Imola

Imola is a care home that provides care and support for up to eight people who have a learning disability or who are autistic and have complex support needs. At the time of the inspection there were eight people living at Imola.

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

We observed people engaging positively with staff who were committed to promoting their wellbeing. We received largely positive feedback from relatives, who spoke warmly of the support their family members received, particularly from established staff who knew people well.

There had been changes at Imola since our last inspection. There was a new registered manager, deputy and new care staff. The provider had systems in place to check the quality of care and of the accommodation, however these were not always effective. We had concerns around how well some risks were managed across the service, including poor infection control. The provider had also not submitted the notifications and safeguarding alerts to CQC and the local authority, as required.

There were not always enough experienced and skilled staff on each shift. Some families and staff told us this affected the quality of care people received. Prior to our inspection the provider had already started to take action to address staffing retention and practice.

The provider was open to our feedback and demonstrated a commitment to improving care and safety at Imola. They had set up workshops to promote people’s quality of life, which were positive and reflected a commitment to promoting person-centred care. Despite some concerns around infection control, the provider and staff had worked hard to promote people’s wellbeing during the COVID-19 pandemic. The provider engaged well with external professionals to make decisions in people’s best interests.

Staff knew what to do when they had concerns about people’s safety. The provider carried out investigations into safety concerns and incidents, making changes to people’s care as required. Individual risk assessments were personalised and provided practical guidance to staff.

People received support to take their medicines safely, and to reduce unnecessary use of medicines.

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.

This service was able to demonstrate how they were working towards meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting maximises people’s choice, control and Independence. There is a demand for the type of service Imola provides as it enables people to move out of more restrictive accommodation, such as long-stay hospitals. The provider is working to ensure the property does not feel institutional and meets people’s sensory needs and preferences.

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights. People are treated as individuals and care is provided flexibly in line with their preferences. The provider works in line with guidance around Positive Behaviour Support to provide care which minimises restrictions to people’s freedom.

Right culture:

Staff and management seek to promote a positive ethos, values, attitudes and behaviours which enable people using services to lead confident, inclusive and empowered lives. High staff turnover has meant it has been challenging to establish a consistently positive culture.

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 30 April 2019).

Why we inspected

We received concerns in relation safety, a medicine error and the culture at the service. 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 full report.

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

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified breaches in relation to the lack of oversight and management of risk and in relation to the provider’s failure to send CQC notifications as require.

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 for 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 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 understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. Risks to people's well-being and safety were assessed, recorded and kept up to date. The service demonstrated a positive approach to supporting people with complex behaviours. The provider had systems in place to enable staff to manage people's medicines safely.

The care service was 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 using the service can live as ordinary a life as any citizen.

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 were supported to maintain good diet and access the health services they needed.

Training relevant to people's support needs had been undertaken by staff. The staff team felt involved in the running of the service and were supported by the registered manager. A complaints procedure was in place.

People were treated with dignity and respect by caring staff. Staff had a very good understanding of the care and support needs of people and had developed positive relationships with them. Staff supported people to develop their independence and people were supported in a personalised way.

The service was effectively managed by a registered manager and deputy manager. They led by example and had a passion for continually driving improvements and placing people at the centre of the service. There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

More information is in the detailed findings below.

Rating at last inspection: Good (report published 07 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Imola is a registered care home providing 24 hour support to eight adults with a learning disability. The service does not provide nursing care. On the day of our inspection the service did not have any vacancies.

The service had 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.

People were treated with dignity and respect and staff interacted with people in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

There was a regular and consistent staff team. The provider had appropriate recruitment checks in place which helped to protect people and ensure staff were suitable to work at the service. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported in their role. We saw that staff had received training, but some updates were needed. Formal supervision had been regularly provided.

We found that detailed assessments had been carried out and that the care plans were very well developed around each individual’s needs and preferences. There were risk assessments in place and plans on how the risks were to be managed. We saw that appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves; to help ensure their rights were protected. People were supported with taking every day risks and encouraged to take part in daily activities and outings.

People were happy and relaxed with staff. Systems were in place for people to raise concerns and they could be confident they would be listened to and appropriate action was taken.

People’s medication was well managed and this helped to ensure that people received their medication safely. They were supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice. We found that people’s healthcare was good. People had access to a range of healthcare providers such as their GP, dentists, chiropodists and opticians.

The provider had effective quality assurance systems in place. People and their relatives were encouraged to feedback on their experiences and staff tried to involve people where possible in day to day decisions and the running of the service. The service was well managed.

We found that the service had appropriate arrangements in place to protect people from the risk of abuse. Staff received regular training on safeguarding vulnerable adults and people with learning disabilities. The provider had appropriate arrangements in place for the use of physical interventions and restraint and monitored all incidents closely to ensure people were protected from the risk of inappropriate restraint.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager. There was a sufficient number of staff on duty and recruitment of new staff was ongoing. Staff told us they were able to raise issues with their manager and gave examples of the incidents and concerns, such as staffing levels, that they had reported and their concerns were addressed by the manager.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required.

We observed people being cared for by staff during our visit. People who used the service shared their views through gestures, facial expressions and body language wherever possible. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.

The service was well supported by the provider through extensive training for staff, clear policies and procedures, and regular refurbishment and maintenance of the premises.

People who used the service were not fully protected from the risk of abuse, because the provider had not taken reasonable steps to follow up potential safeguarding matters that they had identified. It is important they do this to ensure that concerns are addressed appropriately and are limited as far as possible from happening again.