CareTech Community Services Limited - 237 Kenton Road

CareTech Community Services Limited – 237 Kenton Road is a residential care home providing care to people with a learning disability and autistic people. The home can accommodate up to 12 people in two separate flats, each with shared communal facilities. The ground floor flat is accessible to people with physical impairments. At the time of our inspection 7 people were living at the home.

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

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.

Right support:

The provider had made improvements to the support they provided to people in relation to recognised models of care for people with a learning disability and autistic people. Staff demonstrated they understood the support people required. Staff were observed to communicate well with people.

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.

Right care:

People’s care plans were person centred, Care plans contained guidance for staff in meeting people’s assessed needs. Staff understood people's wishes and preferences and were observed to support people in a friendly and respectful manner. Where appropriate, staff encouraged people to take positive risks, such as participation in new activities. Staff had engaged with people, health care professionals and other relevant individuals to support people's care and support.

Right culture:

People and those important to them, such as family members had been involved in planning their care and support. People were asked about their needs and preferences and staff developed activities and support to ensure their requests and preferences were met. Staff and managers had received training in supporting people. The training reflected current best practice in supporting people with a learning disabilities and autistic people. Staff were supported to discuss best practice for the people they supported in supervisions and team meetings. People were provided with the support they required to use the home and the local community as they wished.

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 2 September 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider sought guidance in how to engage people and provide person centred care for people with a learning disability and autistic people. At this inspection we found the provider had acted on this recommendation and had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CareTech Community Services - 237 Kenton Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The service could not always show how they met some of the principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and Independence.

People were encouraged and empowered to make their own decisions. Care staff ensured that people were supported and gave people daily choices which were appropriate to their needs and level of understanding and ability. People live in a large home which integrates well within the community. However, at times issues in relation to the maintenance of the property and environment were not responded to, which had an impact on people living in an environment which was not always safe and comfortable.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people very well and established positive relationships with them. Peoples’ dignity, privacy and human rights were maintained. People were treated and supported as an individual, and we saw that the service had made improvements around providing individual stimulating activities. We saw that further improvements are still required. We found some shortfalls around the safe management of topical creams proscribed to people who use the service.

Right culture:

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

People who use the service are involved in the community and take part in a wide range of community-based activities. We saw that the service supported people to access more community-based activities following the closure of facilities during the lockdown. People were put first, and the service has started to build activities and facilities around people. The new leadership team are open and transparent and easy to talk to. They listened to people who use the service and staff and visitors to discuss concerns and improve the service for people who use the service.

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’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs. However, repairs were not always responded to in a timely manner, which may put people at risk,

• People were protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

• People were supported to be independent and had control over their own lives. Their human rights were upheld.

• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.

• People’s risks were assessed regularly in a person-centred way; people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

• People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

• People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported them to achieve their aspirations and goals. The service had started to design and build a sensory garden together with people and sought activities which were of specific interest for people. However, the service acknowledges that further work was required to ensure the service is fully inclusive.

• People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.

• People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice. Staff regularly evaluated the quality of support given involving the person, their families, and other professionals as appropriate.

• People received care, support and treatment from trained staff and specialists able to meet their needs and wishes. Managers ensured that staff had relevant training, regular supervision and appraisal.

• People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

• People were supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve the service.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this inspection to provide assurance that the service is applying the principles of Right support right care right culture.

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 have identified breaches in relation to the safe management of medicines, the response and compliance with maintenance and repair requests and the effective monitoring and assessment of the quality of care.

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.

CareTech Community Services – 237 Kenton Road is a residential care home providing care and accommodation for up to 12 people with a learning disability. During the day of our inspection eight people lived at the service.

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

Quality assurance assessments were not always effective and improvements to the quality of care provided were not always actioned swiftly. As a result, people’s environment was not maintained appropriately. We were not always assured that infection and prevention control was maintained safely. For example, we found surfaces were not cleaned regularly and people’s temperature was not checked daily to ensure they did not show COVID-19 symptoms. There were no COVID-19 risk assessments for people who used the service or staff from vulnerable groups, this may put staff and people at unnecessary risk when exposed to the COVID-19 virus. We were concerned that the service did not used laptops provided for people to communicate with others or take part in virtual activities in replacement for activities provided by day centres they attended prior to their closure due to COVID-19.

Processes and procedures were in place to protect people from abuse and staff were confident that allegations of abuse would be dealt with. Risks in relation to people’s health and social care needs had been assessed and guidance to manage those risk was developed to support staff and people to manage those risks. People who used the service received their medicines safely and enough staff were deployed to meet people’s needs. Accidents and incidents were documented and discussed with staff during team meetings.

People’s needs were assessed and supported by an experienced and skilled staff team. People received a well-balanced and nutritious diet and were not unlawfully deprived of their liberty. People’s health care needs were met, and external stakeholders were involved in the care and support of people who used the service. Most of the time 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.

Care records were detailed and provided clear guidance for staff in how to support people and meet their needs.

Staff and relatives told us that they were happy with the new manager, who they said had an open-door policy and was supportive. The manager engaged with external sources to learn from and improve the quality of care provided.

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 guidance Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture. The service did not always provide person centred activities and lacked imagination in making use of Information Technology and Social Media.

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 11 May 2019).

Why we inspected

We received concerns in relation to safeguarding, staffing, infection control, maintenance, sharing of images, consent, activities and management. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect these. 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, Effective, Responsive 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 coronavirus and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to prevention and controlling of infection, person-centred care and quality assurance monitoring. 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.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes. The principles reflected the need for people with learning disabilities and/or autism to live meaningful lives that included control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

• People told us they felt safe living in the home. Staff were aware of their responsibility of safeguarding people from the risk of potential abuse. Staff had access to risk assessments that told them how to promote people's independence and to reduce the risk of harm whilst doing so. Staff were recruited safely and were provided in enough numbers to ensure people's needs were met.

• People were supported by trained staff to take their medicines as prescribed. Systems and practices reduced the risk of cross infection. Where things went wrong, lessons were learned, and action was taken by the registered manager to reduce the risk of this happening again.

• People were cared for by staff who were skilled and supported in their role by the registered manager. People were involved in the assessment of their needs to ensure they received the service the way they liked. Staff supported people to access relevant healthcare services when needed. The environment was suitable for the people who used the service.

• People's consent was obtained before care and support was provided and staff had a good understanding of the Mental Capacity Act 2005.

• People were cared for by staff who were kind, caring and respected their right to privacy and dignity. People were encouraged and supported by staff to be involved in making decisions about their care and treatment.

• People were treated kindly by staff and were assisted to pursue social activities of their choice. People’s concerns were listened to and acted on to ensure they received a safe service. At the time of our inspection visit the provider was not offering a service to people who required end of life care.

• The culture of the home was person-centred and supported people to achieve their goals. People were encouraged to be involved in the running of the home to ensure the service they received met their specific needs. The provider worked in partnership with other relevant agencies to ensure people's care needs were met. The provider's governance was effective in assessing, monitoring and driving improvements therefore, people received an effective and safe service.

Rating at last inspection: The service was rated Good at the last inspection in October 2016.

Why we inspected: This was a scheduled 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. If any concerning information is received, we may inspect sooner.

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

is a care home that provides personal care and accommodation for up to twelve people who have

learning disabilities. There were ten people using the service at the time of this inspection.

There was a registered manager in post. 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.

At our last inspection on 25 and 26 June 2015, we found breaches of legal requirements in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure there were sufficient numbers of suitable staff deployed to keep people safe and meet their needs. The systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

We received an action plan from the service telling us what action they would take to meet legal requirements in relation to the breaches. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified and the provider was now meeting regulations. We found there were sufficient numbers of staff to meet people’s needs and spend quality time with people using the service and systems were in place to monitor and improve the quality of the service. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. Feedback about the quality of the service people received was obtained through review meetings and satisfaction surveys. Records showed positive feedback had been provided about the service.

Relatives informed us that they were satisfied with the care and services provided. Relatives also told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. There was a record of essential maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control. Bedrooms had been personalised with people's belongings to assist people to feel at home.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. Care plans were reviewed monthly and were updated when people's needs changed.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that some authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met. Details of special diets people required either as a result of a clinical need or a cultural preference were clearly documented in people’s care plans.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

A satisfaction survey had been carried out in 2015 and the results from the survey were positive. The registered manager told us he would be sending out questionnaires for 2016 later this year.

There was a management structure in place with a team of support workers, senior support workers, registered manager and the provider. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen.

Overall, everyone was satisfied with the care provided and said that people were treated with respect and dignity. One person who used the service told us that they were "happy' at the home. One relative told us that staff were 'wonderful'. Another relative said "The home goes to great length to support people'.

Care records we looked at indicated that the needs of people had been attended to. The care records contained assessments, care plans and evidence of regular reviews. There was documented evidence that the healthcare needs of people had been attended to and there were records of appointments with healthcare professionals.

We observed that care plans were recorded in pictorial and written format and contained information about people's preferences.

There were appropriate arrangements in place to manage medicines.

Staff we spoke with told us that they enjoyed working at the home and felt supported by their colleagues.

Records we looked at were up to date could be located promptly.

People's care plans included detailed information about the individual support people wanted and needed from staff. People's independence and skills were promoted and supported by staff. We saw that people using the service were involved in carrying out some household tasks.

People were supported and encouraged to make decisions about their lives. During the inspection people decided what they wanted to eat, and what they wanted to do.

Staff knew about their roles and responsibilities in meeting the needs of people who use the service and they supported people in a friendly and respectful manner.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

There were enough qualified, skilled and experienced staff to meet people's needs.

Records were accurate and up to date.

The manager told us that she had commenced the process of registering with us.