Mrs A and Mr R Brooks - 5 Everton Road

Mrs A and Mr R Brooks - 5 Everton Road, is a residential care home for up to 15 adults with a learning disability and/or autism. The service is set out as a collection of four shared houses which are near each other. At the time of our inspection there were 15 people living at the service.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

Governance systems at the service required improvement to ensure shortfalls in the service were identified. New staff had not always been recruited in line with legislation and the providers policy.

People’s medicines were not always managed in line with best practice guidance.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. Risk assessments were not always fully updated when required.

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 were supported by staff to pursue their interests, so people had a fulfilling and meaningful everyday life. Staff supported people to achieve their aspirations and goals.

The service gave people care and support in a safe, clean and well-maintained environment.

People had a choice about their living environment and were able to personalise their rooms.

Right Care:

People received kind and compassionate care. People’s independence was promoted. Staff understood how to protect people from poor care and abuse. 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.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

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

People received care that supported their needs and aspirations and was focused on their quality of life.

Right Culture:

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

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

People were supported by consistent, longstanding staff who knew them well.

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

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

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was enhanced by the service’s culture and inclusivity.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency and respect.

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 29 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 19 (Fit and proper persons employed).

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.

The service is a residential care home but it is set out as a collection of four shared houses which are near each other. The home has staff available 24 hours a day but these staff are spread across the houses, which means there are periods where people are in their house without immediate access to staff. The houses are situated in a residential area which is within walking distance of the town centre. The four houses can accommodate up to 15 people and it specialises in providing a service to adults who have a learning disability. At the time of the inspection there were 15 people living in the home and all of them could communicate well.

The home was owned by two people, one of which was the 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 care 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.

At our last inspection we rated the service 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 showed 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 being supported by Mr and Mrs Brooks told us they felt very safe living at the home. Staff showed a good awareness of safeguarding procedures and knew who to inform if they saw or had an allegation of abuse reported to them. The registered manager was also aware of their responsibility to liaise with the local authority if safeguarding concerns were raised.

Some areas of medicines management needed to improve but the provider completed most of the improvements before the end of the inspection period and assured us that staff training regarding medicines management, and the providers policies would be updated to ensure staff administered people’s medicines safely.

The provider had suitable processes to assess people’s needs. Care plans were detailed and contained risk assessments that documented areas of risk to people, such as road safety. Staff also sought peoples consent to care.

The provider employed enough staff to cover the needs of the home and there was a robust recruitment and selection process in place where staff had been subject to criminal record checks before starting work at the service, although these needed to be updated.

The provider had infection control arrangements in place and people’s homes were clean, tidy, and free from any unpleasant odour. Accident and incident reporting was robust. Staff knew the reporting process. Records showed that staff had taken appropriate action where necessary and made changes to reduce the risk of a re-occurrence of an incident.

Staff had the skills, knowledge, and experience to support people. Appraisals were completed annually and staff had regular supervision which helped develop and motivate staff to improve on the care and support being delivered.

Staff supported people to eat, drink and keep a balanced diet. People told us that they had choices of food and that the quality of the food was excellent. People told us they had access to healthcare services such as GPs, Dentists, and Chiropodists.

People were supported to take part in activities of their choice. The provider helped people celebrate special occasions such as birthdays and religious festivals such as Christmas.

People told us they were encouraged to give their views and raise concerns or complaints.

The leadership was visible and accessible. The registered manager understood the importance and responsibility of their role and had clear lines of responsibility and accountability. There was evidence that learning from incidents and accidents and investigations took place and appropriate changes were implemented

There were effective quality assurance arrangements at the service to raise standards and drive improvements and the service worked with other health and social care professionals in line with people's specific needs. Staff understood the importance of supporting people to have a good end of life as well as living life to full whilst they were fit and able to do so.

Further information is in the detailed findings below

5 Everton Road is a collection of four shared houses which are in close proximity to each other. The houses are situated in a residential area which is within walking distance of the town centre. The service can accommodate up to 15 people and it specialises in providing a service to adults who have a learning disability.

At our last inspection of the service on 13 November 2013 we did not identify any concerns with the care provided to people.

At the time of our inspection there were 15 people using the service. This consisted of five people who lived in one of the houses, four in another house, three in another of the houses and three people in the last house. We visited each of the houses and met with all but one of the people who lived there. People were able to show us around their homes and were able to tell us about their experiences of living there.

There was 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.

There was a happy, relaxed and inclusive atmosphere in the home. A member of staff said member of staff told us “Everything here is resident led. It’s their home and I am just privileged to be involved in supporting them to live a happy life.” A relative we met with told us “[Providers’ names] and all the staff are fantastic in every way. They really do care about the residents.”

Staff morale was very good and people looked relaxed and happy with the registered providers and with the staff who supported them.

People were able to build trusting relationships with the staff that supported them. There had been only one change to the staff team in the last six years the providers and the majority of the staff team had cared for the people at the home for over 20 years. They knew people and their families very well. One person said “The staff are lovely and they are very helpful.” Another person told us “[Names of providers’] and all the staff are really, really kind. I think the care we get here is excellent.” Another person said “I have an amazing life here. Everybody is really kind. We all get on. I wouldn’t want to live anywhere else.”

People told us they felt respected by the staff who supported them. One person said “This really does feel like my home. I do what I like. The staff don’t interfere but they are there if I need them. It’s perfect really.” Another person told us “I choose what I want to do. Staff never tell me what to do. I have a key to my house and a key to my bedroom. The staff always knock before they come in.”

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe. There were further systems in place to minimise risks to people. These included staff recruitment procedures, staff training in recognising and reporting abuse and the safe management and administration of people’s medicines.

People were supported to live an independent lifestyle with reduced risks to themselves or others. There were risk assessments in place which identified risks and the control measures in place to minimise risk. These were understood and followed by staff. For example, one person who lived at the home told us how they liked to travel. They said “We have a plan and it works. It helps me to do the things I want to do and makes sure I’m safe and the staff know where I am.”

People were supported to maintain good health and wellbeing. They saw health and social care professionals when they needed to. A relative we met with told us “I don’t have to worry about a thing. They [the staff] monitor [name of person’s] health really well. They help them with appointments and they keep me updated too.”

People lived happy and fulfilling lives. Many had work placements in the local community and were also able to work on the providers’ farm. One person said “I like helping at the farm. I collect the eggs and help clean out the sheep.” A member of staff explained that the person was also involved in helping with deliveries of hay and straw to local pet shops. The person said “I enjoy that best of all.” There were also regular trips out and annual holidays. Some people attended a local day centre and one person told us they belonged to a swimming club.

People were supported to maintain contact with their friends and family. The Provider Information Return stated “Staff encourage and support regular family contact and visits. The home provides planning, transport and escorts to enable residents to visit families and friends, attend work placements or events.” This was confirmed by the people we met with.

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person told us, "I am aware that I have a care plan. We go through it twice a year." People's care was regularly reviewed and their personal information was held securely.

We visited the four properties that were registered as 5 Everton Road. We saw that people lived in safe, accessible surroundings that promoted their wellbeing. The four properties had environmental risk assessments and were adequately maintained.

We viewed a selection of staff records, and saw that checks had been carried out when the home employed staff. A person told us, 'The staff are really good here.' Another person said, 'They are real good people.'

We saw that people's personal records, including their medical records, were accurate and fit for purpose. The registered manager told us that the home had off-site archiving facilities in the provider's office. The registered manager went to the office during our visit to retrieve staff records.

People had access to a range of activities both within the home and externally which included work placements. These activities were tailored around people's preferences and people were supported by the staff to develop independent living skills. Personal care plans were individually tailored to meet people's needs and their risks were assessed.

People were protected from harm as there were appropriate safeguarding procedures. Staff were supported by the provider through training and were encouraged in their professional development. Staff received regular supervision but the provider had not completed an annual appraisal with any staff.

The service had effective systems to monitor the quality of service provided.