Real Life Options - Darlington Road

Real Life Options – Darlington Road is a residential care home providing care and support for up to 7 people with learning and physical disabilities and mental health conditions. There were 7 people living at the home 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: People received the right support with their medicines. 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: 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. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture: People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

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 requires improvement (published 11 February 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 7 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance processes.

We undertook this focused inspection to check they had 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 and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Real Life Options – Darlington Road 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.

About the service

Real Life Options – Darlington Road is a residential care home providing care and support for up to seven people. There were seven people living at the home at the time of the inspection.

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

Right Support

¿ Staff did not always follow guidance for giving PRN (as required) medicines. At times staff worked successfully with people when they experienced periods of distress, trying alternative ways of making them calm and relaxed. However, we also saw evidence that medicines were overused on some occasions.

¿ The provider did not always ensure people received care and support in a safe, clean and well-maintained environment. Immediate action was taken to change infection control practices and improve the environment following the first day of inspection.

¿ Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. We observed people engaged in all aspects of daily living such as cooking and cleaning.

¿ People had a choice about their living environment and were able to personalise their rooms. It was evident that staff had worked closely with people and their families to design rooms, which best met their needs and reflected their personalities.

Right Care

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

¿ People who had individual ways of communicating, using body language, pictures and Makaton (a type of sign language) could interact comfortably with staff who had the necessary skills to understand them. Staff were able to describe each person’s individual communication methods to us. One person had not communicated verbally prior to moving to the home and now called out for their favourite staff members. Staff were hoping to work with external professionals to increase their verbal skills.

¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

¿ People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

Right culture

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

¿ People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

¿ Staff placed people’s wishes, needs and rights at the heart of everything they did.

¿ People and those important to them, including advocates, were involved in planning their care.

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 14 February 2020).

Why we inspected

We initially undertook this inspection as part of CQC’s response to the COVID-19 pandemic. 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. This included checking the provider was meeting COVID-19 vaccination requirements. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

On the first day of our inspection we identified concerns in relation to infection prevention and control. As a result, we widened the scope of the inspection to become a focused inspection which included the key questions of 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 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.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have made a recommendation about ensuring all staff participate in fire drills in line with current best practice.

We have identified breaches in relation to safe care and treatment (including infection control measures and safe management of medicines) and good governance (including quality assurance and accurate record keeping).

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 as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Real Life Options – Darlington Road is a residential care home providing care, support and accommodation for up to seven people with a learning disability. At the time of the inspection there were seven people living at the service.

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 received 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

People were supported by a kind, caring and motivated staff team. They were encouraged and supported to achieve personal goals. Staff were extremely dedicated to improving the quality of life for the people living in the home and they were supported in this by a strong registered manager and senior leadership team.

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.

Staff treated people with a high level of dignity and respect and despite having very complex needs everyone’s independence was encouraged and achievements celebrated. People were given opportunities to be truly involved in all aspects of their daily life and staff provided support patiently to ensure they were given the time and space for this.

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.

People were able to maintain strong family links and develop new friendships. Staff were very committed to supporting people to have meaningful relationships with people who were important to them and relatives expressed their gratitude for this. Relatives told us they felt their loved ones were safe and extremely well supported.

People's care was developed around their wishes, preferences and goals. Support plans contained a very high level of detail which meant staff knew exactly how best to support each person. Each person was truly recognised as an individual and supported in that way. Activities were chosen to best suit each person and could be swapped and changed to best meet people’s needs on the day. Staff had worked hard to explore what opportunities were available within the local community and further afield so that people had opportunity to participate in a wide variety of things.

Staff were encouraged to develop their knowledge and skills and felt truly valued. The registered manager was an inspirational leader who had supported staff in the introduction of new ways of working. The senior leadership team were also very supportive and approachable.

Medicines were managed safely. There were systems and processes in place to help protect people from the risk of abuse. There were enough staff on duty to meet people’s needs. Staff understood the needs of the people they supported well. Safe recruitment procedures were followed.

People were able to choose what they wanted to eat and drink using a photo library built up over many months by the cook at the home. People were involved in menu planning, shopping and food preparation as much as possible. Specialist advice and input was always sought if there were any concerns about a person and food was prepared in a way that met any specific needs people had in this area. People were supported to have access to a range of healthcare professionals to ensure they remained healthy.

A range of audits and checks were carried out to monitor the quality and safety of the service. Action was taken if any issues or concerns were identified.

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 7 June 2016). There was also an inspection on 29 June 2017, however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

We last inspected the service in November 2013 and found that it was not in breach of any regulations at that time.

Darlington Road provides care and support for up to seven people who live with a learning disability. The service does not provide nursing care. Darlington Road is a large bungalow with a small first floor extension. Externally there is a large garden. The house is situated close to local amenities.

The home had a registered manager in place. 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.

There were systems and processes in place to protect people from the risk of harm. We saw that individual risk assessments were in place that covered the key risks specific to the person. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination. The registered provider had a whistle blowing hotline and information regarding this is clearly displayed.

People received their medicines as prescribed but medicines were not always stored correctly and the records were not always accurate.

There was a procedure in place to monitor accidents and incidents.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff had not always received regular supervision, and yearly appraisals to monitor their performance had not taken place.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Some refresher training was overdue but we received confirmation after our visit that all staff are now booked on to the relevant courses.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw that people were provided with a choice of healthy food and drinks to help ensure their nutritional needs were met. Staff demonstrated knowledge of people’s likes, dislikes and special dietary requirements. The service worked with a dietician where necessary. The care records we viewed also showed us that people had appropriate access to health care professionals such as dentists and opticians.

People who used the service had a range of communication abilities. Some people could communicate verbally whilst others used noises, signs or gestures which staff were able to describe in detail and interpreted well. Throughout the inspection there was a relaxed atmosphere and staff interacted with each other and with people who used the service in a very friendly and respectful manner.

The scales used to weigh people had been broken for approximately nine months.

The garden at the service was not being adequately maintained to enable people to utilise it safely. Staff were doing their best to maintain it in their own time but the service no longer had a gardener.

We looked at support plans and found that they were written in a person centred way and included a good level of detail. The documents within people’s support plans were not always completed fully. The review of these documents also needed to be more clearly recorded.

We observed that people were encouraged to be as independent as possible given their high level of support need and were encouraged to participate in activities that were meaningful to them. People were watching films on a computer whilst others relaxed in front of the television or engaged in craft activities. People were also supported to go out into the local community and to maintain a good level of contact with their families.

There was a complaints procedure in place and this had been produced in an easy read format with pictures and placed in every person’s support file. There had been no complaints in the previous 12 months.

We found that the registered manager was not conducting effective checks of records and systems at the service as a number of areas of concern had not been identified by the quality assurance process.

At the time of our inspection the registered manager for the service was also managing two other services for the registered provider. Although they were still working at Darlington Road on average three days a week management oversight was lacking within the service and staff and relatives told us they were not happy with the arrangement.

We spoke with staff who told us they felt supported and that the registered manager was approachable but because of current working arrangements was not always available.

Throughout our visit we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other.

We found the provider was breaching four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe management of medicines, staffing, premises and equipment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We found that the nutritional needs of people living at the home were met. One visitor said, 'The food is top class'. Staff and visitors told us that people often choose to go out for meals as they like to socialise.

At the inspection, we found a homely atmosphere, with clean and tidy surroundings. We spoke to staff and they told us they were proud to work there. One visitor took us to their relative's bedroom and said that they were very pleased with it.

The premises provided a safe, warm and suitable environment for people to live in. We spoke to one visitor who said, 'They are always doing something in here to make things better for people'.

We looked at staff records at the home and found that staff were suitably qualified, skilled and experienced to be able to care and support people living at Real Life Options.

People and visitors told us that if they had any complaints they would not hesitate to speak to the staff. One visitor said "Staff will do anything to help as they are very approachable".

We also used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of three people, who spoke very highly of the quality of care, the environment and staff at Darlington Road. They all told us that it had provided them with sense of security and safety for their relatives.

One relative told us, "The manager is very approachable. He knows what is going on and has the best interests of people who use the service at heart. When things don't go as smoothly, he will look into it. He deals with anything that comes up. I feel I can say anything to him, and he puts my mind at rest. He encourages staff to think creatively about how to meet people's needs. I hope he never leaves."

People who used the service were respected, and where appropriate, their relatives, friends and representatives were involved in decisions about care delivery. People experienced care, treatment and support that met their needs and protected their rights.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.