Care at Home (High Street)

Care at Home (High Street) is a supported living service providing personal care to people who may live in single or shared occupancy households with their own tenancy agreements. Some households have shared communal areas and shared care at different parts of the day.

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 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 assessing risk, safety monitoring and management and preventing and controlling infection. Based on our inspection of these areas the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

¿ People who experienced periods of distress had proactive plans in place which ensured restrictive practices were only used by staff if there was no alternative.

¿ Staff sought to minimise their use of restraint. Systems were in place to report and learn from any incidents where restrictive practices were used. Staff discussed techniques that promoted reducing restrictive practice.

¿ Management spoke about the challenges of recruiting staff throughout the pandemic. The provider had developed systems to reduce staff turnover and retention and provide greater consistency for people. However, they acknowledged work was still needed to recruit and embed a permanent and consistent staff team. In the absence of a permanent staff team the provider had block booked agency staff to ensure people received consistent care.

Right care

¿ Staff involved people and ensured individualised risk assessments were undertaken. Where appropriate positive risk taking was encouraged and enabled.

¿ Staff knew people well, and understood the risks aligned to each individual.

¿ Staff supported changes that individuals might want to make and assessed risks continuously

Right culture

¿ Managers and senior staff modelled good practice and led by example in relation to assessing risk, safety monitoring and management.

¿ Staff were trained in and had a good understanding of best practice models of care, such as Positive Behaviour Support.

Action had been taken to reduce the risk of infection spreading which had included the correct use of personal protective equipment (PPE). Staff had received training and support in relation to infection control and COVID-19. Management observed staff practice ensuring they were following the correct use of PPE. People and staff were tested in line with national guidance.

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 23 July 2021). As this is a targeted inspection the overall rating for this service remains good.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about noise levels at one of the households. We specifically needed to check that people with behaviours of distress had proactive plans in place and were being supported by trained staff who understood their needs. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check 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 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care at Home (High Street) 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.

Care at Home (High Street) is a supported living service providing personal care to people who may live in single or shared occupancy households with their own tenancy agreements. This registered location supports people living in seven households of different sizes (single and multiple occupancies). Some households have shared communal areas and shared care at different parts of the day.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Care at Home (High Street) was supported by a new provider and management structure. A service improvement plan had been developed as a result of the provider’s governance and quality assessments of the service. The plan helped focus and direct the provider and managers on areas which required further improvement.

Additional management support had been implemented to support managers to understand their role, share learnings, review incidents and set new improvement targets.

However, further work was needed to ensure all households were consistent in their infection control practices. We have made a recommendation that the provider reviews their monitoring systems to ensure good infection control practices are fully embedded across the service in line with national guidance.

The provider had identified that further development was needed to assist and demonstrate that people were being supported to live a life of their choice and reach their potential in independent living, with support as required.

The provider used feedback from staff, people, relatives and other stakeholders to help understand their experience and also help shape the culture of the service moving forward. They were open to learn and promote a culture which was person centred and empowering.

Clear procedures were being implemented to help ensure people were involved in their decisions about where they wanted to live, who they wanted to share their home with, and how they wish to be supported. This new process will help to ensure the service could meet their needs and ensure people who shared households were compatible.

Throughout our visits to four households, we observed staff treating people with kindness and in a dignified and respectful manner. People looked relaxed around staff and engaged with them freely. Staff were aware of people’s communication needs and spoke to them in a polite and respectful manner.

Support plans described people’s preferences and support requirements. Risk management plans and how staff should respond to changes in people’s needs had been identified and recorded. Staff had sought specialist health care advice when people’s needs had changed. An internal positive behaviour support trainer assisted staff teams to identify triggers and strategies to support people who express their distress in ways that other people find difficult.

People received their medicines as prescribed. Their medicines were regularly reviewed and there was evidence that alternative strategies were used to support people with their emotions before ‘as required’ medicines were administered.

Suitable numbers of safely recruited staff were available to support people. Regular agency staff who were familiar with people’s needs were used when there were staff shortages. Plans were in place to review their recruitment processes with the aim of reducing agency staff.

Progress was being made to ensure all staff received regular supervisions and had current and in date training. The method of delivering training and the induction programme was being reviewed to ensure staff had the skills they needed to support people.

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.

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.

The service was able to demonstrate how they were progressing to meet the underpinning principles of Right support, right care, right culture. We found that people received care which was focused on their support needs and in their best interests. There was a shift in culture away from residential care to supporting people to reach their potential in a supported living setting. Staff were observed supporting people in a kind and friendly manner and ensured people’s human rights and dignity was always protected. The provider was implementing a service improvement plan which helped to implement the provider’s values and to promote a culture which was open and inclusive.

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

Rating at last inspection

This service was registered with us on 3 April 2020 and this is the first inspection.

Why we inspected

This service had not been inspected since their registration in April 2020, therefore, this inspection was carried out to gain assurances about the quality of care and systems used to monitor and manage the service.

Follow up

We will continue to meet with the provider and to monitor their progress in implementing their service improvement plan and ensuring that the principles of supported living is fully embedded. We will also monitor the 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.