Lansdowne Road (67-71)

About the service

Lansdowne Road (67-71) is a residential care home providing personal care for up to 26 people with a learning disability and or autism. At the time of the inspection, 25 people were living the service.

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

Right Support: People’s support plan and risk assessment guidance provided to staff of actions required to manage and mitigate known risks, were not consistently followed by staff. Guidance for staff was also limited in places, however, action was being taken to make improvements and was ongoing.

Incident management procedures such as de-brief meetings and incident analysis to support learning opportunities needed to improve. Physical intervention was used as a last resort, whilst staff had recently received enhanced training, they were not sufficiently confident. Further training and support were required.

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 did not support this practice.

Cleaning of the environment needed improving in some areas, to ensure effective infection prevention and control measures.

Right Care: The service had enough staff deployed to meet people’s individual needs and keep them safe. Staff had been recruited safely.

People, relatives, and external professionals provided positive feedback on the staff’s approach to care and support.

People were supported to lead active and fulfilling lives, there was a person centred approach, independence was promoted, and staff supported people effectively to achieve positive outcomes.

Right Culture: The provider’s systems and processes to monitor quality and safety were found to be ineffective. A recent internal action plan had been developed to address the required improvements identified by a local authority visit. Whilst this advised overall actions had been completed and signed off, we identified continued shortfalls.

Staff had received training for working with autistic people and people who have a learning disability. Staff meetings and supervisions were held and provided an opportunity to raise concerns and ask questions. Staff were positive about working at the service.

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 rated inspection for this service was good (published 4 March 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s care and support needs. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

The registered manager took some immediate actions to mitigate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ Lansdowne Road (67-71) link on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to governance procedures at the service. Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

People had been supported to maintain contact with friends, families and advocates during the pandemic. Visits were in line with government guidance and included, face to face, window visits and contact via telephone and Skype.

The provider ensured visitors to the service provided a negative COVID-19 test result and had their temperature taken and completed a COVID-19 screening questionnaire before they entered. Professional visitors were required to show their COVID-19 vaccination passport. All visitors wore personal protective equipment (PPE) and regularly washed or sanitised their hands.

Staff and people using the service were participating in the COVID-19 testing and vaccination programme. COVID-19 related risk assessments had been completed in relation to the environment, staff and people to reduce risks.

Staff received ongoing infection prevention and control training and COVID-19 government guidance updates. The registered manager and provider supported staff through regular staff meetings, supervision and an employee assisted well being service was available.

There were sufficient stocks of PPE and staff were observed to be wearing PPE as required during our visit. Cleaning schedules were in place to confirm cleaning practices used, and this including the cleaning of high touch areas.

People were supported to isolate in their bedrooms when required and consideration in relation to shielding and social distancing had been taken to protect people.

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 can live as ordinary a life as any citizen.

Landsdowne Road (67-71) accommodates up to 26 people across four separate units, each of which have separate adapted facilities. One of the units, the Cedar unit currently specialises in providing care to people with autism, and the Elm and Aspen units for a focus on daily living skills to transition to independent living.

We found the following examples of good practice.

Track and trace communication sheets have been introduced for all visitors including professionals as well as family members.

The registered manager has commenced a process to introduce face mask photograph’s alongside ‘normal’ staff photos on the communication board.

Visits by professionals are well planned in advance. Visiting staff are prompted to observe social distancing, the regular changing of Personal Protective Equipment and disinfection of equipment between each person being tested.

Further information is in the detailed findings below.

Landsdowne Road (67-71) 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.

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 can live as ordinary a life as any citizen.

Landsdowne Road (67-71) accommodates up to 26 people across four separate units, each of which have separate adapted facilities. One of the units, the Cedar unit currently specialises in providing care to people with autism, and the Elm and Aspen units for a focus on daily living skills to transition to independent living. There are enclosed gardens to the rear of the service. People living at the home have a learning disability, which may include a mental health disorder. At the time of our inspection there were 24 people who lived at the home.

At the last inspection on 15 September 2015 the service was rated Good.

At this inspection we found the service remained Good.

At the last inspection we asked the provider to take action as some moving and handling practice was not considered to be safe. At this inspection we found people were safe and moved around the service independently and assisted safely by staff. People using the service were from a number of cultures which was reflected by a diverse staff group.

People and their relatives felt staff were kind and caring. People felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives that commented were complimentary about the staff and the care offered to their relatives.

People were aware of their care plans and they were involved in care plan reviews, when necessary relatives were include as well. Staff offered people everyday choices and respected their decisions. People had their care and support needs assessed and were involved in the development of their care plan. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment, and people attended routine health checks.

People were provided with a choice of meals that matched their cultural and dietary needs. Staff ensured people were able to maintain contact with their family and friends and visitors were welcome without undue restrictions. There were sufficient person centred activities provided on a regular basis. People and their relatives felt they could raise any issues with the acting manager or staff.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the service. All the staff received a training induction and then on-going training for their specific job roles. Staff were informed about; and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what assistance was available from external bodies to report suspected abuse on to, and follow up alleged incidents. Staff were available in adequate numbers to meet people’s personal care needs.

People, their relatives and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

There was a clear supportive management structure within the service, which meant the staff were aware of who to contact out of hours. The provider undertook quality monitoring in the service and was supported by the acting manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance services and manage any emergency repairs.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives. We received positive feedback from the local authority with regard to the care and service offered to people.

People's care and support plans had a strong emphasis on promoting the independence of people and their right to make decisions about their daily lives. People met regularly with their key worker to review and discuss their care and support plan. People were supported to make decisions about their daily lives and we saw people accessing a range of community based activities, whilst some people remained at the service and were supported to take part in activities within the service which included cooking. People in some instances received one to one support.

We spoke with staff and found they had a good understanding as to the needs of people and they spoke with us about the support they provided. Records showed staff had undergone a robust recruitment process and had received and continued to receive training which enabled them to meet the needs of people.

We found people living at the home were supported to access the community, taking part in social and recreational activities. We also saw staff supporting people when they became anxious and upset consistent with guidance as recorded within their support plans. People living at the home were encouraged to ask questions about visitors and were introduced to them and were included in conversations wherever possible. People we spoke with told us they had the opportunity to attend meetings where they talked about issues which affected them as a group and individually and that they were confident to speak with staff.