Archived: Prospects for People with Learning Disabilities - 3 Norwich Road

Prospects for People 3 Norwich Road provides accommodation and care for up to 3 people who have autism and or learning disabilities. At the time of our inspection 3 people were living in the home.

A registered manager was 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.

During our previous inspection on 22 February 2016 we found that the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was required to take action to address the concerns we found. During this inspection on 12 April 2017 we found that these actions had been completed.

We found a further breach of the regulations as there was a lack of robust systems in place to routinely monitor and assess the quality of the service being delivered. The registered manager did not audit people’s care records or people’s medicines. The registered manager did audit the weekly health and safety checks but did not provide an action plan for any shortfalls found. Any remedial action was not taken in a timely manner. A member of the provider’s quality assurance team conducted an internal monthly quality audit, again these were ineffective at addressing concerns within the service.

The registered manager was also the registered manager for another of the provider’s services which meant that the registered manager was not on site all of the time. They maintained regular contact via telephone and used a staff message book to communicate with staff. Staff added that they were able to contact the manager and felt supported in their role.

Whilst permanent staff received regular supervision, we found that the staff who worked on an as and when basis did not receive any formal supervision. There were also gaps in staff training records. Staff did not have regular meetings and this was due to the difficulties with agreeing on a suitable time for everyone. In spite of this, staff felt supported in their role by both the registered manager and their colleagues.

People’s care plans were not always person centred and some of what was written in people’s care plans was duplicated across all three people’s care plans. However, people’s individual communication needs were clearly documented as were risks to people’s health and wellbeing.

Staff were caring and treated people in a kind and compassionate manner. Staff engaged with people well. They supported people to make choices about what they wanted to do with their day through to how they preferred to have their care and treatment delivered. People were supported to be as independent as possible and they contributed towards weekly health and safety checks and shopping for the home. People were given opportunities to pursue their interests and hobbies both inside and outside of the home.

The service was working within the principles of the Mental Capacity Act 2005 and no one was being unlawfully deprived of their liberty. We saw that appropriate applications had been made to the relevant authorising body to deprive people of their liberty, in order to provide safe care and treatment.

Staff knew what constituted abuse and what procedures they would follow to report any concerns. There were safe recruitment practices for new staff and appropriate references and police checks had been sought before staff started working in the home. This helped to ensure that people were protected from abuse.

People’s medicines were not consistently audited but we saw that they were stored and administered in a safe way.

The provider’s website indicates that it operates as a Christian organisation providing support to people with learning disabilities and their families. The home we inspected provides accommodation and support to a maximum of three people who have lived together for a long time. The home is arranged over two floors in a small domestic setting, in keeping with other houses in the same row.

There was a manager in post who had applied for registration and was overseeing two of the provider's services. The last manager had left the service more than three years previously. The provider is required to have a registered manager for the service. 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.

People's safety within the home was sometimes compromised. There were shortfalls in the way that the environment was maintained to ensure people's safety, particularly in the event of a fire which placed them at risk of harm.

People's medicines were managed safely. They were supported by enough staff who had been subject to a robust recruitment process which contributed to protecting people against the employment of unsuitable staff. Staff understood the importance of reporting any concerns that people may be at risk of abuse.

Although training provision had lapsed during the period that appropriate management support had not been in place, staff understood how to meet people's needs. Improved systems of support for staff were being put in place. Staff ensured that people were supported to access health professionals so that their welfare was promoted. Staff were aware of the importance of supporting people to make their own decisions about their care and how they might communicate their agreement to, or refusal of, proposed treatment. The provider had not taken action in the absence of a manager to ensure people were not unlawfully restricted. However, the new manager was aware of their responsibilities in this area. They were in the process of addressing this, to ensure people's rights were protected.

People had enough to eat and drink and were able to enjoy their meals together with staff, in a family type setting.

People received support from a stable staff team who had developed good, caring relationships with them. Their privacy and dignity was promoted.

Staff were aware of people's interests and preferences and what was important to them. The manager was taking action to ensure that plans of care were updated to ensure they continued to reflect people's current needs. People's relatives could be involved in the review process to support people with decision making if it was needed. People using the service would need support from their family members or staff to raise concerns. Their relatives had confidence in the manager that any concerns or complaints would be addressed properly.

The service had not been consistently well-led due to the absence of an appropriate manager for a prolonged period of time. The service had failed to notify the Care Quality Commission of an event taking place within the service which affected the premises, compromising facilities available to people which meant that they had to move out for a period of time. There was a lack of attention to routine 'housekeeping' which compromised the quality and homeliness of the environment people were living in.

There were systems in place for gathering people's views about the service and how it might improve. The incoming manager was attempting to prioritise a wide range of improvements they had identified as required, including updates to records and training. People's relatives recognised that they were having a positive impact on the service and welcomed the appointment of the new manager.

You can see what action we told the provider to take at the back of the full version of the report.

A corporate recruitment policy was in place to help ensure that staff were suitably skilled, qualified and experienced to work with vulnerable people.

People were protected from the risks of unsafe or inappropriate care and treatment because appropriate procedures and records were in place to ensure the safe operation of the service.

People told us that they got on well with the staff, who supported them to go out, to follow their favourite football team, to be part of the local community and to go on holiday. They also told us that their rooms were comfortable and that they had their own belongings around them.

People told us how they were supported to live as independently as possible and that they were able to attend a day centre, carry out voluntary activities and work part time.