Archived: 186-188 Lowdell Close

186-188 Lowdell Close is a care home providing personal care for up to four adults with learning and physical disabilities. Four people were using the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support (RRS) and other best practice guidance in relation to environmental considerations.

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

While the service was meeting the principle of RRS in relation to the environment, the outcomes for people did not fully reflect the other principles and values of Registering the Right Support for the following reason. The service had been working to develop positive behaviour support plans for people, but improvements were required for this to be in line with good practice guidance.

The provider had ensured more staff were now always on shift to meet people’s needs. However, some staff still had not completed communication awareness training to ensure all staff were competent and skilled to meet people's needs effectively.

There had been some improvements to managing people’s medicines, but some assessments of staff competency to provide medicines support were not up to date.

The provider's systems for identifying, assessing and mitigating risks to people's well-being had improved and addressed some of the issues we found at our last inspection such as deploying sufficient numbers of staff and responding to incidents and accidents. However, some improvements were still required.

A relative of a person using the service told us, “It has improved. Hopefully it stays like it.”

People using the service and staff experienced a challenging time as a result of the COVID-19 pandemic. Staff had supported people to shield based on health professionals’ advice and this meant some people had not been able to access their community as they would have usually liked. The provider had improved support to people to take part in activities that may be meaningful to them.

There were appropriate procedures for infection prevention and control.

Rating at last inspection

The last rating for this service was requires improvement (published 14 January 2020).

Why we inspected

We undertook this targeted inspection to check whether the provider had met the requirements of Warning Notices in relation to regulations 9 (Person centred care), 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was also carried out to check if the provider had met regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities), which they were also breaching at our last inspection in October 2019. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

During the targeted inspection we also looked at the infection control and prevention measures the provider has in place. As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes.

Please see the safe, effective, responsive and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 186-188 Lowdell Close on our website at www.cqc.org.uk.

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. At the last inspection we served Warning Notices for breaches of regulations 9, 17 and 18. During this inspection we found that while there have been some improvements the provider had not fully met the requirements of the Warning Notices. We will ask the provider for a new, updated action plan to confirm by when they will meet these requirements in full.

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.

Life Opportunities Trust - 186-188 Lowdell Close is a care home providing personal care for up to four adults with learning and physical disabilities. Four people were using the service at the time of the inspection.

Services for people with learning disabilities and/or autism should be developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values are to ensure people who use the service can live as full a life as possible and achieve the best possible outcomes. They reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the services should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Relatives of people using the service told us, “Generally, it’s not a bad home but it’s not the same as it was.” Relatives said the quality of the service had declined since the last inspection. They felt this was because of staffing issues and people not being supported to go out and about very much.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. This is because people were not treated with dignity and respect at all times. There had been some improvements in supporting people to participate in activities, but some people were not always supported to help them experience good, meaningful everyday lives. This was in part because the provider had not consistently deployed enough sufficiently trained and competent staff to meet people’s needs effectively at all times.

The service did not have robust arrangements to ensure people always received positive behaviour support in line with good practice guidance. Staff were caring with people but did not always promote good communication with them.

The provider engaged temporary agency staff to cover support worker vacancies. They arranged for the same agency staff to attend so people could be supported by people they were familiar with. Medicines were not always managed appropriately and incidents and accidents were not recorded consistently, which could put people at risk of poor care.

The provider's systems for identifying, assessing and mitigating risks to people’s well-being and the quality of the service had not always been operated effectively.

People were not always supported to have maximum choice and control of their lives. However, staff did support them in the least restrictive ways possible and in their best interests. Policies and systems in the service promoted such practice.

There were systems to safeguard people from the risk of abuse and to prevent and control infection. There were fire safety arrangements in place.

The provider operated suitable recruitment procedures designed to ensure only 'fit and proper' staff were employed at the home.

The provider had improved the home environment by ensuring mobility and bathing equipment had been repaired, decorating some areas and ensuring the garden was more accessible to people.

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 (published 5 June 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person-centred care, staffing, 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 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.

186-188 Lowdell Close is a residential care home providing personal care to four adults with learning and physical disabilities. The service is managed by Life Opportunities Trust, a charitable organisation running care homes in London and the South East of England.

People’s experience of using this service:

There were not enough staff deployed to meet people's needs or keep them safe. This meant that they did not always have varied or meaningful activities, their personal care needs were not always being met and their choices were not always considered. A high proportion of the staff supporting people were temporary staff sourced from agencies. Whilst the provider tried to source the same regular workers, this was not always the case, and many of the staff were unfamiliar with people's needs.

People's needs were recorded in care plans, but these needs were not always being met. People did not participate in social or leisure activities and did not access the community. Their personal care needs were not always being met. The staff showed limited understanding about meeting people's sensory needs or supporting people with their communication.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support. People's care was not person-centred or proactive. The support from staff did not focus on promoting people's choice and control in how their needs were met.

The staff did not always have the skills or experience to provide effective care. They had received some training in order to provide safe care. However, they had not received support and information to help them understand about the different and more complex needs of people living at the service. They did not reflect on their practice to look at ways in which they could improve the care being provided.

Some of the time, staff did not show care or respect toward the people they were supporting. They did not always offer choices or take time to consider what the person was trying to communicate.

One of the hoists used for accessing a bath was broken and had been for over two months. This meant that three of the four people who lived at the service had not had access to a bath during this time.

The provider's systems for identifying, assessing and mitigating risks had not always been operated effectively. The provider and staff carried out audits of the service but these had failed to ensure that people were always safe and that their needs were being met.

Feedback from one person's relative was positive. They said that they felt the person was safe and well cared for.

There was a calm atmosphere at the service and the staff were gentle when they approached people and when supporting them. People looked at ease in the home and with the staff.

Some of the principles and values of Registering the Right Support were being followed. People were supported to access the healthcare services they required. There was evidence that the provider had sought guidance and support from different healthcare professionals to make sure they were providing care which met people's health needs.

People were given enough to eat and drink. Meals were freshly prepared at the service and the staff offered people choices.

The provider had acted in line with the requirements of the Mental Capacity Act 2005. They had made appropriate applications for the legal authorisation to deprive people's liberty for their own safety. They had also tried to explain different aspects of the service to people and gain their consent for specific care interventions. The provider had involved people's families and other representatives when making decisions about their care.

Rating at this inspection:

We have rated the service as requires improvement for all of the key questions. This was because the service was not always safe, effective, caring, responsive or well-led. The overall rating of the service is requires improvement.

We identified breaches of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, premises and equipment, good governance and staffing. You can see what action we have asked the provider to take within our table of actions.

Rating at last inspection:

The last inspection of the service was 29 December 2016, when we rated the service Good.

Why we inspected:

The inspection was a scheduled/planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if we receive any concerning information.

At the last inspection in 2014, the service was rated Good.

At this inspection we found the service remained Good. The service met all relevant fundamental standards.

The service is rated Good as it continues to provide safe person centred care and support to the people using the service. There were sufficient numbers of staff working to meet people’s needs.

People had a range of needs and communicated in different ways to the staff team.

There were systems in place to ensure people safely received their medicines.

Staff are supported with regular training and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

We received limited verbal feedback from people using the service and so we carried out observations to see how they were being supported and cared for. We observed positive interactions between the staff and the people using the service.

People’s welfare was checked throughout the visit and staff ensured people were happy and comfortable.

People had the opportunity to engage in activities and see their family when they wanted to.

People’s care records continued to be informative and guide staff on how to care and support people appropriately. People’s health and nutritional needs were assessed to ensure they maintained good health.

The staff team understood people’s individual needs and how they communicated and their personal preferences.

Some people were able to make a complaint if they were unhappy and they also had the support of their family members who could also represent their views.

The registered manager had worked in the service for several years and also regularly worked directly with staff on shift so that they could see how the service met people’s needs.

Checks on the building and how people were supported continued to be in place to ensure the quality of the service was monitored and improvements made where necessary.

Further information is in the detailed findings below.

We undertook this short notice announced focused inspection to check that the Provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lowdell Close on our website at www.cqc.org.uk

We gave the registered manager notice the day before we carried out the focused inspection to ensure, as it is a small service, that they would be available to meet with us.

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.

At this focused inspection we saw that improvements had been made in the service. The downstairs main hall, living room and dining room had new carpets and these rooms had been painted. This made the service lighter, cleaner and welcoming for the people using the service. There was also a new fire door leading out from the living room so that people could safely evacuate the building in the event of an incident or fire.

The registered manager informed us that the upstairs stairway and hall were also due to be painted in January 2016.

There were ongoing discussions between the provider and the housing provider as to who was responsible for the upkeep and maintenance of the service. This had yet to be fully resolved and the registered manager confirmed they would develop a maintenance plan so that they knew what works would need carrying out each year. This could assist the provider in future planning and talks with the relevant housing provider to ensure the delays in getting work completed did not occur again.

At the time of our inspection the provider did not have a registered manager in post.

We could not speak with some people as their complex needs meant they were unable to share their experiences with us. We observed care, spoke with staff and looked at records to find out about their experiences.

We found that people and their relatives were involved in their care and where possible, people were supported in making daily decisions about their lives. People's needs were assessed and care plans developed so staff knew what action to take to meet these. People were also supported to access healthcare professionals and any risks to their welfare had been assessed.

We observed positive interactions between staff and people using the service. One relative commented that “the staff are caring, I have no concerns”.

Systems were in place to report safeguarding concerns and staff received training and information about this subject.

There were sufficient staff working in the home to meet people’s needs safely. One relative told us that they felt there were not always enough staff working at any one time. The acting manager confirmed that there were two staff vacant posts. One was due to be filled in the next week and would offer more flexibility in providing people with extra opportunities to engage in outside activities.

The home had a complaints procedure in place and if people were not able to raise a concern then their relatives or a befriender who could represent their views.

During this follow up inspection we found that the provider was complying with this outcome area. A temporary acting manager who had recently started working in the home was in the process of reviewing the systems in place and working to identify where the home could make improvements for the people using the service.

We saw that overall improvements had been made to ensure more regular reviews of the service were taking place. Checks on medication were in place and health and safety checks and maintenance checks had been carried out. This meant that people could be satisfied that the care and support they received was checked and the premises they lived in routinely looked at and monitored by staff.

One person said "I like going out" and we saw that people had a choice regarding how they spent their time. One person told us they would talk with staff if they were unhappy about something in the home. We saw positive interactions between staff and the people living in the home. As people communicated in different ways we saw that staff adapted how they asked people to make a choice. For example we saw staff showed people different types of drink so that they could point or say yes to what they wanted.

Staff confirmed they discussed people's needs and they shared their experiences and views with each other so that people were supported in a safe and appropriate way. However although there were some systems in place to monitor the quality of the care people received these were not always regular or detailed in identifying where the home needed to be improved.