Compton House

Compton House is a residential care home providing personal care to up to 11 people. The service provides support to adults with learning disabilities, autism and other multiple needs. There is a main house which accommodates eight people and three self-contained annexes which accommodates three people. At the time of our inspection there were 11 people using the service.

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

People were not supported to have maximum choice and control of their lives. 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. The provider was not able to demonstrate how they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support: People were not always supported to use their preferred communication methods consistently. We observed people mostly being supported to make choices and be listened to. However, there were areas where this could be improved. People were offered regular opportunities to share feedback with the service. However, the forms used were generic and did not appear to meet the needs of everyone living at Compton House. The registered manager had developed close working relationships which supported positive outcomes for people.

People were mostly 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. The provider was working with the staff team and people to promote consistent person-centred care and positive risk taking.

Right Care: People’s privacy and dignity was supported, and the provider’s policies and processes supported this. People’s care plans and risk assessments had started to be updated since the last inspection and they were more detailed, and person centred. However, there were occasions when the guidance in place wasn’t being followed.

Right Culture: The ethos, values, attitudes and behaviours of leaders was passionate about supporting people using services to lead confident, inclusive and empowered lives. Training was being utilised to develop best practice and approaches within the service. However, more needed to be done to ensure people were fully involved in shaping their support. People were being supported to identify personal goals to increase their independence. Whilst this was a work in progress, people had successfully achieved some of their goals which had resulted in a positive outcome for them. Relatives were positive about the registered manager and the changes they had made so far to the service.

Safe recruitment processes were not always followed. We had received concerns relating to unsafe staffing levels, especially at weekends. We inspected the service out of hours unannounced. During the inspection we observed safe staffing levels and staff appeared unhurried and available to meet people’s support needs.

People confirmed they were happy living at the service and relatives told us they felt people were safe. There were appropriate policies and systems in place to protect people from abuse. Staff confirmed they were confident appropriate action would be taken if they had any concerns.

We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

Quality assurance processes were not always effective. Some of the concerns identified during the inspection had not been picked up by the provider. Whilst the registered manager was responsive and took action to address concerns when highlighted, we were concerned the provider's systems and processes were not sufficiently robust. The provider had not always sufficiently investigated incidents to prevent reoccurrences. The provider had not ensured records relating to the management of the home had always been completed or were accurate. We identified concerns in relation to poor record keeping.

The registered manager and provider responded immediately during and after the inspection. The registered manager developed an action plan with realistic timescales to address the shortfalls identified.

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 26 April 2022). 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 the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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 received concerns in relation to staffing levels and management oversight. As a result, we undertook a focused inspection to review the key questions of safe 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 remains requires improvement based on the findings of this inspection.

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

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a breach in relation to recruitment of staff and a continued breach in relation to governance at this inspection.

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.

About the service

Compton House is a care home, without nursing, that provides care and support for up to 11 adults with autism and learning disabilities and other multiple needs. There is a main house which accommodates eight people and three self-contained annexes that accommodate a further three people. At the time of the inspection there were 11 people using the service.

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

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

More needed to be done to ensure that people were consistently supported to have a fulfilling and meaningful everyday life and to pursue their interests. People’s care was provided in a safe, clean, and overall, well maintained environment that met their physical needs. People were able to personalise their rooms and a sensory room was available, but this needed to be further developed to ensure this provided a stimulating and interactive environment. Staff enabled people to access health care services in their local community and people’s medicines were managed in a way that ensured good health outcomes. The service planned for when people experienced periods of distress and this supported staff to respond safely, using a person centred approach. However, improvements were needed to ensure that staff learned from those occasions in a timely way.

When supporting people who might lack capacity to make decisions, the approach taken needed to be personalised and best interest decisions more inclusive.

Right Care

Risks to people had been assessed, but there were occasions when the guidance in place was not being followed. People’s support plans did not always fully reflect their needs or contained conflicting information. Staff tried to ensure that people’s wishes, needs and rights were at the heart of the support provided. However, staff turnover was high and too many agency staff were supporting people which meant they did not always receive consistent care from staff who knew them well. More needed to be done to ensure people consistently had sufficient opportunities to take part in activities that enriched their lives. Staff understood how to protect people from poor care or abuse.

Right culture

Staff were provided with training which helped to ensure that they understood how people with a learning disability or autistic people saw their environment. More needed to be done to ensure that people were fully involved in shaping their support. Whilst the provider demonstrated a commitment to create a culture of improvement that provided good quality care to people, the success of this approach had been affected by changes in leadership at the service. The current manager was making improvements and was taking steps towards ensuring a culture where people’s quality of life was being enhanced.

We have made a recommendation about the supervision of agency staff.

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 April 2019).

Why we inspected

We undertook this inspection to assess whether the service was 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.

The inspection was prompted in part due to concerns received about culture and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a breach in relation to governance.

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 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:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. e.g. People’s support focussed on them having as many opportunities as possible to gain new skills and become more independent.

People were happy living at Compton House, interactions between people and staff were relaxed and caring. People were able to communicate in ways they preferred and staff offered people choices about all areas of their care and treatment.

People received a safe service because the provider had systems and processes which helped to minimise risks. This included recruitment procedures and training for staff about how to recognise and report suspicions of abuse.

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 by staff who worked with other professionals to consider the most effective approaches if a person exhibited behaviours which challenged. Staff focussed on spending time with people in ways they wished and were confident about how to respond if a person became upset.

Compton House placed a focus on progression for people. Care plans were regularly updated to reflect people’s changing needs and we saw evidence of the changes in people’s abilities since moving to the home. Staff worked with people to encourage and build independence and social skills.

Staff enjoyed their roles and spoke with affection about the people they supported. The registered manager was approachable and responsive and worked alongside their team to improve outcomes for people. Systems and processes were in place to provide regular oversight of the service and drive improvements.

A full description of our findings can be found in the sections below.

Rating at last inspection: Good. Published 9 August 2016.

Why we inspected: This inspection 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

At the time of the inspection there were five people living in the home. Three people had their own bungalow annexe, while two people had en-suite rooms within the main house. The rear garden had been adapted to provide recreational areas to meet particular individual’s needs. People and staff were proud of their home and garden.

The service had a registered manager. 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.

People and relatives told us they trusted the staff completely as they provided reassurance when people worried and made them feel safe. Staff had completed safeguarding training and had access to current legislation and guidance. Staff had identified and responded appropriately to safeguarding incidents to protect people from harm. People were safeguarded from the risk of abuse as incidents were reported and acted upon.

Since Compton House began providing a service in August 2015 there had been 22 incidents which had been referred to the local safeguarding authority. These incidents had been reported, recorded and investigated in accordance with the provider’s safeguarding policies and local authority guidance. During our inspection we found that effective action had been taken by the provider, which had resulted in a considerable reduction in such incidents. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm.

Where risks to people had been identified in their care plans measures were implemented to manage these. Staff understood the risks to people’s health and welfare, and followed guidance to manage them safely. People were kept safe by staff who demonstrated their understanding of people’s risk assessments and management plans.

There were sufficient numbers of staff deployed with the necessary experience and skills to support people safely. The registered manager completed a weekly staffing needs analysis in order to ensure that any changes in people’s needs were met by enough suitable staff.

Staff had undergone required pre-employment checks, to ensure people were protected from the risk of being supported by unsuitable staff. Staff had received an induction into their role, required training and regular supervision which prepared them to carry out their roles and responsibilities.

People were cared for by sufficient numbers of well trained staff who were effectively supported by the registered manager and senior staff.

Medicines were administered safely in a way people preferred, by trained staff who had their competency regularly assessed by the provider. Medicines were stored and disposed of safely, in accordance with current legislation and guidance.

People were actively involved in making decisions about their care and were always asked for their consent before any support was provided. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People were encouraged to be as independent as they were able to be, as safely as possible.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The MCA 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made in their best interests. People were supported by staff to make day to day decisions.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had completed appropriate DoLS applications where required, which had been authorised. The registered manager had taken the necessary action to ensure people’s human rights were recognised and protected.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, protecting them from harm and promoting their dignity.

Staff had undertaken equality and diversity training and understood how to support people to maintain their privacy and dignity. Where people’s needs changed these were identified by staff and reported to relevant healthcare services promptly where required.

Staff had developed trusting and caring relationships with people and spoke with passion about peoples’ needs and the challenges they faced. They were able to tell us about the personal histories and preferences of each person they supported. Staff understood people’s care plans and the events that had informed them.

The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme ensured people were supported to pursue social activities of their choice, which protected them from social isolation.

Relatives told us they knew how to complain and that the provider encouraged them to raise concerns. Three complaints had been raised since the provider began to provide a service in August 2015. These had been managed in accordance with the provider’s complaints policy and procedures, to the satisfaction of the complainant. When concerns and complaints were raised records showed they were investigated and action was taken by the provider to make improvements where required.

Staff had received training in the core values of the provider, which were; to be committed and passionate, to act with integrity, to treat people with dignity and respect, to strive for excellence in the quality of their service and to be trustworthy and reliable. Staff were able to explain what these values meant to them and how they applied them while supporting people, which we observed being demonstrated in practice.

Relatives and staff told us the service was well managed, with an open and positive culture. People, relatives and staff told us the registered manager was very approachable, willing to listen and make any necessary changes to improve things for people. The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements.

Records accurately reflected people’s needs and were up to date. Detailed care plans and risk assessments were fully completed and provided necessary guidance for staff to provide the required support to meet people’s needs. Other records relating to the running of the home such as audit records and health and safety maintenance records were accurate and up-to-date. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons, whilst remaining accessible to authorised staff.