CareTech Community Services Limited - 7 Russell Hill

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 service was a large house, bigger than most domestic style properties. It was registered for the support of up to 11 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The provider strove to ensure people participated in activities they enjoyed, that improved their wellbeing and helped them to stay in touch with their families despite some considerable difficulties. Staff produced, detailed and holistic plans of people’s care and worked hard to devise creative ways of communicating with people. There was a clear complaints procedure and the registered manager ensured these were responded to appropriately. The registered manager took reasonable action to determine people’s end of life care needs.

The provider took thoughtful action to maintain people’s privacy and dignity, often in difficult circumstances. Staff ensured people’s equality and diversity was respected and promoted. The provider was creative in ensuring people were involved in decisions about their care and empowered them to share their experiences of using the service and living with their conditions to others. The provider worked hard to encourage people to develop their independent living skills.

The provider ensured people were protected from the risk of abuse and risks to people’s health and safety were assessed and mitigated. There were enough staff available to provide people with personalised care. Pre- employment checks were conducted with candidates to ensure they were safe to work with people. People’s medicines were managed safely and the provider acted reasonably to protect people from the risk of infection. Accidents and incidents were investigated and staff learned from these.

People’s needs were assessed before they moved into the home and care was delivered in line with current standards and professional advice. The premises were appropriately designed and decorated to meet people’s needs. The provider ensured people’s health and nutritional needs were met and they had access to healthcare services.

The provider ensured morale was high among staff took action to engage and involve people and staff in the running of the service. The registered manager understood and acted appropriately in accordance with their responsibility to be open and honest. The registered manager and care workers understood and fulfilled their roles. The provider assessed the quality of the service and took appropriate action to improve the quality of care.

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.

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.

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 3 February 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.

Russell Villa is a care home that provides accommodation and personal care for up to 10 adults with learning disabilities and autism. Accommodation is divided into three separate units that includes the main house, where up to eight people reside, and two self-contained flats, which are both single occupancy. There were seven men using the service at the time of our inspection.

At the last inspection in January 2015, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager 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 and associated Regulations about how the service is run.

Improvements had been made to the effective question and we have revised this rating to good. Russell Villa had undergone refurbishment and redecoration since our last inspection. People lived in a safe environment that was furnished according to their needs and choices. Arrangements for staff supervision had been strengthened in order to monitor their practice and performance more effectively.

The provider’s training programme was designed to meet the needs of people using the service. Staff had the knowledge and skills they required to support people with autism. Training included supporting people who presented behaviours that could result in harming themselves or other people. This helped staff to manage situations in a consistent and positive way, and protect people's dignity and rights.

Detailed assessments were carried out before people moved into the service. People had personalised support plans that were accurate and up to date, reflecting the care and support they needed. Plans identified any associated risks to their health and welfare. Where risks were identified, there was comprehensive guidance on the ways to keep people safe in their home and in the community.

People's care records recognised their rights and were person centred. 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.

People were treated with respect and dignity and staff were knowledgeable about their needs, preferences and interests. Staff knew how to recognise and report any concerns they had about the care and welfare of people and how to protect them from abuse. People were supported by adequate numbers of staff who had been safely recruited. Staffing was managed flexibly so that people received their care and support when they needed it.

People were involved in planning and preparing their meals according to their choices. Healthcare needs were monitored and people had access to the services they needed. Referrals were made to other professionals as necessary to help keep them safe and well. Medicines were managed safely and people had their medicines at the times they needed them.

People took part in activities they liked or had an interest in and maintained relationships with people that mattered to them. People decided how they spent their time and staff supported their choices and independence. Pictorial aids were available for those who needed support with communication.

The manager and provider encouraged feedback from people who used the service, relatives, and staff and this was used to improve their experience at Russell Villa. People knew how to complain and told us they would do so if required. Procedures were in place to monitor, investigate and respond to complaints.

There was a thorough and wide ranging system of checks and audits to monitor and assess the quality of the service. Actions arising from these checks were followed up. The service worked collaboratively with others such as the local authority and safeguarding teams. This helped ensure that lessons were learnt and similar incidents were less likely to happen again.

A compliance action meant the provider was non-compliant with the law. We required the provider to produce a report setting out how and when they would become compliant, which they did, and we visited again on the 11th February 2014. Following our visit to the service we considered they had done enough to comply with the law and have therefore removed both compliance actions made previously.

We did on this inspection check aspects which related to medication. We considered the administration of medication met all requirements. However, staff authorised to administer medication had not completed refresher training within the timescale required. This was despite the provider being reminded at the last inspection this was an issue. Therefore we have made a compliance action that the provider had not taken sufficient steps to ensure the safety of people who used the service from the risks associated with the management of medication.

We were not able to talk in a meaningful way to many of the people who used the service as they had limited verbal communication. Instead we used our SOFI tool to observe interactions between people who used the service and staff. In general, staff were aware of people's needs and responded accordingly.

We did have concerns about the home and have made two compliance actions. The first related to the activities offered to people who used the service. The second related to the general standards of the environment and the use of locked doors as a way of managing behaviours. We have asked the provider to supply us with an action plan of how they are going to address these issues. We will also visit the service to make sure that the actions they plan to take are implemented.

The previous manager of the service left in the summer months. The provider had appointed a new manager although they were not yet registered with the Care Quality Commission. The previous manager's name therefore still appears on this report. However, in referring to the manager in this report we are referencing the person who was in day to day charge of the home.

We also saw work to improve the physical environment of the home was well underway. We saw evidence that people received effective and safe care from suitably trained and experienced staff that were clearly familiar with individual's needs and preferences of the people they supported. It was also evident that the provider had effective systems in place to routinely assess and monitor the quality of service that people received.