Rapid Review & Resettlement

Zeno Limited is a residential care home providing accommodation for persons who require personal or nursing care for up to 7 people. The service provides support to children aged 13 – 18 years, younger adults and people with learning disabilities or living with autistic spectrum disorder. At the time of our inspection there were 3 people using the service.

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 model of care did not always maximise people’s choice, control and independence. Restrictions within the home did not always consider people’s individual needs and were not reviewed in line with current best practice.

The provider had not always considered best practice and guidance for the design of the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported to receive a healthy and nutritious diet. There was a lack of meal planning, to ensure people’s dietary needs were addressed and improved.

Staff used pictorial images and social stories to support communication between themselves and people living at the service.

Right Care: Proactive strategies to reduce the risk of people exhibiting behaviours were in place. However, the provider had not agreed the most appropriate strategies for using physical intervention in care records. Assessments had not fully considered holistic person–centred care and did not describe how people should be supported to reach identified goals.

Relatives felt their relation was safe while living at the home. Staffing levels were satisfactory.

People were supported by a range of health and social care professionals. Health actions plans were in place but lacked guidance for how staff should support people to stay healthy.

We observed kind and caring interactions from staff when supporting people. People were relaxed in staff’s presence.

People were supported to attend activities at and away from the home with staff.

Right Culture: The provider had not ensured staff were always recruited safely. The provider had not identified gaps in recording within incident records. The provider was not completing spot checks and fire drills during evenings and weekends to assure themselves the service was operating effectively in their absence.

Incidents of self-injurious behaviour, which required hospital treatment, were not always reported to the local authority or the Care Quality Commission. Commissioning social workers were informed of incidents.

Staff received training to support their job role. Training to support people with learning disabilities and autism was provided.

Staff and relatives felt confident to raise any concerns they had and felt they would be listened to.

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

Rating at the last inspection for this service was good (published 24 December 2019).

Why we inspected

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

We found some of the information received about the service had been incorrectly linked to this location and was connected a separate location of the providers. We have now ensured the information had been aligned with the correct location.

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.

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 Zeno Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person–centred care, safeguarding service users from abuse and improper and good governance at this inspection.

We have made a recommendation the provider consults with a pharmacist to obtain the correct administration process for administering medicines in people's food.

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.

Zeno Limited is a residential care home that provides accommodation and personal care support for up to seven people who have a learning disability and/or autistic spectrum disorder. At the time of our inspection there were three people living at the service. The service provided a 12-week bespoke rapid review and resettlement service. The service focused on developing person centred strategies that supported people to improve their quality of life and reduce behaviours that challenge others.

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. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

People were supported safely and protected from harm. Risks associated with people's care needs were assessed, planned for and monitored. Staff were knowledgeable about risks and had detailed guidance on the action required to manage and reduce risks.

Medicines were managed and stored safely. The service was clean and care staff followed good infection control practices to minimise the risk of infection.

Staff were recruited safely and had the appropriate skills and knowledge to deliver care and support to people in a person-centred way. There were no set meal times, people planned their own meal times in accordance with their own daily planner. Where needed, people were supported with their eating and drinking needs.

People were supported to have maximum choice and control of their lives and staff provided them with care in the least restrictive way possible and acted in their best interests; the policies and systems in the service encouraged this practice.

Care and support were planned and delivered in line with best practice and assessments of needs were comprehensive. Staff worked collaboratively across services to understand and meet people's needs. People’s health needs were identified, and action taken by staff to address any concerns.

Checks of safety of the building were carried out to ensure people were protected from harm. During the inspection the management team were proactive at ensuring external contractors completed robust legionella and fire risk assessments.

There was strong leadership and oversight within the service. People's relatives, staff and professionals spoke positively about the management of the service. Quality assurance systems were effective to check people were receiving care that was of high quality.

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

Rating at last inspection

This is the first inspection of this service which registered with CQC on 25 October 2018.

Why we inspected

This was a planned inspection based on the date the service first registered with CQC. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.