People in Action - 132 Manor Court Road

People in Action - 132 Manor Court Road is a residential care home providing accommodation with personal care for up to 8 people. At the time of our inspection, there were 6 people living at the home. The home is an adapted domestic property where care and support are provided across 2 floors.

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: Improvements had been made and people now received the right day to day support to meet their physical, emotional and social needs. Records showed assessed staffing numbers had been maintained to provide safe and responsive care for people. Staff understood their responsibilities to safeguard people from the risk of abuse. However, systems did not always promote safe care. For example, medicines were not always managed safely, some environmental risks remained, the provider’s policy did not support the safe management of people’s money and records did not show people’s capacity was assessed to ensure people were involved in decisions about their care.

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 did not always support this practice.

Right Care: At our last inspection we found people were not consistently supported to follow their interests or engage in meaningful activities they enjoyed, to help prevent boredom, isolation and a lack of stimulation. Improvements had been made. People were being supported to pursue their interests in their community and records showed people regularly left the home to do things they enjoyed.

Right Culture: A new, experienced manager from within the provider company had transferred to the home and had focused on improving the culture. The provider had made a significant number of staff changes to ensure people were supported by skilled and competent staff who treated people with dignity, respect and kindness. However, further improvements were needed. The provider’s systems and processes failed to assess, monitor and drive forward enough improvement in the quality of care to be compliant with the regulations.

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 inadequate (published 21 June 2023). 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 some improvements had been made abut the provider remained in breach of regulations.

This service has been in Special Measures since 21 June 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to continue to make improvements. Please see the safe, effective 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for People in Action - 132 Manor Court Road on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe treatment and governance at this inspection. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

132-134 Manor Court Road is a care home providing accommodation with personal care for up to 8 people. The home is purpose-built accommodation, providing care and support to people across 2 floors. At the time of our inspection visit there were 7 people living at the home.

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

People did not always receive person centred care in line with Right, Care, Right Support, Right Culture.

Right Support: People had limited opportunities to leave the service and pursue social interests within their local community. There was limited guidance to inform staff how to enrich people's lives through positive engagement and meaningful activities. People's goals and aspirations were not always identified with people or those involved in their care. Risks associated with people's health and wellbeing were not always managed safely. Where risks had been identified, some records contained conflicting information about how staff should manage these risks.

People were not always supported to have maximum choice and control of their lives, and staff did not always support people in the least restrictive way possible and in their best interests; the providers policies and systems did not support best practice.

Right Care: People were not always involved in making decisions about their care. There was limited consideration given to the varying ways people could be empowered to make everyday choices using different communication methods.

Right Culture: The service did not always have a person-centred culture which empowered people to achieve their goals and aspirations. Systems were not operated effectively to identify if people were receiving person centred care in line with Right Care, Right Support, Right Culture.

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 March 2018). The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk at the service and the governance of the service. This inspection examined those risks.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person centred care, staffing levels and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

132 Manor Court Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is split over two floors comprising communal areas and a kitchen. The service is registered to provide care and accommodation for to up to eight people with a learning disability. At the time of our inspection there were eight people living in the home.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified and minimised to keep people safe.

People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Staff recorded medicines administration according to the provider’s policy and procedure, and checks were in place to ensure medicines were managed safely.

There were enough staff to meet people’s needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

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 and relatives told us staff were respectful and treated people with dignity. We observed this during interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People had access to health care professionals when needed and care records showed support provided was in line with what had been recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. People and relatives were involved in how their care and support was delivered.

People and relatives felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided, through checks made both by the registered manager and also the provider.

Further information is in the detailed findings below.

The service is registered to provide care and accommodation for to up to eight people with a learning disability. At the time of our inspection there were eight people living in the home.

The service had a registered manager. 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. The registered manager also manages another service. As the other service is next door, the registered manager is at the home on a daily basis.

People were comfortable with staff, and relatives were confident people who lived in the home were safe. Staff received training in how to safeguard people, and had access to the provider’s safeguarding policies and procedures if they had any concerns. Staff understood what action they should take in order to protect people from abuse. Systems were used effectively to identify and minimise risks to people’s safety. These systems were flexible so people could take risks if they were able to do so and build their independence.

People were administered medicines by staff that were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any errors were identified and action taken as a result. There was enough staff to meet people’s needs, with numbers of staff increased recently in order to support people effectively.

Checks were carried out prior to staff starting work to ensure their suitability to support people who lived in the home. Staff told us they had not been able to work until checks had been completed.

Some people were considered to lack capacity to make day to day decisions such as what to eat, what to drink, what to wear. This had been assessed so staff knew how much support people needed with decision making. However, where applications had been made to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS) because they did not have capacity to decide where they wanted to live, this was not clearly linked to an assessment of capacity. Staff had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people wherever possible. Staff followed the principles of the Act throughout our visit.

Staff were respectful and treated people with dignity. We saw this in interactions between people at our inspection visit, and this was also reflected in records kept. People were supported to make choices about their day to day lives. For example, they could choose what to eat and drink, and were supported to prepare their own meals if they wanted to.

People had access to health professionals whenever necessary, and we saw that the care and support provided in the home was in line with what had been recommended. People’s care records were written in a way which helped staff to provide personalised care, which focussed on the achievement of goals. Staff tried to ensure people were fully involved in how their care and support was delivered, and people were able to decide how they wanted their needs to be met.

Relatives told us they were able to raise any concerns with the registered manager, and they would be listened to and responded to effectively, and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions. There were systems to monitor the quality of the support provided in the home, and recommended actions were clearly documented and acted upon. This was achieved through unannounced provider’s visits to check different aspects at each visit.

People living in the home had complex needs which meant that they were not always able to tell us their experiences. We spent time during our visit observing care to help us understand their experiences.

People appeared comfortable and relaxed in their surroundings and were observed to approach staff with ease. Two people indicated that they were happy living at the home, by answering, "Yes I am" or nodding and smiling at us when we asked.

Support plans were in place for people. Staff told us that they provided information which helped them to support people with their needs. Staff members we spoke with knew about people's needs and were able to tell us about them.

People were supported to attend and participate in a variety of activities throughout the week as well as spending time at home.

Measures were in place to ensure that people lived in a well kept, clean and hygienic environment.

Systems were in place to ensure that medicines were managed appropriately for people.

A process was in place for dealing with complaints. Staff were able to explain how they would recognise if someone was unhappy with something. "You can tell when people are not happy with something by their body language, emotions, sign language or physical contact" was a comment made.

We saw that people had care plans which described how their needs should be met and identified means of reducing risks to their health and well being. We saw evidence that care plans and risk assessments had been updated on a regular basis so that they remained relevant to people's assessed needs.

We were told that people led active lifestyles and had regular opportunities to go out and do things they enjoyed, with support from staff.

We observed staff interacting with people and saw that they had formed positive relationships with them. We saw that staff were respectful and friendly to people who lived in the home.

We saw that there were systems in place to review the quality of care and service provided to people which invited their views and opinions.