Precious Homes East London

Precious Homes East London is a supported living service providing personal care to people living with autism or a learning disability. At the time of our inspection there were nine people using the service. The service was provided to people in their own self-contained flats within two buildings.

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.

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

Right Support:

The model of care and the setting maximised people’s choice, control and independence. People lived in their own flats where they felt safe and comfortable. Care and support was provided in a safe, clean and well-maintained environment which met people’s sensory and physical needs. Staff supported people to achieve their goals and aspirations. People were encouraged to make choices and decisions in accordance with their level of understanding.

People were supported by enough appropriately skilled staff to meet their needs and keep them safe. People’s risks were assessed in a person-centred way. Care plans and risk assessments were regularly evaluated, involving the person, relatives and other professionals as appropriate. People who may become anxious or distressed had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

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:

Care was person-centred and promoted people’s dignity, privacy and human rights. People were protected from abuse and poor care. Staff demonstrated they provided kind and compassionate care to people and relatives. Relatives confirmed that they were included in decision making about their relative’s care. People were supported to maintain their privacy, dignity and independence by a staff team who knew them well. The provider had a system of matching the skills and qualities of staff to the people who used the service.

People had their communication needs met and information was shared in a way that could be understood. People were supported to maintain links with their culture and family. Staff engaged people in activities in accordance with their individual care plans. Support focused on people’s quality of life and followed best practice.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives. The manager had an open door policy and relatives and staff spoke positively of the managers in the service. Relatives and staff told us they felt comfortable raising concerns and making suggestions to enable improvements to be made to the service.

Managers ensured that staff had relevant training, supervision and appraisal. Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People, relatives, staff and other professionals were asked by the provider about their opinions of the service. Staff worked well with other services and professionals to improve outcomes for people.

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 20 June 2019)

Why we inspected

This inspection was carried out due to concerns raised by the local authority regarding the safe care and treatment of people. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Precious Homes East London is a supported living service that was providing personal care and support to 11 people with learning disabilities and autism at the time of inspection.

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 were protected from avoidable harm and abuse.

People’s risks were assessed and plans were in place to minimise the risk.

Incidents were recorded and used to learn lessons.

Staff were recruited safely and were supported to carry out their role with training, supervision and appraisals.

People’s care needs were assessed before they began to use the service to ensure the appropriate support could be given.

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 supported with their healthcare needs and their medicines were managed safely.

The service involved people using the service and relatives in decisions about the care.

Staff knew how to provide an equitable service.

People received personalised care which included their preferences and outcomes.

People and relatives were happy with the service provided.

Staff spoke positively about the leadership in the service.

The provider carried out quality checks of the service provided to identify areas for improvement.

Staff and people who used the service had regular meetings to be updated on service development.

People, relatives, professionals and staff were asked to give feedback through an annual survey.

Rating at last inspection:

Requires improvement (report published on 26 April 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service was last inspected in April 2016 when we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as medicines were not being managed in a safe way. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to address this breach. We found the provider had addressed our concerns about medicines management. However, additional concerns about other areas of care were identified during this inspection in February 2018.

Precious Homes East London provides care and support to people living in two ‘supported living’ settings, so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the service lived in self-contained one-bedroom flats across two sites located approximately 15 minutes’ walk apart from each other in the London Borough of Newham. Each site had a staff office and one site also had a number of communal areas used for meetings and activities. Not everyone using Precious Homes East London received regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. We also take into account any wider social care provided. Four people were receiving personal care within the service.

Precious Homes East London provides support to people with learning disabilities and autism. The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had 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 2008 and associated Regulations about how the service is run.

Care plans and risk assessments lacked details on how to deliver support and had not been kept up to date. Information about people’s healthcare needs lacked detail and was missing key information about people’s healthcare conditions. Although people’s care was reviewed regularly, information from reviews was not used to update care plans or risk assessments.

Staff had not received training identified as being required to meet people’s needs.

Quality assurance systems had identified some of the issues with the quality and safety of the service we found during the inspection, but actions to address the concerns had not been effective as issues remained.

The service had not consistently adhered to the principles of the Mental Capacity Act 2005.

People told us they felt safe in the service and staff were knowledgeable about safeguarding adults from harm. Records showed the service took appropriate action in response to incidents and allegations of abuse.

People received support to take medicines and the service had robust systems in place to ensure this was managed in a safe way.

People and staff told us they thought staffing levels were sufficient to meet people’s needs. Staff were recruited in a way that ensured they were suitable to work in a care setting. Staff received regular supervision from their line managers.

People told us they were involved in the assessment process, and resulting care plans were goal focussed and included information about people’s communication and ability to make certain decisions.

People were supported to access healthcare services when they needed.

People told us they were supported to prepare their meals.

Staff spoke about the people they supported with kindness and compassion.

People told us they thought staff were caring and treated them with dignity and respect.

People were supported to attend religious services where they wished to do so.

People were supported to maintain their relationships with their family members. Information about people’s support needs with regard to personal and sexual relationships was not always clear, although staff described providing sensitive support to people who were exploring their sexual and gender identity.

People knew how to make complaints and records showed complaints were responded to in line with the provider’s policy and procedure.

People were asked about their wishes for the end of their lives, although no one living in the service was approaching the end of their life.

People and staff spoke highly of the management team and told us the provider took steps to engage them. There were regular meetings and surveys for people and staff to inform the development of the service.

The provider had a clear strategy and plan for development.

We identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations regarding person-centred care, safe care and treatment, staff training and governance. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for the service is Requires Improvement. This is the first time the service has been rated Requires Improvement.

Precious Homes East London provides personal care and support to people with autism spectrum disabilities, learning disabilities and substance misuse in their own apartments on a single site. At the time of our inspection eight people were using the service.

The service 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.

We found that medicines were not always managed in a safe manner.

We found one breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Systems were in place to reduce the risk of abuse at the service. Risk assessments were in place which set out how to support people in a way that mitigated the risks they faced. There were enough staff working at the service to support people. Checks were carried out on staff before they began working at the service.

Staff had access to regular support through training and one to one supervision. The service mostly operated within the Mental Capacity Act 2005 and people were able to make choices about their daily lives. This included choices about what they ate and drank. The service supported people to attend medical appointments.

People told us staff treated them with respect. We saw staff interacted with people in a friendly manner. Staff understood how to promote people’s privacy and independence.

The service carried out assessments of people’s needs to determine if they were able to meet those needs. Care plans were developed and reviewed over time. These included personalised information about how to support individuals. The service had a complaints procedure in place and we found that complaints were responded to appropriately.

People that used the service and staff told us they felt the management team was open and supportive. The service had various quality assurance systems in place, some of which included seeking the views of people that used the service.

People did a variety of daily activities. They said 'I go to Dartford FC (football matches) and staff go with me' and 'I go out every day to the cinema, museum or college. I like drawing.' One person had been supported to travel abroad because they wanted to attend a games tournament and risk assessments had been carried out for these events.

Medicines were kept safely and there were appropriate arrangements in place in relation to the recording of medicine.

There were enough staff on duty during each work shift. One person told us 'it's better since the building split ' less crowded and quiet now. Two teams and enough staff.'

Staff received appropriate professional development and support.