CareTech Community Services Limited - 196 High Street

Care Tech Community Services Limited 196 High Street is a residential care home providing personal and care to up to 12 people. The service supports people with learning disabilities and autistic people. At the time of our inspection there were 6 people using the service and 6 people were on holiday.

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.

Right Support:

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 services supported this practice. People’s care was not personalised. The home was not well maintained. The provider did not have effective processes or systems in place to deal with the repairs that were needed in the home to keep people safe. The provider was struggling to recruit permanent staff which meant there was a high use of agency staff, and this impacted on how people received their day to day care and support. Medicines were administered safely. The provider had safe infection control practices. Staff understood how to raise safeguarding concerns.

Right Care:

People received kind and compassionate care. Staff did not always protect and respect people's privacy and dignity. Permanent staff understood and responded to people’s individual needs however some agency staff did demonstrate they had the necessary skills to care for people. Support plans didn't always reflect people’s interests and activities and there was a lack of activities at the home which meant some people did not participate in activities they enjoyed. People were supported to access healthcare services. People were supported to maintain balanced diets.

Right Culture:

The service was not well-led. There was no effective governance system in place to monitor the quality of the service provided to people. The provider was not learning from incidents and accidents which placed people at risk of harm. Based on our review of this service the service was not able to demonstrate how they were meeting some of the underpinning principles of Right care, Right support, Right culture.

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 last rating for this service was good published (22 August 2018)

Why we inspected

The inspection was prompted in part by a notification of an incident following which a person using the service sustained a serious injury. 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 assessing risk. This inspection examined those risks.

We looked at infection and prevention 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care Tech Community Services Limited 196 High Street on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to person-centred care, safe care and treatment, premises and equipment and good governance.

We have sent a Regulation 17(3) Letter to the provider in relation to their failure to effectively operate systems and processes to assess, monitor and improve the quality and safety of the services provided in carrying on the regulated activities. A Regulation 17(3) Letter stipulates the improvements needed to meet breaches of regulation, seeks an action plan and requires a provider to regularly report to CQC on their progress with meeting their action plan.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ The service was clean and hygienic. Cleaning schedules were in place, which were methodically completed throughout the service. Senior staff completed regular infection prevention and control audits. Action was promptly taken to address any issues identified.

¿ The service was receiving professional visitors with clear infection control procedures in place. Visitors were screened and had their temperatures checked by on arrival. Handwashing facilities and alcohol gel were made available and all visitors were required to wear personal protective equipment (PPE).

¿ Guidance for the use of PPE was seen to be displayed in the building. Staff were seen to be maintaining social distance and adhering to the PPE guidance and protective measures in place.

¿ People and staff had engaged with the routine testing scheme. Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed.

¿ The provider had developed policies and procedures in response to the coronavirus pandemic. The registered manager had developed a robust contingency plan for the service.

Further information is in the detailed findings below.

At our last inspection 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 on going 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.

People’s relatives told us that they were confident that people were safe living at 196 High Street.

Risks to people were appropriately assessed and protected people from harm.

The provider operated a thorough recruitment processes which helped to ensure that staff employed to provide care and support were fit to do so.

There were sufficient numbers of staff available to meet individual needs and the service provided was flexible.

Staff had received training, support and development to enable them to carry out their role effectively. The service is required to update records in relation to meeting the requirements of the Deprivation of Liberty Safeguards (DoLs).

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 received appropriate support to maintain healthy nutrition and hydration.

People were treated with kindness by staff who respected their privacy and upheld their dignity. People’s relatives were encouraged to be involved with people’s lives where appropriate, to provide feedback on the service and their views were acted upon.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People’s relatives told us they knew how to complain but had not had occasion to do so. They said they were confident they would be listened to if they wished to make a complaint.

We found that records written in a positive and respectful way we found that records provided guidance on how to support people.

We were told that staff listened to them and responded to them in a positive way. Relatives knew how to raise concerns if they needed to and told us they were confident that the registered manager would take appropriate action to address any concerns in a timely way.

The registered manager had arrangements in place to receive feedback from people who used the service, their relative, external stakeholders and staff members about the services provided.

There was an effective system in place for people to raise complaints about the service they received.

We found that records were sufficiently maintained and the systems in place to monitor the quality of services provided were effective.

The registered manager had created an open and inclusive atmosphere within the service. People who used the service, their relatives, staff and external health professionals were invited to contribute their views in relation to further developing the service.

People living in the home expressed satisfaction with the care and service they received and told us that they liked the staff. People received care and support according to their needs. Staff were equally attentive to people who were less able to communicate their needs verbally. Staff engaged people in activities and conversation related to their interests. One person told us that they enjoyed football and staff helped arrange tickets for football matches.

People who used the service were relaxed in the presence of staff and we heard lots of laughter.The manager and staff understood their responsibilities for safeguarding people who used the service. One person who used the service told us that they felt safe, and if they were not happy with their care, the manager would listen and act on what they said.

The provider carried out effective checks to make sure people who used the service received a good standard of care. They also carried out checks for new staff, which reduced the risk of employing unsuitable people.