Our House

About the service

Our House is a residential care home providing personal care to 8 people with a learning disability or autistic people at the time of the inspection. The service can support up to 8 people.

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

Right Support

People were not supported in a safe, clean, warm and appropriately maintained environment. Risks identified by the fire service and other external safety consultants had not been promptly addressed. Fire doors were propped open with wedges, and flooring was in need of replacement and presented trip hazards in the service’s communal spaces. On the first day of our inspection the service was cold and dirty.

Risks in relation to people’s individual behaviours had not been appropriately identified and mitigated.

In response to feedback during the first day of inspection the provider took action. By the second day of the inspection the service had been cleaned, was noticeably warmer and additional risk assessments had been developed.

Medicines were stored securely; however medicine administration records had not been accurately completed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We have made a recommendation in relation to systems for recording assessments of people’s capacity in relation to specific decisions.

Right Care

The service was short staffed and staff and managers were having to complete additional shifts to ensure people’s safety. Necessary recruitment check had not been completed and a third of the staff team had completed less than 50% of the training identified as necessary to meet people’s needs.

Staff understood people’s individual needs and communication preferences. People were confident approaching staff for support and did so without hesitation. Staff supported people to access healthcare services when required.

Staff understood how to protect people from abuse. There were systems in place to ensure people were protected from the risk of financial abuse.

Right Culture

The providers quality assurance systems were ineffective and had failed to ensure prompt action was taken in response to identified safety concerns.

Staff were complimentary of the registered manager and records showed staff had received regular supervision. The roles and responsibilities of the registered manager and nominated individual were understood by staff.

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 1 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing levels, staff training, safeguarding and the oversight of the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective 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, effective and well-led sections of this report.

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

Enforcement and Recommendations

We have identified breaches in relation to the premises, risk management, staffing, recruitment and governance at this inspection. In addition, we have made a recommendation in relation to the assessment of people’s capacity.

Please see the action we have told the provider to take at the end of this report.

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.

Whilst the environment wasn’t developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, people’s care was. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People at Our House lived their lives as full as possible and had control over what they did and how they were involved in decisions about their care and the service.

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

The ethos of the organisation was to enable people to have as much independence, choice and control as possible. We saw many examples of people leading the life of their choice and being able to influence that on a daily basis. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Any communication challenges were seen as an opportunity to support someone to have a voice and still have control of their life.

We met and spoke to all six people during our visit. However, some people who lived at the service had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore, they were not able to tell us verbally about their experience of living there. We spent time with people seeing how they spent their day and observed some interactions between people and the staff supporting them. One person said; “I like living here, have lived in lots of different places, but this has to be the best.”

Systems were in place to safeguard people. Risks to them were identified and managed. Staff had completed safeguarding training.

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 their medicines safely in the way prescribed for them. Infection control measures were in place to prevent cross infection. Staff were suitably recruited and there were sufficient staff to meet people’s needs. Staffing levels were flexible to enable the service to provide additional staff when needed.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided.

People had their privacy and independence promoted. Systems were in place to deal with concerns and complaints. This enabled relatives and people to raise concerns about their care if they needed to.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People had staff support to access community-based activities and holidays. This was flexible and provided in response to people’s choices. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. Staff were committed to providing good outcomes for people.

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 2o March 2019).

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.

People’s experience of using this service:

¿ Staff told us the service was well managed and the management team was approachable. Changes to the management structure were planned and the registered manager had taken a step back. The deputy manager was overseeing the service on a day to day basis with a view to taking over the registered manager position in the future. They had completed the relevant training and told us they were well-supported by the registered manager who was always available for advice and support.

¿ The registered manager was continuing to work at the service two days a week on opposite shifts to the deputy manager to help ensure a manager was always available. They also worked additional shifts to support the running of the service and the deputy manager. The rest of the week they were based in an office away from the service to enable them to concentrate on paperwork and updating records associated with the management of the service.

¿ One person was having medicines administered without their knowledge or consent. The correct processes had not been followed to ensure this was proportionate, necessary and safe. Policies and procedures were not regularly reviewed. Please see the action we have told the provider to take’ section towards the end of the report.

¿ Systems for the management of medicines were not robust, we discussed this with the management and they took action to address the concerns.

¿ The registered manager had failed to notify CQC of a specific event and we have made a recommendation about this in the report.

¿ There were enough staff to meet people’s diverse needs and preferences. Staff were flexible when organising the day to enable people to take spend time doing things they enjoyed and mattered to them. Staff told us they worked well together and with the management team.

¿ 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. 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 were able to organise their daily routines in a way which suited their own preferences. Adaptations to bedrooms enabled people to have privacy and spend time alone if they wished. People were supported to have choice and control in their lives and staff supported them to do this.

¿ People’s preferred ways of communicating were well known to staff. Staff and people engaged with each other and we observed this was meaningful and positive. People were comfortable approaching staff and frequently entered the office to speak with staff. This was clearly something they were used to doing.

¿ The management team were open and responsive when concerns identified during the inspection were highlighted. They told us they were keen to make improvements and some changes were immediately implemented following the first day of the inspection.

Rating at last inspection: At the previous inspection the service was rated Good. (Report published 5 January 2018)

Why we inspected: This inspection was brought forward due to information of concern received by the Care Quality Commission (CQC). The concerns were around the management and oversight of the service. The registered manager had taken a step back from the day to day running of the service and this was being overseen by the deputy manager. They had recently completed a qualification to enable them to apply for the position of registered manager and they were being supported to do this by the existing registered manager.

Enforcement: Please see the ‘action we told the provider to take’ section towards the end of the report.

Follow up: We will ask the registered manager to provide an action plan outlining how they will make the necessary improvements. We will continue to monitor the service and will re-inspect in line with our inspection programme.

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

Our House 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.

Our House provides accommodation, support and personal care for up to eight adults with learning disabilities, moderate to severe autism, communication difficulties and/or mental health conditions. At the time of the inspection four people were living at the service. The service also provides a respite care service. People accessed this service on a regular basis, when we visited two people were using the respite service.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 spent some time talking with people and staff. Staff were respectful and caring in their approach. They knew people well and had an understanding of their needs and preferences. Staff supported people to take part in a range of meaningful activities. There was an evident person-centred approach to supporting people. The registered manager and deputy manager had a clear set of values and these were known and shared by the wider staff team.

Risks to people’s safety and well-being were clearly identified and well managed. Staff used risk assessments to enable people to live full and meaningful lives. Staff were confident about providing support at any time including any period when people were distressed.

People received their medicines as prescribed. They were supported to understand what medicines were for and the consequences of not taking them. Systems for recording and auditing medicines were not robust. We have made a recommendation about this in the report.

Staff were supported through a system of induction, training, supervision and staff meetings. This meant they developed the necessary skills to carry out their roles. There were opportunities for staff to raise any concerns or ideas about how the service could be developed.

Care plans identified people’s communication needs and this was shared with other agencies when necessary. Where necessary, communication tools were used such as sequence strips and easy read information.

Staff understood the Mental Capacity Act and associated Deprivation of Liberty safeguards. Any restrictive practices in place to keep people safe were regularly reviewed to ensure they remained the least restrictive option. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Some people were able to make decisions about how they lived their life. Others lacked the capacity to make some decisions and this was done on their behalf and in their best interest. Written documentation around decision making was not always available. We have made a recommendation about this in the report.

The registered manager took an active role within the home. Staff told us they were approachable and available for advice and support. There were clear lines of accountability and responsibility within the staff team.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly both within the service and at organisational level.

Further information is in the detailed findings below.