Collinson Court

Collinson Court is a residential care home made up of individual apartments with their own communal spaces and bathrooms. The service provides personal care to a maximum of 9 people who have a learning disability and/or autism. There were 9 people residing there at the time of the inspection.

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:

There were enough staff to support people in line with their commissioned care and support plans. However, staff did not always have all the necessary skills and experience to effectively support people. Risks were assessed and planned for, and staff knew people’s health conditions and risks to their safety. However, we identified some incidents staff had recorded had not always been reviewed by quality assurance systems in place and considered for any learning to reduce the risk of them happening again. Medicines were safely managed. Staff were recruited safely. People were protected from the risk of abuse by staff. Where abuse had been identified action was taken by the provider to safeguard people. People were protected from the risk of infection.

People were not always supported to have maximum choice and control of their lives as there were staffing difficulties which meant people did not always have the range of choices they have previously had. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People’s social activity needs continued to not always be met. People still had varying levels of access to the community. No one was nearing the end of their life, although relatives had been offered the opportunity to discuss people’s end of life wishes if they wanted to. People were supported to communicate in a way that suited them. Relatives felt able to raise concerns, if needed, although there was mixed feedback about the response to these concerns.

Right Culture:

There had been numerous management changes over a long period of time, and a new manager had started since the last inspection. The relatives and staff were positive about the new manager and continued to be positive about the deputy manager. Quality assurance system to monitor and improve the quality and safety of the service were not always effective, although some improvements had been made. The service worked in partnership with external professionals.

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 requires improvement (published 10 November 2023).

Why we inspected

We carried out an unannounced inspection of this service on 17 and 21 July 2023. Breaches of legal requirements were found. We issued a warning notice on the provider. The provider completed an action plan after the last inspection to show what they would do and by when to improve managing risk, supporting people appropriately and in-line with their needs and the oversight and monitoring of the quality and safety of care.

We undertook this focused inspection to check they had complied with the warning notice and followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Collinson Court on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to supporting people appropriately and in-line with their needs and the oversight and monitoring of the quality and safety of care. We also found an additional breach regarding staff skills and experience.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

About the service

Collinson Court is a residential care home made up of individual apartments with their own communal spaces and bathrooms. The service provides personal care to a maximum of 9 people who have a learning disability and/or autism. There were 9 people residing there at the time of the inspection, although 1 person was on holiday so was not present during our site visits.

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

Right Support:

Risks were not always assessed and planned for so we could not always be sure people would always be kept safe. There were enough staff to support people in line with their commissioned care and support plans. However, staff did not always have all the necessary skills and knowledge to effectively support people. Medicines were generally safely managed, but improvements were needed. Staff were recruited safely. People were protected from the risk of abuse by staff. Where abuse had been identified action was taken by the provider to safeguard people. People were protected from the risk of infection.

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.

Right Care:

People’s social activity needs were not always met. People had varying levels of access to the community. No one was nearing the end of their life. Some practical arrangements had been made if someone was to pass away, however personalised plans about people’s choices had not been put in place. People were supported to communicate in a way that suited them. Relatives felt able to raise concerns, if needed.

Right Culture:

There were culture concerns at the service. There had been numerous management changes over a long period of time, so staff had not always had consistent leadership in place. The provider had failed to ensure sufficient oversight of the service had been maintained during periods of change. The registered manager and deputy manager were person-centred and were working on making improvements with the culture of the service. Quality assurance system to monitoring and improve the quality and safety of the service were not always effective. The service worked in partnership with external professionals and organisations.

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 overall, but requires improvement in well-led (published 23 July 2022).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and staff culture and lack of activities. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of an incident following which a person using the service was allegedly abused. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s support in the community and staff culture. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, 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 Collinson Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to managing risk, supporting people appropriately and in-line with their needs and the oversight and monitoring of the quality and safety of care.

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.

About the service

Collinson Court residential care home provided personal care to nine people at the time of the inspection. The service can support up to 12 people.

The home is divided into eight units, each providing a bedroom, a lounge/dining area, kitchenette and a bathroom.

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

Right Support

There was no registered manager in place and there had been a decline with the quality of service provided to people. At the time of the inspection staff were supported in their role by the newly appointed independent consultant.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported to take their medicines by skilled staff. Staff had a good understanding about how to protect people from the risk of potential abuse.

Staff were kind and friendly and people could be assured their right to privacy and dignity would be respected. Staff recognised when people were unhappy and took the appropriate measures to resolve their concerns.

Staff supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives.

Right Care

People received kind and compassionate care. Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

People were supported to pursue their interests and lived a full and active life. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

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 outstanding (published 28 February 2020).

Why we inspected

We received concerns in relation to poor skin care for one person that allegedly compromised their skin integrity and staff were not considering their special dietary needs. We also received safeguarding concerns regarding the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

During this inspection we assessed if the service was applying the principles of right support right care right culture.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Collinson Court is a residential care home providing personal care to seven adults with learning disabilities and autism at the time of the inspection. The service can support up to 12 people. Collinson Court accommodates seven people in one adapted building which is divided into a number of separate apartments; these are either shared between two people or occupied by a single person.

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.

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

Without exception, relatives and staff spoke positively about the service. Relatives told us their family member received excellent care which had a positive impact on their well-being and enhanced their lives. Relatives described the support provided by the staff team as life changing and brilliant.

People’s quality of life was enhanced by a positive approach to risk taking. People and relatives were involved in discussions about the management of risk and staff were empowered by the registered manager to think creatively about people’s potential and goals while maintaining people’s safety.

The staff team were trained and knowledgeable about how to keep people safe while also promoting independence and new experiences. Staff members worked with external healthcare professionals to reduce the amount of ‘as required’ medicines people were prescribed and this had a positive impact on people. Staff explored the reasons behind people’s anxieties and distress and involved them in making decisions about how their mental health was supported.

People were supported by a consistent staff team who knew them well. Staff had been safely recruited to ensure they were safe to work with vulnerable people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There was a strong, visible person-centred culture at the service. Equality and diversity were both recognised and embedded with staff practice. People were valued as individuals and staff knowledge of people’s individual preferences, needs and personalities was excellent.

Staff developed strong working relationship with people, which enhanced the level of trust people placed in the staff team. This enabled staff to provide innovate support that pushed the boundaries of people’s previous experiences.

There was a responsive approach to care planning and review and staff were kept updated with any changes to people’s support. The registered manager had responded creatively to complaints, and this had a positive impact of people’s experience of support.

Relatives and staff were extremely confident in the management of the service. There were consistently high levels of engagement with relatives who recognised the positive leadership of the registered manager. Feedback from people, relatives and staff was actively sought and they were given opportunities to share their views about the service. The registered manager used feedback as a tool to drive improvement acted to address any areas of concern.

Incidents involving the use of restriction or restraint were consistently reviewed to ensure people were supported safely. Information gathered from audits and behavioural analysis was used to promote risk taking rather than restrict new activities. The registered manager and senior staff carried out regular audits relating to the quality of care people received and had an open and transparent approach to continuous learning.

Staff felt supported and recognised the importance of reflecting on incidents and events to enhance learning and make improvements. The registered manager placed a strong focus on innovative person-centred care which was based on best practice.

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.

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 September 2017).

Why we inspected

To assure ourselves the service was meeting people’s needs, that staff had the necessary skills and experience and the management processes were effective we completed a focused inspection on the first day. We reviewed the key questions of Safe and Well Led only. However, as a comprehensive inspection was due, according to our reinspection timescales, we returned for a second day of inspection and reviewed the key questions of Effective, Caring and Responsive.

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 was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

A positive approach to risk was used that meant people were encouraged and enabled to try new, meaningful activities at the service and in the local community. We saw and people's representatives told us that this had resulted in significant improvements in people’s quality of life. Staff thought outside the box to enable people to experience these new activities and used a person centred approach to ensure these activities were tailored to each person's needs.

Innovative methods were trialled and used to enable people to be involved in the planning and review of their care. Staff gained regular feedback about people’s care experiences, which enabled them to ensure people’s care was centred around their individual preferences and needs.

Some people who used the service had difficulties communicating their needs and wishes. Staff used a variety of tools that enabled and empowered to share their thoughts and care experiences which gave people a voice.

Staff understood how to keep people safe and people were involved in the assessment and management of risks to their health, safety and wellbeing. People’s medicines were managed safely.

People were protected from the risk of abuse because staff knew how to recognise and report potential abuse. Safe staffing levels were maintained to promote people’s safety and to ensure people participated in activities of their choosing.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs.

Staff supported people to make decisions about their care and when people were unable to make these decisions for themselves, the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People could eat meals that met their individual preferences. People’s health and wellbeing needs were monitored and people were supported to access health and social care professionals when required.

People were treated with care, kindness and respect and staff promoted people’s independence and right to privacy.

Staff sought and listened to people’s views about the care and action was taken to make improvements to care. We saw that complaints were managed in accordance with the provider’s complaints procedure.

The management team regularly assessed and monitored the quality of care to ensure standards were met and maintained.

The registered manager understood the requirements of their registration with us and they and the provider kept up to date with changes in health and social care regulation.

We undertook this focused inspection on the 11 July 2016 to check that the required improvements had been made. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Collinson Court on our website at www.cqc.org.uk

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

At this inspection we found that the provider had made the required improvements and people were now receiving safe and effective care.

Changes in people’s needs triggered a review of the risks posed to their health, safety and wellbeing, and people’s risk management plans were consistently followed to promote their safety and wellbeing.

People’s health needs were effectively monitored and advice from health care professionals was sought and followed to promote their health and wellbeing.

At this inspection we found that the improvements the provider and registered manager had made were enough for us to remove the service from being under special measures.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People’s known risks were regularly assessed, planned for and reviewed and the staff understood how to manage these risks. However, improvements were needed to ensure changes in people’s risks triggered a review of how their needs should be met.

Improvements in the monitoring of people’s health and wellbeing had been made, but further improvements were required to ensure changes in people’s physical health were acted upon in a prompt manner.

Advice from health and social care professionals was sought when needed. However, improvements were needed to ensure professional advice was followed to improve people’s care.

People’s medicines were managed safely, which meant people received the medicines they were prescribed when they needed them.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff received regular training that provided them with the knowledge and skills to meet people’s needs effectively.

People could access suitable amounts of food and drink that met their individual preferences and dietary needs.

Staff showed they understood and applied the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This ensured decisions were made in people’s best interests if they were unable to make decisions for themselves.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to be treated with dignity and privacy.

People and their relatives were involved in the planning and review of their care and staff supported and encouraged people to access the community and participate in activities that were important to them.

People’s feedback was sought and used to improve the care. People were supported to share concerns about their care and complaints were managed in accordance with the provider’s complaints policy.

Significant improvements had been made in the way the service was managed. People and staff were supported by the registered manager and provider.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us.

The service was registered to provide accommodation and personal care for up to 12 people. People who use the service have Autism and behaviours that challenge. Behaviours that challenge are behaviours that place a person or other people at risk of harm or reduced quality of life. At the time of our inspection 10 people were using the service.

The service did not have a registered manager. 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 and associated Regulations about how the service is run. A new manager had been recently recruited by the provider and they told us they were applying to register with us.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. This meant people’s safety, health and wellbeing was not consistently promoted.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

Medicines were not managed safely and people were not protected from the risks associated with them.

Safety incidents were not always reported and lessons were not learnt after safety incidents, which meant the risk of further incidents was not reduced.

People’s health needs were not always consistently monitored and managed effectively to promote their health, safety and wellbeing.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs. Effective systems were not in place to check staff had understood training they had completed.

People were enabled to participate in activities of their choosing, but improvements were required to ensure people could participate in their chosen activities at a time that suited their individual needs.

Improvements had been made to the way people received their care and support. People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy.

Relatives were now involved in the planning and review of their relations’ care. Plans were in place to enable people to become more involved in this process.

Systems were now in place to ensure people’s liberty was only restricted when this had been legally authorised. Staff followed the requirements of people’s Deprivation of liberty Safeguards authorisations.

The provider was now informing us and the local authority of reportable incidents in a timely manner. Staff told us they were supported by the managers and provider to make improvements to the way they delivered care and support. Complaints were managed effectively.

People told us they were happy with their or their relatives care. One person told us, 'I'm happy here because I like going outside' and 'I like the staff'. A relative told us, 'It's a homely place and the staff do the best that they can'.

We saw that people's needs were met in a caring, compassionate and timely manner, by staff who had received appropriate training and support. People were kept safe because they had received an assessment to identify their needs and people's care was delivered in accordance with their support plans.

Staff involved people who used the service in making choices about food and drink, and we saw that staff were responsive to people's choices and requests.

People were protected from the risks associated with medicines because effective systems were in place to manage medicines at the home.

The service was well led because the registered manager and provider regularly assessed and monitored quality at the home, so that improvements to people's care could be made.

During our inspection staff told us that staffing numbers had been low at times, but the numbers had recently improved. One staff member said, 'We have been struggling, but recently we have been able to borrow staff from another home and use agency staff'.

We saw that there were enough suitably skilled and experienced staff on shift to meet people's needs.

The provider had completed an internal investigation into staffing levels and had taken appropriate action to ensure that shifts were covered and people's needs were met.

We saw that agency staff who were temporarily working at the service received a suitable induction to provide them with the information required to enable them to meet people's needs.

On the day of our inspection the home was also being accredited by the National Autism Society (NAS) The NAS had two assessors present and we were able to speak to them about what they found.

We observed the routines and daily activities were flexible and staff responded to people's needs. All the people were supported on an individual basis were given choices and allowed time to consider their options.

People received care and support that met their individual needs. People had care records which had been written in a style that people understood. A relative told us, 'They seem very happy'.

We saw that there were risk assessments and systems in place to protect people who used the service against abuse.

We checked records and spoke to staff and managers about the recruitment process for staff, and how staff were monitored and supported to ensure appropriate care was provided.

We saw that there was a complaints procedure and this was available in an easy read format which people could understand. We saw evidence that complaints were recorded, responded to and dealt with in an appropriate manner. A relative of a person who used the service said, 'I'm more than happy with the service'.