CareTech Community Services Limited - 68 West Park Road

68 West Park Road is a residential care home providing personal and nursing care for up to 14 people. The service provides support to people with learning disabilities and autism. At the time of our inspection there were 13 people using the service. Each person had their own flat within the home including a living room, bedroom, and bathroom. All but one person had their own kitchen. People had access to a shared lounge area and a shared kitchen. They also had access to a shared garden.

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.

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

Right support

Systems had not always highlighted health and safety risks within the home. When health and safety concerns were identified, they were not always addressed in a timely way. Recording of incidents was not always detailed and records had not always been checked by management. This meant a safeguarding concern had been missed but was investigated when we highlighted it.

Right Care

People’s care records were not always up to date regarding the possible need for the use of restrictive practice as a last resort. This led to confusion amongst staff. Although staff could tell us about some people’s wishes and plans, it was not easy to see how their long-term goals and aspirations were being met.

Right Culture

Staff did not always receive regular supervision, which meant some opportunities to identify gaps in their knowledge could be missed. Agency staff were not given the same training in restrictive practices as the established staff team. This could create a risk of confusion about appropriate practice amongst the staff team.

People were not always supported to have maximum choice and control of their lives. It was not always clear staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this 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 20 January 2022).

Why we inspected

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.

We received concerns in relation to the management of health and safety risks and recording and monitoring of incidents in the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

During the inspection the provider took steps to address many of the concerns we raised. All the immediate health and safety risks which had been identified in the home had been addressed shortly after the completion of our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 68 West Park Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to ineffective systems to protect people from possible harm, poor maintenance of equipment designed to keep people safe and failings in the oversight and quality assurance systems in the home at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Caretech Community Services Limited – 68 West Park Road is a residential care home providing personal and nursing care to 14 people who have Learning Disabilities at the time of the inspection. The service can support up to 14 people.

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

The provider had developed a range of audits and quality assurance checks to assist with driving improvement within the service.

People were clearly comfortable, relaxed and happy around care staff and staff understood how to keep

people safe.

Training for staff to understand people's individual circumstances had been provided.

Staff understood who to report concerns to as well as the risks to people's health.

Staff had very good knowledge and understood people's health conditions and the support they required.

The risks to people's health were reviewed regularly and care plans updated following any changes.

Safe recruitment and background checks were carried out prior to staff commencing employment.

People's changing needs were reviewed and staffing needed to support people safely was updated.

People received their prescribed medications safely and in accordance with their specific guidance.

Staff were supported with regular supervisions and training.

People were supported to attend appointments with healthcare professionals and guidance was sought

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 working towards consistently 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

Right care:

• Care is person-centred and promotes people's dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 27 July 2021).

Why we inspected

We received concerns in relation to the management of safeguarding incidents and the administration 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

About the service

Caretech Community Services Limited – 68 West Park Road is a residential care home providing personal and nursing care to 14 people who have Learning Disabilities at the time of the inspection. The service can support up to 14 people.

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 service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was 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, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. 14 people were using the service.

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

Records showed that people had not always been treated in a dignified way. These practices were no longer used, and the new management team acknowledged previous practices were not in line with best practice.

People were supported by staff who knew how to report concerns of abuse and manage risks to keep people safe. There were sufficient numbers of staff to support people. Medicines were managed safely and there were effective infection control practices in place.

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.

People received support from staff who had received training relevant to their role and the people they supported. People had independance and choice with regards to their diet. People accessed healthcare services where required.

People had positive, friendly relationships with staff and described staff as kind. People’s dignity was promoted and people were supported to maintain their independence.

People were supported by staff who knew them well. People’s likes, dislikes and preferences with regards to their care were recorded. People had access to activities that met their individual interests. Complaints made were investigated and resolved.

There were systems in place to monitor the quality of the service. People were given opportunity to feedback on the quality of the service. People and staff spoke positively about the changes in management and felt the service was now well led.

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 20 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Staff knew the procedures they should follow to ensure people did not suffer harm or abuse. People were supported by enough staff to ensure their complex needs and lifestyle could be supported safely. Procedures were followed to ensure staff were recruited safely. Staff had been trained to support people with their medicines and most checks on medicines were accurate.

People were supported by staff who had been trained to meet their specific needs. People are 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 the support they needed to maintain their health and access health professionals. People had control over what they ate and drank with support to help them do so independently.

People had benefitted from phased introductions to staff which had enabled them to build positive relations with the staff who supported them. Staff demonstrated a thorough knowledge of people’s needs and desires and used this well to support them with their lifestyle.

People had been actively involved in developing social opportunities within the local community which had been tailored to their needs and preferences. People were supported to develop their independence and skills to support their goal of moving on to independent living. Each person had been involved in identifying and developing plans which reflected their personal goals and aspirations.

We received positive feedback that the home was well run. The provider had ensured the on going quality of the service by developing their facilities and opportunities for people. The provider worked with a number of other organisations to support people transitioning into or out of the home. This provided assurance that the service remained good, and that the service was meeting people's needs.

From our previous inspection some action had been taken to improve the service to people. However, there are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 11 people living at the home on the day of the inspection. We were not able to speak with people as they were unable to verbally express their views so we observed where we could how people were supported and how staff interacted with them. During our inspection we spoke with three members of staff who supported people, two relatives and the manager who had been employed since our last inspection and was supporting the inspection process. We looked at three people's care records.

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

Is the service safe?

We found that the provider had a system in place to ensure newly recruited staff were suitable to work with vulnerable adults. The provider also had in place a risk assessment process to ensure that staff continued to be suitable. This meant that people could be confident that staff were being appropriately checked.

Relatives told us they felt people were safe living in the home. One relative said, "He is definitely safe". Staff we spoke with were able to explain how they would keep people safe and who they would report concern to. This meant that people had the appropriate knowledge to ensure people were safe from harm.

We found that where risk assessments were needed to ensure the safety of people they were in place.

We found that an application under the Deprivation of Liberty Safeguards (DoLS) was in place to ensure the person affected was being supported in their best interest. There was a reviewing process in place as part of ensuring the person who liberty was being deprived was still appropriate. Training records showed that not all staff had received the appropriate training in the (DoLS) or the Mental Capacity Act (MCA). The staff we spoke with were aware of the application in place for the person who was being restricted and were able to explain this. However one member of staff was unable to explain in any way what DoLS or MCA was and its impact on people. The manager confirmed that some staff were still awaiting training.

We found from our previous inspection that people's finances were not being audited regularly. Evidence we saw at this inspection showed that the balance total on one persons account was in correct and staff were not always signing when they accessed people's monies. This meant there had been no improvement since our last inspection.

We discussed with the provider two safeguarding alert that was being investigated. The manager confirmed both investigation had been concluded and were found to be unsubstantiated.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We looked at three people's care records and found that pre-admission assessments were not in place to identify their support needs. We saw that support plans were in place and the provider was using specific support plans to identify how people with diabetes should be supported by staff. Staff we spoke with were able to describe the needs of people. This meant that people could be assured that staff would know how what their support needs were.

Care records showed that the need to see a health professional like a dentist or optician was highlighted in people's health action plans. However there was no evidence to show that people were having access to dentist, opticians and chiropodists where needed. We saw blank appointment forms that had not been completed. The manager told us that people were able to see their doctor or other health professionals when needed, these appointments were just not being recorded as they should have been. This meant that documents were not being completed sufficiently or accurately to reflect the support people were receiving.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

Relatives we spoke with told us that staff supported people appropriately and that they were caring. People were unable to share their views with us directly due to their complex support needs but we observed staff interacting with people. People were comfortable and happy around staff. This meant that people were happy and secure in how staff supported them.

We spoke to staff who had a good understanding of the people who they cared for and they were able to explain their support needs. We saw staff support people on an individualised basis. On the day of our inspection we went on a tour of the home and visited people being supported on a one to one basis in their flats by staff. The people we saw were happy and even where some people were being supported by two staff, due to their complex health needs, our observations were that people were happy and relaxed and interacting with staff. This meant that people needs were being met appropriately.

People were supported to go shopping and on trips. This was highlighted in their support plan. One person who had been out to the shops came back and gave the impression they were happy to have gone out and gestured they wanted to go back out. This meant that people were able to go out when they wanted with support from staff.

Is the service responsive?

The manager had recently been employed and was very responsive to the concerns we highlighted. The manager discussed with us the actions that had already been taken and the actions to be taken as part of improving the service. The manager recognised that there were still improvements to be made.

We found that since our last inspection there was evidence that 'relative's meetings' were now taking place on a regular basis. This meant that relatives had the opportunity to share any concerns they had with the manager.

Is the service well-led?

In this report there is the name of the registered manager Mrs Yvonne Whitehouse who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still identified as the registered manager on our register at the time.

The service was managed by a registered manager who was supportive throughout the inspection. Evidence we saw showed that where the manager needed to act in people's best interest this was being done. This meant that people could be confident that where needed their interest would be an important part of the support they received.

We found that there were systems in place to support the learning from events like accidents, incidents and complaints. The relatives we spoke with told us they would speak with the manager if they had a complaint. We saw that the complaints process was displayed and this meant this information was available for visitors to view.

We found from our previous inspection that medication audits were not being carried out to ensure medicines were being administered safely. We saw no evidence of these audits being carried out at this inspection, which meant the provider had failed to make the necessary improvements.

At the time of inspection the registered manager had left their post. We spoke with the service manager who was responsible for the running of the service, the deputy manager and four members of staff.

Care was person centred, planned and delivered to ensure people's safety and welfare. One person told us, “We get a choice in what we do, I like to go shopping and swimming".

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "The staff are nice and help me when I need it".

Systems were in place for the on-going monitoring of the quality of service. However, a lack of analysis meant that the provider may not identify themes and trends in order to learn and improve from the findings

A lack of detail and inconsistencies in record keeping meant that people were not protected from the risks of unsafe or inappropriate care.

People told us that they were afforded dignity and respect and their independence was promoted. One person that we spoke with told us, "Staff always knock on my door".

Care was person centred so that people received care in the way that they preferred. However the lack of relevant and consistent information meant that care was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse so that people were protected from the risk of harm.

People were cared for by staff who were supported to deliver safe care and treatment.

Comments and complaints people made were responded to appropriately. One person that we spoke with said, "I am happy with everything".