Precious Homes North London

Precious Homes Wembley is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation from three locations, Verney Street, Sanderling Place and 75 The Avenue. At the time of the inspection one person was receiving care at Verney Street, two at Sanderling Place and four at 75 The Avenue.

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 guidance Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection and our focus and judgement in relation to Right support, right care, right culture was limited to the use of restraint and consistency in staffing. We have judged that, in as much as the provider had made progress there was still some work to be accomplished and further embedding of systems and processes to meet the underpinning principles of Right support, right care, right culture.

We received information about the use of inappropriate restraint. Therefore, we inspected the service to see current usage of restrictive practices, such as physical restraint, seclusion and as required medicines. Seclusion is the supervised confinement of an individual receiving care in a room, which may be locked, to protect the person and others from significant harm. We observed the provider adopted a least restrictive approach in supporting people whose behaviours posed challenges to services.

However, there was still some work in progress relating to creating a consistent and predictable environment for people. Generally, people with autism spectrum disorders and related needs find it difficult to cope with change. We found evidence people had not benefitted from a stable and consistent environment, including receiving care from regular staff for a significant period prior to this inspection. At this inspection we saw evidence the provider had begun taking action to address that. We made a recommendation about an effective recruitment and retention strategy.

Although there was a system for learning lessons from incidents, we judged this was underutilised. We found the system did not ensure underlying as well as immediate causes of accidents and incidents were understood, taking full account of organisational factors. We have made a recommendation about this.

In the final analysis, we were satisfied that there was a minimum use of physical restraint. Physical restraint had been used on one person since January 2021. The person was no longer receiving care from the provider. During the inspection we observed staff using effective reactive strategies, including distraction and de-escalation to minimise use of restrictive interventions. Furthermore, the provider had put in place interim measures to minimise further use of physical restraint. Therefore, although more improvements were required, the provider had responded promptly to make people safe by reducing the use of physical restraint.

Rating at last inspection

The last rating for this service was Requires Improvement (published 8 March 2021).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns about the use of inappropriate restraint at the service. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

Precious Homes Wembley is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for 10 people.

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

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

People did not always receive person centred care. Whilst there were measures to promote person-centred care, these were not implemented effectively. This was evident in areas such as medicines management, managing people’s finances, the management of premises and safety of people’s personal spaces. Cumulatively this meant people did not always receive care that met their needs.

People receiving care were at risk of financial harm. Although we have received evidence the provider is making improvements, at the time of this inspection, the provider was the appointee for financial matters relating to a person receiving care. This arrangement was a source of concern to us because providers should not act as financial appointees, unless there is no other practical alternative.

Quality assurance systems had not been used effectively. Whilst the provider carried out audits in relevant areas, we could not be assured of the robustness of the process. For example, although health and safety audits identified shortfalls, action was not taken within a reasonable time either to improve or mitigate risks.

We were reassured by the deployment of the operational manager following our inspection. She had assumed a more enhanced role to manage improvements. We found her to be knowledgeable regarding her responsibilities and possessed a good grasp of changes that were required to make improvements. Following this inspection we received an action plan, which showed some action that had already been taken to make improvements.

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

Rating at last inspection

The last rating for this service was good (published 25 April 2019). At this inspection we found three breaches of regulation.

Why we inspected

We had concerns in relation to how the service was managed in relation to risks to people and overall leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding and governance. 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 return to visit this service at a later date to check compliance.

• Precious Homes Ltd is a supported living scheme providing personal care support for up to 20 people with learning disabilities and complex needs.

• The scheme comprises studio flats in a large detached house with additional communal living areas, and is in Wembley.

• The scheme covered a range of areas including prompting with medicines, personal care, weekly shopping, housework and laundry.

People’s experience of using this service:

• People received personalised care and support specific to their needs and preferences. The scheme was responsive to people's individual needs and delivered care that supported people's choices, and thus enabling them to achieve their potential and meet their goals. We saw examples where the scheme had transformed people’s lives through evidence based person centred approaches.

• People felt safe in the care they received from care workers. There were safeguarding systems and processes to support care workers to understand their role and responsibilities to protect people from avoidable harm. Risk assessments were comprehensive and up to date, with detailed guidance for care workers on how to reduce identified risks.

• People’s needs were assessed, and care delivered in line with standards and guidance. Care workers were trained and skilled so that they could support people in line with the required standards. They had also received training to ensure their knowledge and practice reflected the requirements set out in the Mental Capacity Act 2005 (MCA). They supported people to eat and drink enough to maintain a balanced diet. They supported people to live healthier lives and to access healthcare services and support.

• People's diversity and human rights were highlighted in their care plans. Referrals included a section relating to people's diverse needs such as their religion, culture and ethnicity. People were treated with dignity and respect. They were supported to maintain their independence.

• The scheme was well-led. Throughout this inspection, we observed practices and behaviours that were consistent with the values of person centred approaches. The registered manager and staff were clear about their roles. They understood quality performance, risks and regulatory requirements. There was range of quality assurance systems and processes in place to drive improvement. Areas of improvement were identified and we saw examples of lessons learned to prevent reoccurrences.

Rating at last inspection:

At our last inspection, the service was rated ‘Good’. Our last report was published on 21 June 2016.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

• Going forward we will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Good.

There was a registered manager working at the service. 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.

People told us that they felt safe within the service. They were positive about the way staff treated them. Each person we spoke with told us their care workers were kind and compassionate. We observed how staff talked and interacted with people and saw that people were at the centre of the service and were treated with respect.

People and where necessary those who mattered to them were involved in care planning. This assisted staff in identifying needs, and how people preferred to be supported. We saw that staff provided personalised care and support.

Staff had a good understanding of how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet those needs.

Medicines were administered safely and on time. Staff had completed training in medicines administration.

There were systems to monitor important aspects of the service. This ensured the services continued to receive internal and external audits, which were used to monitor quality and to make improvements.