231 Brook Lane

231 Brook Lane is a residential care home that can support up to 10 people with a learning disability. At the time of our inspection, 7 people were using the service. The service provides support to adults with a learning disability and/or autism, mental health conditions and physical disabilities.

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: We found staff training had improved and the provider had systems in place to monitor training, competence and qualifications more effectively. Whilst some staff had not fully completed all their training, we were assured further learning and development opportunities were available for staff. Information provided to us demonstrated staff had been booked to attend various training sessions.

This was a targeted inspection to follow up 1 warning notice served at the previous inspection about number of suitably skilled, qualified and trained staff deployed to meet people’s needs. We use targeted inspections to follow up on Warning Notices or to check concerns. We did 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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection was required improvement and the report was published on 4 August 2022.

At the last inspection we served a warning notice because we found insufficient numbers of suitably skilled, qualified and experienced staff.

The provider had failed to meet the requirements of Right support: The model of care failed to provide people with the appropriate opportunities to maximise their choices, Right care: Care was not always provided in a person-centred manner and relatives told us they felt people were isolated and Right culture: The leadership in the service failed to create a culture of inclusion which empowered people’s lives

Why we inspected

We undertook this targeted inspection to check whether the warning notice previously served in relation to Regulations 18 (1) (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Therefore, the overall rating for the service has not changed following this targeted inspection and remains requires improvement.

Enforcement

The provider remains in breach of regulations found at the last inspection. We found breaches in relation to the management of medicines, staff deployment, training, notification of incidents, mental capacity, premises and governance. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care and right culture.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 18, staffing. However, improvement is still required to ensure all staff are suitably skilled, qualified and experienced.

Follow up

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link 231 Brook Lane. View on our website at www.cqc.org.uk

The service provides care and support for up to 10 people who may be living with a learning disability or autism. At the time of our inspection seven people were 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.

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

Right support:

¿ The model of care failed to provide people with the appropriate opportunities to maximise their choices.

Right care:

¿ Care was not always provided in a person-centred manner and relatives told us they felt people were isolated.

Right culture:

¿ The leadership in the service failed to create a culture of inclusion which empowered people’s lives

The provider failed to ensure the service was consistently well led and governance systems did not protect people from possible harm.

Staff were not always trained to administer medicines properly.

The provider failed to notify CQC and the local authority about incidents of possible abuse.

Infection control procedures were not always effective or in place. Staff failed to wear PPE appropriately which placed people at risk.

We could not be assured sufficient staff were deployed at all times to meet people’s needs.

The provider failed to manage and monitor risk effectively.

Requirements of the MCA were not consistently followed. Care records failed to demonstrate the least restrictive practice had been reviewed on a frequent basis.

The provider failed to ensure staff were appropriately trained and qualified to meet people’s needs at all times.

Whilst the provider had systems in place for investigating and responding to complaints, not all complaints were appropriately dealt with in a timely manner. People were not always kept updated on progress.

The provider failed to ensure effective infection control procedures were consistently applied.

The design and layout of the premises was not suitable for people to access safely.

Relatives told us staff were caring and said they were compassionate in their approach.

Safe recruitment practices were followed.

Relatives told us they were supported to maintain a balanced diet and said they were assisted to access external healthcare appointments when needed.

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

This is the 231 Brooks Lane’s first inspection under the new provider.

Why we inspected

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

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, staff deployment, training, notification of incidents, mental capacity, premises and governance. We issued the provider with a warning notice in relation to Regulation 18 (staffing) and told them to make improvements. Please see the action we have told the provider to take at the end of this report. 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.

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. Due to the issues we found, we referred our concerns the local authority and their quality team.

231 Brook Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided.

We were assured that this service met good infection prevention and control guidelines.

• Alternative forms of maintaining social contact were used to ensure people were able to stay in touch with their friends and relatives; for example: through using video calls, weekly newsletters to family members, visiting in communal garden or through meeting at a closed window. Technology was also used effectively to support communication with other visitors such as professionals and for clinical consultations.

• Staff wore appropriate personal protective equipment (PPE) when providing care and support.

• There were designated areas for donning/doffing PPE.

• The service ensured patients had been tested for COVID-19 by the hospital, or in the community before they agreed to admit them.

• For people who lacked mental capacity, the service had considered if any new measures and arrangements in relation to infection, prevention and control (IPC) amounted to a ‘deprivation of liberty’ and had taken appropriate action.

• The testing scheme for all staff and residents known as ‘whole home testing’ had been conducted and was on ongoing process.

• Risk assessments had been carried out on people and staff belonging to higher risk groups and actions have been taken to reduce the risk of these contracting Coronavirus.

• All care home workers had a test without delay if they became symptomatic and the frequency of testing followed current guidance.

• Communal areas such as outdoor spaces and garden areas were used creatively to help with IPC.

• All areas were uncluttered so cleaning could take place effectively.

• Employees in the clinically ‘extremely vulnerable’ group do not work in the care setting.

• All staff in high risk groups such as black and minority ethnic (BAME) groups had been risk assessed, and adjustments had been made.

• The registered manager demonstrated a good understanding of when and how to access local IPC resources (for example the local health protection team or infection control nurse) when they needed advice and support.