We carried out a review of the data available to us about Lethbridge Road on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lethbridge Road, you can give feedback on this service.
Lethbridge Road is a residential care home providing personal and nursing care to five people at the time of the inspection. The service can support up to six people.
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 and what we found
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.
As part of thematic review, we carried out a survey with the registered manager 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.
Positive behaviour support plans were developed in line with current guidance and had resulted in people no longer require this type of support as they developed skills themselves to manage how they feel.
The service applied the principles 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 in the promotion of 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. Lethbridge Road is located in an area that enabled people using the service to participate in their own local community.
People were active each day and travelled independently on public transport to local places of interest and shops and enjoyed day time activities, such as swimming. Social activities took place in local restaurants and pubs.
Risks that people faced had been assessed and those identified were safely managed. Medicines were managed safely. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm.
Staffing levels were appropriately managed and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs, keep them safe and give them the opportunity to take part in their chosen activity.
Staff received a range of training appropriate to their role and people's needs and were supported by the registered manager through regular supervision.
People were encouraged and supported to eat and drink well. People were given a choice of suitable meals and snacks. Staff supported people to make meals of their choice throughout the week. People were supported to access healthcare when needed.
People were offered choice and control and where able, consented to their care and support. Staff supported people to be as independent as possible with activities of daily living, such as laundry, cooking, shopping and personal care.
Effective systems were in place to check the quality and safety of the service. The environment was safe and in a good state of repair and decoration.
The leadership of the service promoted a positive culture that was person-centred and inclusive. The registered manager and the staff team showed a desire to improve on the service provided and in turn the quality of life experiences for the people at Lethbridge Road.
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 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor 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.
Lethbridge Road is a large detached house in a residential area of Southport. The service is run by Autism Initiatives and provides accommodation, care and support to six people with learning disabilities. There is parking available to the front of the property and a garden area to the rear. The home is located close to Southport town centre, giving access to public transport and other amenities.
The home was last inspected in November 2014, and was rated ‘good’ overall, with one domain, the safe domain, rated as ‘requires improvement’. We found the provider was in breach of regulations relating to the safe management of medications. Following our last inspection the provider wrote to us and told us what action they were going to take to meet this breach. We checked this during this inspection, and found the provider had taken appropriate steps to address the anomalies found at the inspection in November 2014. The provider was no longer in breach of this regulation.
A registered manager was 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.
During our last inspection in November 2014, the provider was in breach of regulations relating to the safe management of medications. We saw however, during this inspection that medications were now managed safely, in accordance with clinical guidance, and only administered by staff who had the training to do so. The provider was no longer in breach of this regulation.
Everyone we spoke with told us they felt safe and well cared for at the home.
Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. Staff had received the correct training in adult safeguarding, and information regarding who to contact was displayed around the home. Staff also told us they would not hesitate to whistle blow if they needed to.
Risk assessments were in place, and were detailed. They provided staff with information about how to keep people safe, while ensuring their rights and choice were respected. Risk assessments were reviewed every month as part of the quality assurance process, and any changes were implemented and discussed at key worker meetings.
Staff were being safely recruited to ensure they were suitable to work with vulnerable people.
There was a procedure in place for recording and analysing incidents and accidents.
Rotas showed there were enough staff employed by the organisation to deliver a safe, consistent service. Each person had the required number of staff working with them to help keep them safe and access the community.
There were regular checks taking place on the equipment in the home, such as the fire extinguishers, gas, and PAT (potable appliance testing).
Staff were aware of their roles in relation to the Mental Capacity Act 2005 (MCA) and DoLS. We saw that appropriate applications had been made to the Local Authority for people who were required to have a DoLS in place, and these were kept under review.
Staff were supported through regular training, supervision and appraisal. Supervisions were taking place every few weeks, and all staff had had an annual appraisal. The induction process for staff was in line with national guidance as well as the providers own requirements.
People were supported to eat and drink at times that fitted in with their routines. Each person had a dedicated section in the fridge where they kept their ingredients.
We observed staff delivering support and they were kind and compassionate when working with people. They knew people well and were aware of their history, preferences and dislikes. People’s privacy and dignity were upheld. Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed.
Care plans with regards to people’s preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. Person centred means the service was tailored around the needs of the person, and not the organisation.
We discussed complaints with the registered manager. Complaints had been responded to by the registered manager and appropriately dealt with including any changes, which needed to be implemented because of the complaint.
Quality assurance procedures were robust and identified when actions needed to be implemented to drive improvements. We saw that quality assurance procedures were highly organised and processes had been implemented from another internal source to help support the service to continuously improve. We were shown these procedures by the registered manager during our inspection and how they worked.
Feedback had been gathered from people who used the service in the form of questionnaires. This was presented in a way people understood, containing a mixture of words and pictures.
We received positive feedback about the registered manager and the home in general. The registered manager clearly led by example, and had used innovative ideas to encourage and promote staff moral and teamwork.
Lethbridge Road is registered to provided accommodation and personal care for up to six adults with a learning disability / autism. It is a large detached house in a residential area of Southport. The service is run by Autism Initiatives. From the observations we made of the care in the home and from talking to people who lived in the home, as well as staff and visitors, it was clear that people living at the home were able to enjoy many aspects of daily living as well as learn adaptive strategies aimed at encouraging more independence.
This was an unannounced inspection which took place over two days on 27 and 28 November 2014. The inspection team consisted of an adult social care inspector.
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.
During our inspection we saw that staff and visitors were made aware of the need to ensure safety at all times. Visitors to the home commented that they always felt safe in the home environment as there was always staff available. Staff were seen as flexible in their approach which reflected the diversity of peoples care needs and support plans.
People living at the home were ‘safe’ from abuse because the staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported. Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People and their families told us there was sufficient numbers of staff on duty at all times.
We found some anomalies with the medication administration records [MARs] which meant that they were not always clear and there was risk that some medicines may be missed. We found some peoples records difficult to follow; especially those who had had medication changes recently. We told the manager our observations that staff had not followed some of the homes own policies around recording as well as good practice guidance. Staff felt that the current risk was low in terms of any medication errors as they were familiar with the people living at the home and their different medicines. We did not find any evidence that people had not received their medicines. The medication administration records did not support a safe practice however.
You can see what action we told the provider to take at the back of the full version of this report.
We observed staff supporting people in a way that ensured their safety whilst maintaining their dignity and promoting their independence. The care records we looked at showed that a range of risk assessments had been completed depending on people’s individual needs. These assessments were detailed and specific to specific behaviours and were aimed at trying to get the person to be as independent as possible, including accessing the local community safely.
Staff had been specifically trained in this approach which was also supported, in some instances, by the use of visual aids to make it easier for people to understand. We spoke with a relative who said this approach had been consistent and helpful and there relative was becoming more independent.
Professionals who visited the home gave us feedback about the care. This was wholly positive. We heard about how one-person living in the home had come on ‘‘leaps and bounds’’ and have extended their coping skills immensely. The professional explained that the person was now able to enjoy time in the community whereas previously they had been confined in the house. All professionals we spoke with gave positive feedback about the home. They described a proactive service which identified any issues regarding people’s health and ensured they received the right support and intervention.
We looked at the training and support in place for staff. We saw a copy of the induction for new staff and staff we spoke with confirmed they had up to date and ongoing training. One staff showed us the induction programme they had attended. This included sessions on autism which included Autism Initiatives five point ‘star’ framework to help understand people with autism. Specific communication strategies involving visual aids had also been learned.
The manager told us that most staff had a qualification in care such as NVQ [National Vocational Qualification] or Diploma and this was confirmed by records we saw where 60% of staff had a qualification. This helped show staff had the knowledge and skills to work with people at the home.
We looked to see if the service was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. We were told that all of the people at Lethbridge Road had capacity to make decisions about their daily life and care needs. Staff told us that time needed be taken to ensure information was clear and the right support was in place so that people could be enabled to make decisions. We saw this followed good practice in line with the MCA Code of Practice.
We were told that the home does not currently support anybody who is on a deprivation of liberty authorisation [DoLS]. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.
We discussed with staff and the people living at the home how meals were organised. We saw that people were involved in planning their own meals but there were also communal meals available. We saw that in the kitchen staff had put up meal suggestions aimed at promoting a more healthy diet. Individual meal plans were also displayed.
Communication was seen as a priority to carrying out care. We saw references in care files to individual ways that people communicated and made their needs known. We saw that these entries were detailed and were reviewed regularly. We also saw examples were people had been included in the care planning so they could see and play an active role in their progress. We noted there was positive and on-going interaction between people living at the home and staff. We heard staff taking time to explain things clearly to people in a way they understood. A relative told us staff were consistent in their approach and displayed a lot of patience and a caring attitude.
The staff we spoke with had a good knowledge of people’s needs. The pre inspection report (PIR) completed by the manager states: ‘’All staff members have an excellent knowledge about the individuals that we support and deliver all support in a caring, pro-active and personalised way. All staff are eager to learn and develop their own skills and knowledge and utilise this in a way that will benefit each service user.’’ This theme was supported by the observations, interviews and records we saw on the inspection.
People told us the staff respected their preferred routine. This could mean that plans agreed previously might have to be changed due to people making a different choice. Staff explained that this process in itself was important as the person was learning to manage how to change and plan their day depending on different circumstances. This showed a respect of the person’s right to choose as well as an understanding of the main aims of the support.
We looked at the care record files for three people who lived at the home. We found that care plans and records were individualised to people’s preferences and reflected their identified needs. They were very detailed and there was evidence that plans had been discussed with people and also their relatives if needed. We could see from the care records that staff reviewed each person’s care on a regular basis.
We observed a complaints procedure was in place and people, including relatives, we spoke with were aware of this procedure. An easy read version was displayed on the notice board in the entrance hallway. We saw that any concerns or complaints made had been addressed and a response made.
We enquired about the quality assurance systems in place to monitor performance and to drive continuous improvement. The manager was able to evidence a series of quality assurance processes both internally and external to Lethbridge Road that senior managers for the organisation carried out. These provided feedback and monitoring so that the service could continue to develop.
At the time of our follow-up visit, we found people in the home preparing for Christmas. Since our visit in October, there had been a programme of improvements to the home, which included re-decoration of communal areas and some of the bedrooms. The improvements to the kitchen and dining area will take place after Christmas when any disruption to people's routines would be minimized. The home appeared a lot fresher and homely as a result of the improvement worked already carried out. We noted many positive comments had been received from relatives of people who lived at Lethbridge Road.
When we reviewed people's care records, we found any treatment or care was consented to and staff understood people's right to make choices about how their care and support was delivered. People living in the home had access to other clinicians in the community, for example a GP, dentist or district nurse. This meant their overall health and welfare was maintained.
The provider had a robust safeguarding policy in place and training for staff on this was up to date. Staff we spoke with demonstrated their understanding of the term safeguarding and knew how to report any incidents or concerns.
We found quality monitoring systems were in place, but some areas of audit had been overlooked in the past. When we spoke with the provider they confirmed the new manager at the home was addressing these areas.
Three people told us they were able to make decisions and had control over their day to day lives. Two people told us of the holidays that they had planned and taken with family members. Another person told us " I go out shopping and for a walk when I like".
People told us they were involved in all day to day decisions within the home. We saw that care plans reflected people's needs and wishes and were periodically updated. People told us how they planned their own food menu, went shopping and prepared their own food choices.
We observed good interaction between people who use the service and staff who were on duty on the day of our visit. Staff were observed supporting people in a calm and supporting manner.One person told us "the staff are great, they are the best here".
Overall we found people we spoke with to be happy in the home and they all appeared comfortable and relaxed when talking to staff.