Support for Living Limited - 246 Haymill Close

About the service

Support for Living Limited - 246 Haymill Close is a care home for up to 7 people with learning disabilities and/or autism. At the time of our inspection, 7 people were living at the service.

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

The service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. However, they needed to make improvements to fully meet these.

Right Care

People received kind and compassionate care and staff respected their privacy, but their dignity was not respected at all times.

Staff understood and responded to their individual needs. They communicated with people in ways that met their needs.

The service had enough staff to keep people safe. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff attended training and completed an induction to help them support people.

Right Culture

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support.

There was a service culture of supporting people to receive compassionate care that was tailored to their needs, but we received mixed feedback about the leadership at the home.

The service involved people and those important to them, including advocates, in planning and reviewing their care.

Right Support

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; however the policies and systems in the service did not support always this practice.

Staff supported people with their medicines safely, but the medicines management arrangements were not always effective.

Staff enabled people to access health and social care support in the community.

People had some choice about their living environment and were able to personalise their rooms. Staff supported people in a clean and equipped environment and the provider had processes in place to maintain this.

The provider follow appropriate recruitment procedures to ensure only suitable staff were recruited to work at the service.

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 1 July 2022).

Why we inspected

We received concerns in relation to providing safe support to people. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We inspected and found there were concerns with promoting people’s dignity and working in line with the Mental Capacity Act 2005, so we widened the scope of the inspection to become a focused inspection which included the key questions of Caring and Effective as well. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Support for Living Limited - 246 Haymill Close on our website at www.cqc.org.uk.

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

Enforcement

We have identified breaches in relation to treating people with dignity and respect, safe care, record-keeping and governance at this inspection. Please see the action we have told the provider to take at the end of the full version 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.

About the service

Support for Living Limited - 246 Haymill Close is a care home for up to eight people with learning disabilities and/or autism. At the time of our inspection, seven people were living at the service.

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

Right Support: The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff did everything they could to avoid restraining people. The service supported people to have the maximum possible choice, control and independence. People had control over their own lives.

Right Care: Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. 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. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks

Right culture: Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

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 rating at the last inspection was requires improvement (published 2 November 2019).

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 focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Support for Living Limited - 246 Haymill Close on our website at www.cqc.org.uk.

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 also undertook this inspection to assess that the service is applying the principles of Right support right care right culture within the areas we inspected.

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.

The care home accommodates people in one adapted building. 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

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. The registered manager was working in line with the Mental capacity Act 2005.

However, we found some risks to people had not been mitigated when we inspected the service. This included, some potentially harmful items left unsecured in the garden and kitchen. Access to the building was not being monitored in a robust enough manner. This was because individuals from other units had access to the building without the knowledge of staff overseeing the home.

Generally, medicines were administered appropriately but we found the use of some medicines was not always stated. There was a concern therefore staff might not realise the importance of specific medicines.

The registered manager assessed staffing levels, but we found staff were at times too busy to spend time with people as people’s support needs had increased significantly. We have made a recommendation to the provider to review staffing levels in line with national guidance.

Notwithstanding the above, relatives and professionals told us people seemed well cared for by staff who were kind and knew people well. Some people had been supported so well that incidents where they behaved in a way that challenged had reduced and their medicines had been reviewed and reduced to reflect that positive change.

Staff ensured people had access to health and social care professionals. Staff followed professionals’ recommendations and guidelines. When necessary training was provided to manage people’s changing health support needs.

Staff told us they received appropriate training and felt well supported by the management team. They found the registered manager approachable as did people’s relatives who felt they could raise a complaint or issue.

Staff communicated with people in a manner they could understand and were observed to be respectful and promoted people’s dignity.

People were supported to attend activities that reflected their preferences and were supported to access the local community to meet friends and socialise.

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 some restrictive intervention practices in the form of medicines as a last resort, in a person-centred way, in line with positive behaviour support principles. The provider had worked successfully with their own behavioural support team and health care professionals to reduce the use of these medicines and incidents of behaviour that challenged the service had also reduced.

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 on the 19 January 2017 (published 15 March 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. The provider took immediate action to address the concerns we found during our inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

246 Haymill Close is a residential care home, which provides accommodation and personal care for up to eight people. The service specialises in the care and support of adults who have moderate to profound learning and physical disabilities. At the time of our visit there were eight people using the service.

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.

Family members told us that the majority of staff at the service were caring and they were happy with the care offered to their relatives.

The service protected people from harm and abuse. Staff had safeguarding of vulnerable adults training and they knew how to report any safeguarding concerns they might have. Safeguarding information was displayed throughout the service.

The service assessed the risk to people's health, safety and welfare. Staff had detailed guidance on how to minimise risk to people’s wellbeing.

The service had recruitment procedures to ensure only suitable staff were appointed to work with people who used the service.

There were sufficient staff numbers on each shift to meet people’s needs.

Medicines were stored safely, and people received their medicines as prescribed.

Relatives told us they had confidence in staff and they felt the service had a good understanding of their family member's support needs.

Each new staff member undertook an in-depth induction that consisted of the training the provider considered mandatory. Staff also received yearly refresher training to ensure continuous review of the skills and knowledge needed to support people they cared for.

Staff received regular supervision and appraisal of their work to ensure the best possible support was provided for people they cared for.

CQC is required by law to monitor the implementation of the Mental Capacity Act (MCA) 2005 and the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and least restrictive way, when it is in their best interests and there is no other way to look after them. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have the capacity to consent to specific decisions, staff involved relatives and other professionals to ensure that decisions were made in the best interests of the person and their rights were respected.

The service had monitored people’s nutritional needs to make sure these were being met. Family members told us they were happy with how the service supported people to have sufficient food and drink.

People were supported to maintain good health and to have access to healthcare services. The staff made appropriate referrals in a timely manner to ensure that people’s changing health needs were addressed.

The service supported people in pursuing their individual choices and supported them in achieving personal goals.

Staff demonstrated a good knowledge of people's personal needs and preferences, which they knew from people’s care plans and day-to-day interactions with them.

Staff delivered care which protected people’s dignity and privacy. People could choose if a male or a female worker supported them during personal care.

People received care that reflected their needs, interests, personal preferences and aspirations. The staff encouraged people to make choices and have control where possible.

The service regularly reviewed people’s care needs and involved people and their relatives in the process. Staff informed family members about any changes to people’s health and wellbeing.

People who used the service had access to a range of activities in the home and the local community.

The provider had a complaints policy and procedure in place and family members said they were happy to approach the management team with any complaints.

The registered manager promptly addressed with staff any training gaps and performance issues.

The service had internal auditing and monitoring processes in place to assess and monitor the quality of service provided.

Family members and the staff team said that the service was well led and they felt supported by the registered manager.

Following our inspection that was carried out on 12 September 2013, we issued a compliance action to the provider because they were not compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place in respect of the recording and administration of medicines.

The provider told us that arrangements would be reviewed and action would be taken to ensure compliance by the 6 December 2013.

During this inspection we found that the provider had addressed shortfalls identified with medicines management and medicines were being managed safely and people were receiving the medicine they required.

We saw that staff had a good understanding of people's individual needs and capabilities. Relatives told us they were involved in the development and review of care plans.

The arrangements for the management of medicines were not always effective in protecting people against the risk associated with medicines.

People had equipment that promoted their comfort and independence.

There were sufficient numbers of staff on duty to meet people's needs. All relatives we spoke with spoke of their satisfaction with the staff and the care their family member received. Comments we received included 'they talk to my family member respectfully, the staff are good, they really are excellent' and 'The staffing at the home is consistent and this is good for my family member, it means the staff know my family member and my family member knows them'.

There were appropriate systems in place to minimise the risk of abuse to people, and staff received relevant training to support them when working with people.