Archived: Sable Care Limited - 22 Ashbridge Road

Sable Care Limited - 22 Ashbridge Road is a residential care home providing personal care for up to four people with a learning disability and autism. At the time of the inspection one person was living at the home.

The home provides accommodation across two floors. People have their own bedrooms with shared bathrooms. The ground floor has a kitchen, dining room and living area.

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

Infection prevention control measures were not effective, and practices meant that people were at risk of infections. Staff did not use safe practices when using personal protective equipment (PPE). The provider had not deployed safe systems of care to manage people's medicines.

People were not supported by staff who understood best practice in relation to learning disability and/or autism. Complaints were not always dealt with effectively.

The service had an end of life policy however people’s end of life wishes were not explored. We have made a recommendation about exploring people’s end of life wishes.

People’s communication needs were not always met. Support plans were not accessible to people. We have made a recommendation about exploring communication needs for people.

There was a lack of oversight of the service and the provider had not developed a systematic approach to quality assurance to identify shortfalls and drive improvements.

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.

Based on our review of the five key questions the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment required modernising and was not homely. People’s care was not always person-centred and did not promote people’s dignity, privacy and human rights. Support plans were not accessible for people with learning disabilities. The service did not reflect best practice guidance for supporting people with a learning disability and/or autistic people. Staff did not have an understanding of autistic people when asked. The service did not provide specific training for people with autism. Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using the service led confident, inclusive and empowered lives. The registered manager and staff referred to the home as ‘the setting’ and ‘the unit.’ They also referred to the person living at the home as ‘the client’ which meant the service was not person-centred.

People were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests.

Discussions with the registered manager and staff showed they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

People were supported with food and nutrition intake. People had access to health and social care professionals.

The person who used the service and staff told us they liked the registered manager. Staff told us they felt well supported by the registered manager. The service worked with other organisations to improve people’s experiences.

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 1 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about support plans, people’s finances, medicines, accommodation and staffing raised by the local authority. We also had received complaints from members of the public. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 reviewed the information we held about the service. Concerns were identified in the other key questions therefore the focused inspection became a comprehensive inspection looking at all five key questions.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the key questions of safe, effective, caring, 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sable Care Limited - 22 Ashbridge Road on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe and person-centred care; complaints; management; governance and in relation to their registration.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sable Care Limited – 22 Ashbridge Road accommodates up to four people with learning disabilities in one building. At the time of this inspection four people with learning disabilities were using the service.

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/or 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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People’s experience of using this service

People were protected from the risks of harm or abuse. People had risk management plans to minimise the risks of harm or abuse they may face. Staff knew what action to take if they suspected somebody was being harmed or abused. People were protected from the risks associated with the spread of infection. Medicines were managed safely.

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 needs were assessed before they began to use the service. Staff were supported to carry out their role with training, supervision and appraisals. People were supported to maintain their health and nutritional needs. Staff understood their responsibilities under the Mental Capacity Act (2005).

Staff were knowledgeable about people’s individual needs and how to deliver a personalised care service. Care plans were detailed, personalised and contained people’s preferences. People’s communication needs were met. The provider had a system in place to handle complaints.

Relatives and staff spoke positively about the management of the service. The provider had systems in place to identify areas for improvement. These systems included carrying out quality checks, regular meetings with people who used the service and staff and feedback surveys. The provider worked in partnership with other agencies.

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 24 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service is registered to provide accommodation and support with personal care to a maximum of four adults with learning disabilities. Four people were using the service at the time of our inspection.

The service had recruited a new manager in December 2016. They were not registered with the Care Quality Commission at the time of our inspection. 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.

The manager of the service did not have a good understanding of the effective management of medicines in a care home and we have made a recommendation that they undertake comprehensive training about this.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. Medicines were managed safely.

Staff received on-going training to support them in their role. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the registered manager. Systems were in place to seek the views of people on the running of the service.

Sable Care Limited - 22 Ashbridge Road is a residential home that provides accommodation and support with personal care for up to four adults with complex needs including learning disability, autistic spectrum disorder and challenging behaviour. Four people were using the service at the time of our inspection.

At the time of our inspection a registered manager was in place. 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. The registered manager left their employment with the service after our inspection.

The service did not have sufficiently robust systems in place to protect people from financial abuse. Although people were not permitted to leave the service without staff support there were no Deprivation of Liberty Safeguard authorisations in place. The service had not carried out any mental capacity assessments where it was judged people lacked capacity. The service did not have sufficiently robust quality assurance and monitoring systems in place and the registered manager was not aware of all their legal responsibilities. Guidelines were not always in place about when to administer ‘as required’ (PRN) medicines. Staff did not always act in a respectful manner towards people.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering our response to these breaches.

There were enough staff working at the service to meet people’s needs. Robust staff recruitment procedures were in place. Risk assessments had been carried out to help support people in a safe manner. Medicines were stored securely.

Staff received regular training and supervision. People were supported to make choices including about what they ate and drank. People had access to health care professionals.

People told us they were treated well by staff. Care plans included information to promote people’s independence. Staff had a good understanding of how to promote people’s independence. Most of the time staff interacted with people in a caring manner.

Personalised care plans were in place which set out how to meet people's individual needs. People were involved in planning their care as were family members. People had access to a range of activities in the community. The service had a complaints procedure in place and people knew who they could complain to if needed.

People told us they were supported by the registered manager and staff told us there was a good working atmosphere at the service.

The overall rating of this service is “Inadequate” and the service is therefore in “Special Measures”. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame.

If not enough improvement is made within this time frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with told us they felt safe living at the home. One person told us "I'm safe." Staff had undertaken training in areas that promoted people's safety including training about safeguarding vulnerable adults. Risk assessments had been carried out to help reduce the risks people faced.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their support plans. People told us that they had been involved in writing them and they reflected their current needs. We looked at one of the support plans with the person it related to. They were able to confirm they had been involved with the planning and the information was correct.

Is the service caring?

We observed that staff supported people in a way that promoted people's dignity. For example we saw people were provided with choices about what to eat and daily activities. Staff told us how they promoted dignity by respecting the wishes of people who used the service. One person told us 'I like it. They [staff] help me with bathing and cooking.'

Is the service responsive?

The service carried out assessments of people's needs before they began to provide support. Assessments included information on people's likes and preferences. The service involved others such as community nurses, psychologists and family where there was a need.

Is the service well-led?

The service had a registered manager in place and a clear management structure. Staff we spoke with said they found management staff to be approachable. Clear records were maintained which were stored securely. Quality assurance and monitoring processes were in place. These included seeking the views of people who used the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People seemed happy and liked the staff. One person told us 'I like music and dancing' and 'Rukshana (staff member) does nice meals'. People did a variety of activities each week. One person worked in a charity shop for some hours a week. Other people who used the service told us 'I go to (local supermarket)' and 'I don't like college'.

Appropriate checks were undertaken before staff began work. Staff had relevant ongoing training and underwent regular supervision and appraisal.

There was a complaints policy/procedure. Staff understood the process and confirmed that complaints were discussed and actions taken if appropriate.

Staff told us that every person was different in the home and they required individualised support according to their personalities and needs. Staff worked closely with people to improve their daily living skills and to promote their independence.

We found that people's well-being was closely monitored through daily discussions and weekly key-working sessions. Monthly progress reports were written for the care managers and people's care was reviewed regularly by staff and the local authority as well. The provider monitored the service to ensure people's well-being and that the quality of the service is adequate.