Archived: Flat A 291 Harrow Road

Flat A 291 Harrow Road is a care home for people with learning disabilities. It provides accommodation and support for up to four people. The building is a four bedroom level access flat with a shared open plan lounge/dining area and separate kitchen. At the time of our inspection there were four people living at the service.

We found the following examples of good practice.

People were supported to self isolate following a positive test for COVID-19 in a way which took account of their care needs and understanding of the risks from the virus.

People were supported to engage with regular testing which meant the outbreak was detected and contained.

The provider had deployed a suitable contingency plan for staffing pressures which mitigated the effect of staffing shortages on people’s essential care.

People’s experience of using this service

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

This was a targeted inspection that considered aspects of the safety of the service. Based on our inspection of these areas we did not identify any areas of risk to people’s safety.

People were safeguarded from abuse and poor care. Care workers were confident recognising abuse and reporting concerns to managers. Staffing levels had been reviewed to ensure there were sufficient staff to meet people’s needs, and the provider continued to review staffing levels with commissioning bodies.

There were suitable measures for assessing and managing risk to people's health and safety. The provider worked with specialist teams such as occupational therapy to ensure appropriate risk management plans were in place for people.

Medicines were safely managed and the registered manager carried out frequent audits to ensure errors were identified and addressed promptly.

People were protected from the risk of contracting COVID-19 in the service. Staff had access to suitable personal protective equipment and handwashing facilities. People using the service and staff were regularly tested and supported to access the vaccination programme. The registered manager continued to review how people’s needs were met in response to changing guidance during the COVID-19 pandemic.

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 13 April 2021).

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We also received information concerning a neighbouring service managed by the same provider.

The information CQC received about the incident indicated concerns about the management of staffing levels and safeguarding issues. This inspection examined those risks.

We undertook this targeted inspection to check on a specific concern we had about staffing levels and safeguarding. The overall rating for the service has not changed following this targeted inspection and remains good.

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 this concern.

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 .If we receive any concerning information we may inspect sooner.

Flat A, 291 Harrow Road provides accommodation and support to up to four people with a learning disability. The building is a four bedroom level access flat with a shared open plan lounge/dining area and separate kitchen. There were four people living at the service on the day we carried out our site visit.

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

People were protected from avoidable harm. People's relatives told us their family members were safe and well cared for and that staff did "a wonderful job." People were protected from abuse as staff were aware of their responsibility to report any safeguarding concerns.

Staff and professionals provided positive feedback about the management of the service and about standards of care. Staff members told us that team morale had improved under the current acting manager, whom they described as "supportive", "calm", "easy to approach" and "a good communicator."

People were protected from the transmission of infectious diseases including COVID-19 and the service was complying with government policy for safety within care home settings.

There were systems in place to monitor the quality and safety of the service. When areas of improvement were identified, actions were taken to address them.

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 good (published 27 March 2020). At this inspection, the overall rating for this service has not changed and remains good.

Why we inspected

The Care Quality Commission (CQC) has introduced focused/targeted inspections to check specific concerns. We used the targeted inspection approach to look at infection prevention and control measures under the safe key question. We look at this during all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. As we only looked at part of this key question, we cannot change its rating from the previous inspection. Therefore, the rating for this key question will remain good.

We undertook a focused inspection approach to review the key question, is the service well-led? This was because we had specific concerns in relation to how the service was managed and the impact of this on people using the service and staff. As no concerns were identified in relation to the key questions, is the service effective, caring and responsive? we did not inspect them on this occasion. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection, which remains good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Flat A, 291 Harrow Road on our website at www.cqc.org.uk.

Flat A, 291 Harrow Road provides accommodation and support to up to four people with a learning disability. At the time of our inspection four people were using the service. The building is a four bedroom flat with a lounge, kitchen and dining area.

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

People’s relatives gave good feedback about the care workers as well as the quality of the service. The provider had identified and appropriately mitigated risks to people’s health and safety. The provider supported people with their healthcare and nutritional needs. The provider had appropriate systems in place for reducing the risk of abuse and care workers were aware of these. People’s medicines were managed safely. The home was clean and tidy on the day of our inspection and the provider had appropriate systems in place to reduce the risk of infection. The provider properly managed and learned from accidents and incidents.

The provider conducted appropriate pre- employment checks and ensured there were enough staff supporting people. Staff received the support they needed to conduct their roles. The home was appropriately designed and decorated to meet people’s needs.

The provider was proactive in ensuring people’s needs and preferences were met. 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.

People’s cultural and religious needs were met and the provider took action to support them to express their views. People’s privacy and dignity were respected and promoted and people were encouraged to be as independent as they wanted to be.

The provider had detailed communication care plans in place and had developed personalised communication techniques with people. The provider was meeting the requirements of the Accessible Information Standards (AIS) and was able to provide information to people in different formats when needed. People’s social interests were met and there were clear and appropriate complaints and end of life care policies and procedures in place.

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.

Staff and people’s relatives gave excellent feedback about the registered manager. All staff members understood their responsibilities. The quality of care was effectively monitored.

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 09 June 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.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a comprehensive inspection on the 16 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

The service had a new registered manager in post at the time of our visit. 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.

The registered manager was accessible and approachable and staff felt able to speak with her and provide suggestions and feedback on the running of the service.

Initial assessments were completed by senior staff members to ensure that the service was able to identify and meet people’s support needs before they moved into the service.

People received individualised support that met their needs. The provider had systems in place to ensure that people were protected from risks associated with their support, and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Medicines were administered safely and records were kept of this.

Care plans were written in plain English and easy to understand. Care plans contained information in relation to people’s preferences about their life choices, health needs, meals, activities and other information related to their care. Care plans were developed in consultation with people and their family members. Where people were unable to contribute to the care planning process, staff worked with people’s representatives and sought advice from relevant health and social care professionals to assess, monitor and review the care needed.

Risk assessments were completed when people first started to use the service and reviewed in line with the provider’s policies and procedures. People’s risk assessments covered a range of issues including guidance around accessing the community, personal care, moving and positioning. For those with complex health and well-being care needs, more detailed guidance was in place from the appropriate health and social care professionals.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and DoLS, and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Where people were not able to communicate their likes and/or dislikes, staff sought advice and guidance from appropriate healthcare professionals and consulted family members.

Staff had received training in mental health legislation which had covered aspects of the MCA and DoLS. Senior staff understood when a DoLS application should be made and how to submit one.

Staff were familiar with the provider’s safeguarding and whistleblowing policies and procedures and able to describe the actions they would take to keep people safe.

People were supported to participate in a full range of activities, went swimming, attended music sessions, went for walks, ate out in restaurants and visited parks, museums and local attractions.

Staff supported people to attend health appointments and the provider had protocols in place to respond to any medical emergencies or significant changes in a person’s well-being. These included contacting people’s GPs, social workers and family members for additional advice and assistance.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. Staff were aware of people’s specific dietary needs and preferences and offered people choices at mealtimes.

Recruitment procedures ensured that only staff who were suitable worked within the service. Work had been completed to ensure that all staff files contained appropriate references, identity and checks with the Disclosure and Barring Service. There was an induction programme which included shadowing for new staff, which prepared them for their role. Staff were given opportunities to develop professionally through regular training opportunities and ongoing supervision sessions.

The provider had adequate systems in place to monitor the quality of the care and support people received. Monthly audits were carried out across various aspects of the service, these included the administration of medicines, care planning and training and development. Where these audits identified that improvements were needed action had been taken to improve the service for people.

Feedback was sought through house meetings and staff team meetings and relatives told us they were contacted by staff and given news and updates about their family members.

Below is a summary of what we found. The summary describes what people using the service and their relatives/friends told us, the records we looked at and what staff we spoke with also told us.

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

Flat A 291 Harrow Road is a registered care home for people with learning disabilities. There were four residents living at the home at the time of our visit. We looked at two care records and saw that these contained a variety of risk assessments which included those in relation to the environment, personal care and fire safety.

The service had a safeguarding policy and procedure in place. All staff we spoke with were aware of their responsibilities to report any concerns they had about potential safeguarding issues and were able to describe potential signs of abuse.

Appropriate checks were undertaken before staff began work. All staff were required to undergo a Disclosure and Barring Service check (previously a Criminal Records Bureau check) before commencing employment.

There were arrangements in place to deal with foreseeable emergencies. All staff had received first aid training which was repeated annually. There was a policy in place for dealing with accidents and incidents and we were told that a senior staff member was always on call in case of an emergency. We spoke with six members of care staff and each person correctly explained the policy for handling an accident or incident.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We asked staff how they obtained consent from people using the service on a daily basis. We were given detailed examples of the routines of each person as well as the general likes and dislikes of people.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. Staff were aware of the policies and procedures relating to the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and understood when an application should be made and how to submit one. No applications had been submitted at the time of our visit.

Is the service caring?

We carried out observations using the Short Observational Framework for Inspection (SOFI) and observed positive interactions between staff and people using the service.

There were a range of activities available for people who used the service. This included music sessions, baking and going out into the community.

Is the service responsive?

Staff told us that they organised resident's meetings where issues such as the range of activities, food choices, the home environment, staffing and well-being were addressed.

Is the service well-led?

The service had a registered manager in post. Staff we spoke with told us that the manager was approachable and cared and listened to them.

Staff meetings took place every month and a separate residents meetings took place once a month. We saw that an annual audit took place every year and monthly compliance audits were also conducted.

People were assessed regularly by staff to ensure that all their care needs were being met. This included assessing their nutritional status on a monthly basis.

All people's risk assessments and care plans were up to date.

The service had procedures in place to prevent abuse from happening and provided annual training to staff in safeguarding vulnerable adults.

People were cared for in a clean, hygienic environment by staff that had been trained, supervised and supported to undertake their duties appropriately. Staff had received training in infection control and there was a policy and procedure in place.

People were cared for in safe, accessible surroundings which promoted peoples' wellbeing. However, some areas of the home were in need of repainting.

There was a complaints policy in place and people were given information on how to make a complaint.