Select Lifestyles Limited - 512-514 Stratford Road

Select Lifestyles Limited – 512-514 Stratford Road is a care home without nursing which provides accommodation and personal care for to up to 6 people. Six people lived at the home at the time of this inspection.

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

People received personalised and responsive care and support in line with their needs and wishes. The accommodation met people’s needs and the environment was clean. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s dignity was maintained, their right to privacy was respected and their independence was promoted.

Right Care

The atmosphere was warm and friendly. People felt safe and told us the staff were kind and attentive. Staff had been recruited safely. They knew people well and understood what was important to them. Risks had been assessed and outcome focussed care records helped staff to provide safe and individualised care. People had access to a range of healthcare professionals which supported them to remain healthy and well. People received their medicines when they needed them from trained staff.

Right culture

The culture was person centred and inclusive. This demonstrated significant improvements had been made since August 2022. People and their relatives felt involved and listened to. Staff felt valued and appreciated and they understood what their managers expected from them. The management team had a clear overview of the care and support provided to people. The provider’s governance systems were effective and embedded into practice.

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 10 October 2022). Following that inspection, we served a warning notice because the provider was in breach of multiple Regulations. We undertook a targeted inspection in November 2022. A rating was not awarded at that time, but the provider had complied with the warning notice and was no longer in breach of the Regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We also undertook this inspection to assess that the service is applying the principles of right support right care, right culture.

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, which will help inform when we next inspect.

Select Lifestyles Limited – 512-514 Stratford Road is a care home without nursing providing accommodation and personal care for to up to 6 people. Six people lived at the home at the time of this inspection.

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

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.

Right support

Improvements had been made since our last inspection. Where possible people contributed to planning and reviewing their care and making decisions about their lives, including deciding how they spent their time. This demonstrated people’s voices were being listened to. People had maximum possible choice and control over their lives, and they had opportunities to maintain and gain independence. Staff understood the importance of maintaining people’s dignity and their right to privacy. People receive their medicines when they needed them.

Right Care

People felt safe and the safety of the service including cleanliness of the home had improved since August 2022. People received personalised care and support. Risks associated with people’s care had been assessed and more information had been added to people’s care records to help staff provide safe care.

Right culture

The leadership of the service had been strengthened and the providers quality assurance systems were being operated in line with their expectations. Whilst feedback confirmed the culture of the service had improved the provider needs to embed and sustain the improvements made to demonstrate consistent good practice over time.

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 10 October 2022) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We also undertook this inspection to assess that the service is applying the principles of right support right care right culture.

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.

We use 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Select Lifestyles Limited 512-514 Stratford Road 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.

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.

About the service

Select Lifestyles Limited – 512-514 Stratford Road is a care home without nursing providing accommodation and personal care to up to six people. Six people lived at the home at the time of this inspection.

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

Right Support

People did not receive good quality person centred care and support. People were not supported to contribute to planning and reviewing their care and making decisions about their lives, which included planning their meals or deciding how they spent their time. This demonstrated their voices were not always listened to. People did not have the maximum possible choice and control over their lives, and they did not have enough opportunities to gain independence. Accepted poor staff practice meant people’s dignity was not maintained and their right to privacy was compromised. People did not always receive their medicines when they needed them, which was unsafe. People had access to health professionals, but action was not always taken when staff had identified medical treatment was needed.

Right Care

People did not always receive safe care and support because risks associated with their care were not always assessed. Staff understood people’s preferred methods of communication but many interactions between people and staff were task focussed. Also, staff did not have all of the information they needed to provide care in line with people’s wishes. Some staff had not received all of the training they needed to meet people’s specific needs and others did not put their learning into practice. Staff recruitment checks needed to be strengthened. The home was not a clean and pleasant place for people to live and infection prevention and control practice was unsafe. Multiple risks associated with the environment had not been identified or mitigated. Systems were in place to ensure people were protected from the risk of abuse and harm.

Right culture

A person-centred culture with clear outcomes for people was not promoted. Discussions and observations demonstrated person-centred approaches were not understood or embedded into practice. Leadership of the service was poor. The providers quality assurance systems were ineffective and had not been operated in line with their expectations. This meant opportunities to drive forward improvement and learn lessons had been missed. Some prompt responsive action was taken in response to our inspection feedback and further action was planned 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 and update

The last rating for this service was good (published 09 November 2019).

Why we inspected

We received concerns in relation to staffing levels. We also undertook this inspection to assess that the service is applying the principles of right support right care right culture.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this

inspection.

We have found evidence that the provider needs to make improvements. The provider was in breach of regulations in relation to person-centred care, dignity and respect, safety and good governance. Please see the safe, caring, responsive and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took

account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering

what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to

hold providers to account where it is necessary for us to do so.

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.

Please see the action we have told the provider to take at the end of this report.

The overall rating for this service is 'Inadequate' and the service is 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 reinspect 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 in any of the five key questions it will no longer be in special measures.

Select Lifestyles Limited is a care home which provides support for up to six people in one adapted building. At the time of our visit, six people were using the service. These are people with learning disabilities and autism.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look

in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

As part of the thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Staff were caring in their approach and had good relationships with people. Promoting independence was encouraged, to enable people to improve their daily life skills further.

There were enough staff to ensure people were safe. Where risks associated with people's health and wellbeing had been identified, plans were in place to manage those risks. Medicines were stored and administered correctly, and staff had received training in relation to this.

Staff understood their responsibility to safeguard people from harm and knew how to report concerns.

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; systems supported this practice.

People received care which was responsive to their individual needs. Staff knew people well and had a good understanding of how to support them. Care records provided staff with person centred information in relation to people’s backgrounds, interests and individual health needs.

Staff encouraged people to maintain a balanced diet and understood people’s special dietary needs. The provider and staff team worked with external health professionals to ensure people's health and wellbeing was maintained.

A registered manager was in post. Positive feedback was received in relation to the management of the service. People, relatives and staff had opportunities to feedback about the running of the service. Quality checks were carried out to monitor the service and identified where improvements could be made.

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

Rating at last inspection

The service was rated as Good (published 29 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Select Lifestyles Limited is a service which provides personal care support for up to six adults with a learning disability. At the time of our visit, six people used the service.

The service had a registered manager however this person no longer worked at the service and was in the process of de-registering with us. 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. A new manager was in post and had been since December 2016. They were in the process of registering with us.

At our previous inspection in June 2016 we rated the service as ‘requires improvement’ in the areas of ‘effective’ and ‘well-led’. We found referrals to other professionals were not always made in a timely way. Staff did not always feel that they could raise concerns with the management team. We had not always received the notifications required to enable us to monitor the service. At this visit staff felt the new manager in post was approachable, effective and would listen to any concerns raised. People had been referred to health professionals by staff when required and we had received statutory notifications correctly.

Relatives told us people were safe at the service because staff were skilled and knew how to care for them well. Staff had a good understanding of what constituted abuse and knew who to contact if safeguarding concerns were raised.

Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. The provider was improving their recruitment processes further to ensure they recruited suitable staff. Staff received an induction to the organisation, which included working alongside other more experienced staff, and a programme of training to support them in meeting people’s needs effectively.

Staff understood the principles of the Mental Capacity Act (2005), and the manager had taken the required action if they felt people were being deprived of their liberty. Capacity assessments were decision specific in line with the principles of the Act.

People were assisted with their nutrition and to manage their health needs. Staff referred people to other health professionals for further support if they had any concerns.

People received support from staff they were familiar with who provided the support as outlined in their care plans. There were enough staff to care for people.

Relatives told us staff were kind and caring and had the right attitude and skills to provide the care people required. People were supported with dignity and respect. Staff encouraged people to be independent.

Care records contained relevant information for staff to help them provide personalised care including processes to minimise risks to people’s safety. Care records were in the process of being reviewed by the manager. People received their medicines when required from staff trained to administer them. Senior staff checked that staff remained competent to do this.

People and their relatives knew how to complain and had opportunities to share their views and opinions about the service they received. This was through meetings and surveys.

Staff were confident they could raise any concerns or issues with the manager knowing they would be listened to and acted on. People and staff told us the management team were available and responsive.

The manager gave the staff team formal opportunities to discuss any issues or raise concerns at individual and team meetings. There were processes to monitor the quality of the service provided. These checks were carried out by the manager and the provider. These ensured staff worked in line with policies and procedures.

Select Lifestyles Limited is a residential home which provides care for up to six people with a learning disability in Solihull. At the time of our inspection there were six people living at the home.

The service had a registered manager who had been in post since 2014. 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.

Relatives and staff told us people who used the service were safe. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Risks to people’s safety were identified and ways to how to manage and reduce these risks were documented.

There were enough staff to care for the people they supported and checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time.

Staff encouraged people to be independent. Care plans contained information for staff to help them provide personalised care.

People received medicines from senior staff who were trained and medicines were administered safely.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided.

People were assisted to manage their health needs, with referrals to other health professionals where this was required. Some people felt that referrals were not always made in a timely way by the management team.

People had enough to do to keep them occupied and staff tailored activities to people’s individual interests.

People knew how to complain and complaints were documented and responded to. People were given the opportunity to feedback about the service they received.

Staff had mixed views as to whether they could raise concerns with the management team and whether they were approachable. There were formal opportunities for staff to do this at group and one to one meetings. Some staff felt that they would like to do more to support people at the home such as updating care records and administration of medicine.

There were processes to monitor the quality of service provided. There were other checks which ensured staff worked in line with the provider’s policies and procedures.

Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

We had not received all the notifications required, to enable us to monitor the service.

Following our visit we received some further concerns from staff about the management of the service which we raised directly with the provider. They agreed they would discuss this with staff further.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us. If you want to see the evidence that supports our summary, please read the full report.

Is the safe?

The manager understood their responsibilities in relation to Deprivation of Liberty safeguards and told us they had responded to a request for information from the relevant body.

Routine maintenance checks and tests were carried out at the recommended intervals to ensure the building and environment remained safe for people.

Staffing levels were sufficient to meet the care and support needs of the people who lived in the home.

Is the service effective?

People had care and support information in place. Although this was basic, staff knew people's needs and were able to respond appropriately. People's care was evaluated regularly to ensure it was current and appropriate. The manager had commenced formal reviews of people's care and support plans.

Is the service caring?

Staff were observed to be kind and caring to people. People told us they liked the staff by nodding their heads and answering, "Yes" and "Yes, I do " when we asked.

We saw staff provided support at the preferred pace of the person concerned, and included them in conversations.

Is the service responsive?

People were supported to maintain their health through regular appointments with health and social care professionals as appropriate.

People were observed to respond positively to the manager and staff. The manager and staff clearly recognised people's communication methods and responded appropriately to them.

Is the service well led?

There was a quality assurance process in place which included seeking the views of people, their relatives, staff and associated healthcare professionals about the quality of the service provided. These views were used to make improvements to the service people received.

The health, safety and welfare of people was maintained as routine maintenance checks and tests were carried out as required.

Staff had a good knowledge of people's needs and responded appropriately. We saw staff were patient and respectful to people. People who lived in the home looked relaxed and interacted with staff and other people living in the home in a friendly way.

We saw people were offered choices throughout our visit, for example what they wanted to eat and drink and how they wished to spend their day. Two people went out for lunch. When they returned one person said they had been to a 'Carvery' and had enjoyed their meal.

People indicated they were happy living at the home. One person said "I like it here.' Another person smiled when we asked if it was a nice place to live.

Plans we looked at provided staff with good information about the care and support people required. Plans were personalised to meet the needs of each person.

Records confirmed the service co-operated with other professionals involved with peoples care, such as day centres, GP's and other healthcare professionals when necessary.

We found there was a safe procedure for assisting people with medication. Medication was stored safely and there was a process in place for checking people received their medication as prescribed.

Records showed staff had been checked properly before they started to work in the home. Staff we spoke with had the necessary skills and experience to work with people who used the service.

The home had a complaints procedure for raising concerns. Most of the people living at the home would require support to raise concerns. Staff we spoke with had a good understanding of people's communication and behaviours and would have been able to identify if people were unhappy. We were told the home would involve relatives or advocates to support people to raise their concerns if needed.

All five people living at the home were present during our visit. To gain insight of the care and services provided we observed and where possible spoke to people using the service. We reviewed notes for all five people at the home, observed policies and practice, saw three staff records and spoke to four members of staff.

We observed people using the service throughout the day. One person went to a day centre and one out for lunch and shopping. Two stayed in the home listening to music or watching TV. One person remained in bed. We saw that people using the service were able to personalise their own rooms and that the home was comfortable.

Staff showed a good knowledge of people living at the home and there was good rapport between them. There were three people on duty and the operations manager visited to conduct a spot check and update documentation. Staff told us they liked working there.

People we spoke to said they liked living there and the staff were nice. Two of the people had a good range of activities planned each week according to the records we viewed. The other three people using the service did not benefit from the same level of activities and this will be reviewed following our visit.