other ways. For example, through physical gestures, body language, Makaton and British Sign Language.

People were supported to purchase and prepare the food and drink that they chose. People who lived at the home, their relatives and other professionals had been involved in the assessment and planning of their care. Care records were detailed and gave staff the information they required so that they were aware of how to meet people’s needs.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff, the deputy manager or the registered manager.

Staff were trained and skilled in all subjects required by the provider and additional training which was taking place within the organisation at the college. Staff we spoke with were able to explain their development plans to us in detail and told us they enjoyed the training they received. Staff told us they could approach the management team anytime and ask for additional support and advice.

Staff said they benefited from regular one to one supervision and appraisal from their manager. Staff spoke highly about the registered manager.

Managers were able to evidence a series of quality assurance processes and audits carried out.

Care plans contained regular communications with healthcare workers, social workers and families. Staff told us they had a good rapport with all parents and would often talk with them on a daily basis. There was evidence of a person centred approach in all care plans.

The service user we spoke to said they had no concerns over the welfare of any of the other people living there. The service user told us they could praise the staff enough for how helpful they have been. Staff were observed as being kind and caring.

We looked at six staff folders of people who worked at the home all of which contained the correct documentation for recruitment. We saw all personnel folders contained full and satisfactory Criminal Records Bureau (CRB) checks before commencing employment. We also noted all staff files contained application forms, contracts, references and picture identification.