21 Lucerne Road

About the service

21 Lucerne Road is a residential care home providing personal care to 3 people with a learning disability and/or autism at the time of the inspection. The service can support up to 3 people.

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

Right Support:

People did not always receive care in an environment which was safe as risks relating to radiator burns and falls from height had not always been fully assessed. Risks relating to each person’s care had not always been fully assessed. This meant the service may not have been doing everything possible to keep people safe.

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 at the time of this inspection supported this practice.

The service gave people care and support in a clean and hygienic home and a plan to renovate the service was in place. People received care in a person-centred way, to meet their needs. People were encouraged to do as much as they wanted, to build and maintain their independent living skills. People were supported to see the healthcare professionals they needed to remain healthy. Staff supported people to make day to decisions about their care and support and people were asked for consent and for their preferences. Staff understood the best ways to communicate with people.

Right Care:

People’s care plans were not always sufficiently detailed nor recently reviewed to remain reliable for guiding staff. The provider told us this was an oversight due to switching to an electronic system and they would rectify this immediately.

Staff promoted equality and diversity and respected people’s cultural needs. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. The registered manager and staff understood how to protect people from poor care and abuse. The service had enough staff to meet people’s needs and keep them safe. Staff understood the best ways to communicate with people. People could take part in activities they were interested in.

Right Culture:

The provider’s oversight of the service could be improved because they had not always identified and rectified the issues we found. Despite the issues we found, people received good care and support and had a good quality of life. Staff understood people well and had worked with them for many years. People and those important to them, were involved in planning their care.

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 requires improvement (published 17 April 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 have found evidence that the provider needs to make improvements. Please see the full report for further details.

Enforcement

We have identified 2 breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of 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.

21 Lucerne Road is a family run residential care home providing accommodation and personal care. It is registered to support up to three people with learning disabilities and/or autism. At the time of the inspection there were three people using the service.

The service has not always been fully 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 should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

At this inspection we found a continued absence of monitoring systems to improve the quality and safety of the service. This meant that some areas of risk had not been identified. The provider acted to address some areas we identified following the inspection, but they had not recognised these issues through their own quality monitoring. Some areas we had identified for improvement at the last inspection, such as systems for monitoring staff training had not been fully addressed.

The provider had addressed the issues we had previously identified in relation to DoLS. However, we found continued concerns about arrangements to ensure staff followed the Mental Capacity Act 2005 (MCA) code of practice.

Medicines were safely administered but arrangements for ‘as required’ medicines did not follow best practice guidance. Staff had not been assessed as competent to administer medicines.

We have made two recommendations, one about the use of best practice guidance on managing medicines and the other that the provider consults best practice guidance on positive behaviour support to better inform the planning of people’s care.

The registered manager was involved in the day to day care of people at the service and they were supported by a deputy manager. However, they had limited understanding of their roles and responsibilities. They had limited contact with other providers or health and social care professionals to help stay up to date with changes and developments in adult social care.

Some Improvements had been made since the last inspection and people were accessing the community for some activities. People had care plans that reflected their care needs. However, further improvements were needed to care records to evidence that outcomes for people consistently demonstrated the principles of choice and control, independence and inclusion. People did not always have information about the service in a format they understood.

People were not able to express their views to us verbally at the inspection. Relatives told us people were safe at the service and we observed people were relaxed in the presence of staff and each other. Staff understood how to protect people from abuse or neglect and how to raise safeguarding alerts if needed.

Details of accidents or incidents which occurred at the home were recorded. The registered manager and deputy reviewed accident and incidents for learning, to reduce the risk of repeated occurrence.

There were enough staff to meet people’s needs. Staff understood how to protect people from the risk of infection.

People’s nutritional needs were met. Staff received training and support, but improvements were needed to ensure the training was reflective of people’s needs. People had access to health care services.

Relatives told us staff were kind and caring. Staff knew people well and understood their likes and dislikes as well as their needs. Staff treated people with dignity and respected their privacy.

People were involved in making decisions about the support they received. Since the last inspection the home had introduced measures to try to gather feedback from people and their families about the running 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 and update:

The last rating for this service was requires improvement (report published 13 February 2019).

At the last inspection we found two breaches of regulation in relation to the arrangements to follow the MCA and Deprivation of Liberty Safeguards (DoLS), and in the way the service was managed with an absence of quality assurance systems.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on the actions we had asked the provider to take at the last inspection.

Enforcement

At this inspection we identified continued breaches in relation to quality monitoring and systems to oversee possible risks, and in the provider’s arrangements for meeting the requirements of the MCA. We also found a new regulatory breach because risks to people had not always been identified and action had not always been taken to manage risks safely.

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 and we will meet with them following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

21 Lucerne Road 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 service is registered to accommodate up to four people with learning disabilities. At the time of our inspection there were three people living at 21 Lucerne Road.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was also the provider and had managed the service since first registration with the CQC.

The care provided was not sufficiently developed 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. People with learning disabilities and autism living in the home were not fully living as ordinary a life as any citizen. People had limited opportunities to participate in activities go out in the community. Furthermore, the registered manager and staff had not refreshed their knowledge of the Mental Capacity Act (MCA) 2005 and therefore did not have a clear understanding of how the MCA applied to people as their circumstances changed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the lack of procedures and systems in the service supported this practice.

Staff received training and supervision but the scope of both could be further developed to better meet the needs of people and staff. People told us they felt safe living at 21 Lucerne Road and with the way they were supported by staff. There were arrangements in place to help protect people from the risk of abuse. Staff knew how to identify potential abuse and how to report any concerns. People knew how to make a complaint.

Risks to people’s health, safety and well-being were assessed and management plans devised to guide staff on how to protect them from harm. However, we found that people's care records including their risk assessments were not always fully completed or accurate. Additionally, more needed to be done to ensure information regarding people's care was in a format which was accessible to people.

People told us staff were caring and kind to them; they were satisfied with the quality of care provided. Staff respected people’s privacy and dignity and treated them with respect. Relatives and other visitors were made to feel welcome and told us they were free to visit people at any time. Staff knew people well and understood their communication needs. There were sufficient staff recruited in a safe way to provide care and support to people.

People received their medicines as prescribed. People had access to external health care professionals to maintain their health. People had sufficient food and drink to meet their nutritional needs. People told us they enjoyed the meals provided.

There was not a system in place to ensure that people's views were obtained and used to make improvements if needed. There were limited systems in place to assess and monitor the quality of service provided and the systems which were in place were not always as effective as they needed to be. The provider's established quality checks had not identified the issues we found with record keeping and mental capacity assessments.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations in relation to the provider's failure to act in accordance with the MCA 2005 and the provider's lack of good governance. You can see what action we have asked the provider to take at the back of this report.

21 Lucerne Road is a care home which is registered to provide accommodation and personal care for a maximum of three adults with learning disabilities. The home is located in a terraced house on a residential road in Thornton Heath. At the time of our inspection there were three people living in the home.

The home had a registered manager. 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.

There was a sufficient number of suitably qualified staff to care for people safely and meet their needs. There was a system in place to determine the number of staff required to care for people safely. On the day of our inspection, the registered manager and deputy manager were on duty. The staffing arrangements were sufficiently flexible so that in the event of an emergency, there were enough staff to cover the emergency and routine work of the service.

This was an unannounced inspection that took place on 31 March 2016.

21 Lucerne Road is a family run home which provides care for up to four people with learning disabilities. On the day of our inspection there were three adult males living in the home.

The home had a registered manager. 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.

At our last inspection in February 2015, we found there were inadequate systems in place to ensure people received their medicines safely, appropriate checks were not conducted on staff before they began to work with people and staff were not receiving regular supervision or appraisal. We also found that people were not involved in the care planning process and people’s care plans were not up to date. There were not effective systems in place to monitor the quality of care people received. We asked the provider to take action to make improvements. The provider sent us an action plan and this action has been completed.

During this inspection people told us they were satisfied with the care they received and that they enjoyed living in the home. Relatives were also satisfied with the care provided. Staff had formed good relationships with people. The staff team were caring, attentive and provided the care and support people needed in a kind and friendly way.

Staff were knowledgeable about the people they supported. They had appropriate skills, training and were focused on providing individualised care. Staff were further supported through induction, supervision and the opportunity for career advancement.

There were appropriate arrangements in place to help ensure people received their medicines safely. Appropriate checks were conducted before staff began to work with people. People's care was planned to minimise the risk of foreseeable harm.

People were encouraged to discuss their health needs with staff and were supported to access community based healthcare professionals. People were protected from nutrition and hydration associated risks with balanced diets which also met their preferences.

The home was clean and provided a safe environment for people to live and staff to work in.

Following our inspection visits, we were informed of a safeguarding issue, in that a concern had been raised. This is where one or more person's health, wellbeing or human rights may not have been properly protected. The overall review of this matter was not yet concluded.

Below is a summary of what we found. The summary is based on our observations during the inspection visit, speaking with two people using the service, the registered manager, one staff member supporting them and from looking at care records. We also received feedback from a professional involved with this service following our inspection visits.

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

Is the service safe?

One person using the service said 'Yes I am being treated properly here' and they told us they liked living at the home. Another person told us 'Yes, I like it'.

We saw people's medicines were handled appropriately and kept safely. Staff received medication training and written guidance was available to them to reference.

The premises were clean and hygienic when we visited. Regular checks were being carried out to ensure the health and safety of the people living there.

Is the service effective?

People's assessed needs were being met by staff with the necessary skills and knowledge. We saw that staff had access to training and supervision to help them do their jobs well.

A care manager reported that the person they knew had 'made good progress' and reported that the individual said they were happy living at the home.

Is the service caring?

The people we spoke with said that they were treated with dignity and respect.

We saw that care plans were kept up to date and appropriate support provided to individuals with their activities of daily living as required. Staff were aware of people's preferences and needs and we were given examples of how the home tailored the support provided to each individual to meet these.

Is the service responsive?

One person using the service told us that "I do choose my own food" and said they were able to enjoy their favourite meals regularly.

We saw that service user meetings had taken place regularly with minutes available for February and March 2014. These regular forums could be developed to ensure people have a regular formal opportunity to meet with advocacy services or other appropriate people external to the home.

Is the service well-led?

We found that the service had not formally notified the Care Quality Commission (CQC) about the recent Safeguarding allegations. We discussed the importance of notifying CQC of these and other incidents that may affect the welfare of people using the service with the registered provider.

We were informed that support was being provided from an external company to help ensure the service met CQC compliance standards. We saw that important health and safety checks were taking place including testing schedules for gas safety, fire safety and electrical appliances.

We observed positive interactions between staff and people using the service during the course of our visit.