Caretech Community Services (No 2) Limited - 22 Prices Avenue

About the service

22 Prices Ave is registered to provide personal care and accommodation for up to 6 people in one adapted building. There were 5 people using the service at the time of our inspection who had a range of health and support needs, these included learning disabilities. Some people had additional conditions such as autism, sensory impairment and medical conditions.

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

Right Support:

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. However, when people needed cream applying to their skin to keep it healthy there was not always guidance in place to inform staff where the cream needed to be applied and staff had not consistently recorded that it had been applied. Action was taken by the registered manager to address this issue.

Risks to people were identified and there was full guidance in place to mitigate the risks. Staff followed the guidance. They recorded and reported to management when incidents occurred.

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 could communicate with staff and understand information given to them as staff supported them consistently and understood their individual communication needs.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. We did find a recent entry in one person’s daily record which was written in an authoritarian manner. The registered manager addressed this issue after the inspection. During the inspection staff treated people with respect and kindness.

Staff placed people's wishes, needs, and rights at the heart of everything they did. The stable management and core staff team supported people to receive consistent care from staff who knew them well. People received compassionate and empowering care which was tailored to their needs.

Quality assurance systems were in place to monitor the service people received. Staff evaluated the quality of support provided to people, involving the person, their families and other professional. All the relatives we had contact with were complimentary and positive about the service and the care and support their loved ones received.

Right Care:

People received kind and compassionate care. Staff protected and respected people's privacy and dignity.

Staff understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff had recently reported an incident to the registered manager and appropriate action had been taken to make sure people were safe.

People's care, treatment and support plans reflected their range of needs and this promoted their

individuality, wellbeing and enjoyment of life. People could take part in activities of their choosing at the service or in the wider community and pursue their own interests. Staff received training and support to provide care effectively.

People were provided with meals and drinks to maintain their wellbeing. People were supported by health care professionals who worked in partnership with the service to maintain people's health and wellbeing.

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 good (published 8 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The inspection was also prompted in part due to concerns received about safeguarding incidents. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern as appropriate action had been taken. Please see the safe and well-led sections of this full report.

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 read the report from our last comprehensive inspection, by selecting the 'all reports' link for Caretech Community Services (No 2) Limited - 22 Prices Avenue on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

22 Prices Avenue 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, and both were looked at during this inspection.

22 Prices Ave is registered to accommodate care and support for up to six people in one building. At the time of the inspection there were six people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were supported to live as ordinary a life as any citizen.

The service had a registered manager in post. A registered manager is a person who is 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.

At the last inspection in October 2016 we found breaches of the legal requirements. We asked the provider to complete an action plan to show what they would do and by when to improve consent to care and treatment; preventing, detecting and controlling the spread of infections, effective systems to regularly assess and monitor the quality of service and ensuring there were sufficient numbers staff deployed in order to meet people's needs. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the breaches in the regulations had been met.

There were sufficient staff deployed to support people at all times. 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. The registered manager knew when assessments of people’s capacity to make decisions were needed. Staff assumed people had capacity and respected the decisions they made. Some decisions were made in people’s best interests with people who knew them well. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to the relevant supervisory body in line with guidance.

Improvements had been made to the environment and further decoration of communal areas was due to start soon. The service was safe internally and externally. People were all able to freely access all communal areas of the service. The environment suited the people who lived at 22 Prices Avenue. The service was clean and there were measures in place to prevent the risk of infection. The building was fitted with fire detection and alarm systems. Regular checks were carried out on the fire alarms and other fire equipment to make sure it was working.

Safeguarding incidents were recorded and these showed how the provider had worked with the local authority safeguarding team to investigate incidents that had occurred. Records reviewed confirmed staff had received adult safeguarding training and the provider had a policy and procedure to support staff. Accidents and incidents were recorded and analysed for themes and patterns, and appropriate action was taken to reduce risks. Lessons had been learnt when things went wrong.

People said and indicated that they were satisfied and happy with the care and support they received. People received care that was personal to them. People, and those close to them, were involved in planning and reviewing their care and support.

People were involved in activities which they enjoyed and were able to tell us about what they did. Planned activities took place regularly and there was guidance for staff on how best to encourage and support people to develop their interests, skills and hobbies. Staff supported people to achieve their personal goals. People were being supported to develop their decision making skills to promote their independence and have more control about how they lived their lives. Some people accessed the community independently as they wished.

Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people. People were comfortable and at ease with the staff. Staff had a clear understanding of people's individual needs, preferences and routines. People were involved as fully as possible in decisions about the care and support they received. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly.

External healthcare professionals had worked with staff in managing risks that had been identified. The staff worked with a range of healthcare professionals. If people were unwell or their health was deteriorating staff contacted their doctors or specialist services so they could get the support they needed. The staff worked with the local safeguarding team, care managers and with commissioners who funded people’s care and support. They also worked with local charities to offer voluntary work for people and people raised funds for charities.

Some people had thought about the support they wanted at the end of their lives and this had been recorded. The registered manager was working with others and people’s families to make sure people’s wishes at the end of their lives were respected and implemented.

People were given choices about the meals and drinks they received and were involved in shopping and preparing their meals if they wanted to. People said and indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet.

There had been no new people at the service for a long time and there were no plans for any new admissions. But if a new person was thinking about coming to live at the service their support needs would be assessed by the registered manager to make sure they would be able to offer them the care that they needed. The staff worked in line with current legislation. People were treated fairly and equally.

People received their medicines safely and when they needed them. They were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Temperatures of the medicine cupboard where stocks of medicines were stored were not consistently taken. This was rectified on the day of the inspection.

The complaints procedure was on display in a format that was accessible to people. People and staff felt confident that if they made a complaint they would be listened to and action would be taken.

Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supervised, monitored and supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The registered manager had good oversight of everything that happened at the service. They promoted the ethos of the service which was to give personalised care and support to people and to support people to achieve their full potential and be as independent as possible.

There were quality assurance systems in place. Audits and health and safety checks were regularly carried out by the registered manager and the quality assurance manager from the company’s head office. The audits had identified any shortfalls and action was taken to make improvements.

The registered manager had sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Staff told us that the service was well led and that the registered manager was supportive and approachable. There was a culture of openness within 22 Prices Avenue which allowed people, relatives and staff to suggest new ideas which were often acted on. Records for each person were accurate and complete and stored securely.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of significant events at the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating at the service and on their website.

Caretech Community Services (No 2) Limited - 22 Prices Avenue provides accommodation and personal care for up to six people living with a learning disability and or autistic spectrum disorder. At the time of our inspection there were six people living at the service.

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. The registered manager was not present on the day of our inspection.

The provider had no system in place to assess people’s dependency needs. There were insufficient staff deployed to support people at all times. Safe staff recruitment checks were completed before staff commenced employment.

Concerns were identified with the cleanliness and the measures in place for the prevention and control of infections. Parts of the premises internally and externally were not safe and people were placed at risk of avoidable harm. The provider took immediate action to make the required improvements.

Not all people had their needs appropriately risk assessed or planned for. Risk plans in place were regularly monitored for changes.

Staff had received appropriate safeguarding training and understood their role and responsibilities to protect people. Accidents and incidents were recorded and external healthcare professionals were involved at times to provide support to staff about how to manage and reduce risks. People received their medicines as prescribed and these were managed correctly.

The Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), had not been appropriately applied so that people’s rights were protected. Staff received an induction, training and appropriate support.

People were involved in the menu planning and their nutritional needs had been assessed and planned for. People’s healthcare needs had been assessed and were regularly monitored. The service worked with visiting healthcare professionals to ensure they provided effective care and support.

Staff were kind, caring and respectful towards the people they supported. They had a clear understanding of people’s individual needs, preferences and routines. People were involved as fully as possible in decisions about the care and support they received.

There was a complaint policy and procedure available and confidentiality was maintained. People did not have access to independent advocacy services; however this was made available after our inspection. There were no restrictions on people visiting the service.

People were supported to participate in activities, interests and hobbies of their choice, independence was promoted. Some people accessed the community independently as they wished.

The provider had systems in place that monitored the quality and safety of the service but these were ineffective. There was a registered manager in place. The provider was not always meeting their regulatory requirements.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we spoke with three people who used the service, four staff and the manager.

We observed how people spent their time and their interactions with staff. We reviewed care plans and other records relating to the management of the home.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. Risks associated with people's care delivery were identified during assessments, and staff had guidance for staff to follow, to make sure people were being cared for as safely as possible.

There were systems in place to record accidents/incidents. There were also processes to analyse to identify trends and patterns to make sure that the staff learnt from events, to prevent them from happening again. There had only been two incidences at the service which had been dealt with safely.

At the time of the inspection there was sufficient staff on duty to meet the needs of the people using the service.

Most staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DOLS). There were no Deprivation of Liberty Safeguards authorisations in place, and no applications had been made.

Is the service effective?

The service was effective. People had their needs assessed prior to moving into the service, including visits to the service.

People told us that they were satisfied with the care they received, and felt their needs were met. We saw that staff knew the people well and understood people's care and support needs.

Care plans were in place for each person, which were personalised with details of people's routines, and staff demonstrated they knew how to care for the people in line with their preferences and choices.

People had access to health care professionals to make sure their health care needs were met.

Staff meetings were in place to give staff an opportunity to voice their opinions of the service. There was a programme of regular supervision and appraisals which were completed at required times to make sure staff development was recorded and achieved.

Staff had the knowledge, skills and competencies to carry out their role effectively and safely because staff were properly trained.

Is the service caring?

The service was caring. We saw that staff showed patience and gave encouragement when supporting people and promoted their independence. People we spoke with said they liked the staff.

People told us that the staff were kind and caring. They said, 'They understand me and what I need". 'They support me to do the things that I want'. 'I have a key worker I talk to if there is a problem, they listen'.

People told us that the staff were respectful and treated them well. We saw that staff were inclusive of people and they were involved in the day to day running of 22 Prices Avenue.

Is the service responsive?

The service was responsive. People received personalised care that met their needs.

The service listened to what people had to say in a variety of ways. There was meetings and one to one time with staff. People told us they could talk to the manager or staff if they had any concerns and that they would be listened to and their concerns would be acted on.

We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Activities at the service were organised and were in response to the requests and the needs of the people.

Is the service well led?

The service was well led. Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the manager. They told us the manager was approachable and listened to what they said.

The service had effective systems in place to provide on-going monitoring of the care being provided; therefore shortfalls were identified and usually acted on. However, we did find that some environmental maintenance work that had been identified in the services quality assurance visits had not been addressed by the provider.

We saw evidence which showed that the service worked well with other agencies and services to make sure people received their care in a joined up way.

The manager of the service was in the process of registering with the Commission and was waiting for an interview.

We found that people were asked to give consent and were involved in the decisions about the care and support they received. People told us and indicated that they were asked for consent before any care took place and their wishes were respected.

People who used the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. They were able to let staff know what they wanted and we saw staff respond in a caring and positive way.

People said that there were enough activities going on and said that they enjoyed going out in the local area.

People who used the service lived in an environment that was safe, accessible and promoted their well-being. People told us that they liked living at the service. They told us they were very happy with the new kitchen and bathroom.

There was enough staff on duty to meet support and meet people's needs.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

The views of the people who use the service were listened to and acted on. People told us they did not have any complaints but would not hesitate to speak to the manager or staff if they had any concerns and they would be listened to.