Archived: Real Life Options - 18 Bisley Drive

Real Life Options-18,Bisley Drive is a residential care home providing accommodation and personal care to up to 7 people with a learning disability or Autism Spectrum condition. The service provides short term, respite care. At the time of our inspection there were 4 people using the service.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

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. The service was flexible and adapted to people's changing needs and wishes and promoted their independence. Care was completely centred and tailored to each individual. A relative commented, “[Name] likes going out and about, but staff will respect whatever [Name] wants to do, even if that means some private time.”

Risk assessments were in place. They identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks, including positive risk taking. Staffing capacity was sufficient and staff deployment was effective to ensure people's needs were met in a safe, timely and consistent way. A relative commented, “Staff are friendly and professional, they do care about the people. They have formed a relationship with us as family members. The staff are regular and the continuity helps.”

Systems were in place for people to receive their medicines in a safe way. Staff were encouraged to continue their professional development in order to progress and provide the best outcomes for people. Staff demonstrated that they really understood the importance and benefits of providing person-centred care. The service was following safe infection prevention and control procedures to keep people safe.

Right Care

The staff team supported some people with complex needs. People's diversity as unique individuals with their own needs was well-respected by staff. The staff team knew people extremely well and provided support discreetly and with compassion. People’s privacy was respected, and people were supported to maintain contact with relatives and friends. There was clear evidence of collaborative working and excellent communication with other professionals to help meet people's needs and enhance their quality of life. Everyone complimented and highly praised the staff team. Comments from relatives included, “Staff are all spot on, they are all great” and “It’s fabulous, they are brilliant staff there. I could go on all week, to tell you how much I love that service. It’s just a fantastic place, I can’t find anything wrong with them. I could go there myself for a holiday. I know [Name] is being really well looked after.” People were encouraged and supported to lead as fulfilled a life as possible. They were supported to follow their dreams and aspirations. A relative said, “[Name] is probably out nearly every day when they’re there, they have a better social life than I have.”

Right Culture

Real Life Options-18,Bisley Drive was exceptionally well led. The provider's vision and values were truly person-centred to make sure people were at the heart of the service. This vision was driven by the exceptional leadership of the registered manager and management team. There was a positive atmosphere at the service. Staff spoke very positively about working at the service and the people they cared for. Staff said the management team were very approachable and they were supported in their role. There was a very strong and effective governance system in place. People, relatives and staff were very confident about approaching the management team if they needed to. They recognised that their views and feedback were valued and respected and consistently used to support quality service development. Strong processes were in place to manage and respond to complaints and concerns.

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 19 October 2017).

Why we inspected

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

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Real Life Options-18,Bisley Drive on our website at www.cqc.org.uk.

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 remained good. This is based on the findings at this inspection.

Follow up

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

We found the following examples of good practice.

Staff were confident and knowledgeable about government guidance and what visitors were required to do prior to entering the service. Professional visitors and relatives were tested for COVID-19 at the service or provided a negative lateral flow test result from that day. Visiting professionals and staff provided evidence of their vaccination status to the registered manager before entering the service.

Staff wore appropriate PPE and could explain what PPE to wear and how to safely put on/remove their PPE. PPE was available throughout the home and there were designated PPE stations.

The management team had effective systems in place to check that safe infection prevention and control processes were being followed by staff.

A manager was in place and they had applied to become registered with the Care Quality Commission. 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.

At the last inspection in June 2016 the service was not meeting all of the legal requirements. People were not always protected from the risks of inappropriate care because care records were not always complete to ensure their needs were met and people were at risk of being deprived of their liberty without proper authorisation. At this inspection we found improvements had been made and the service was no longer in breach.

Care plans were individualised and contained comprehensive personalised information about the person and their preferences.

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 were supported to make decisions about their care and support and staff obtained their consent before support was delivered. The service was able to assist people to access an advocacy service where people had no family or personal representative.

Staff we spoke with were knowledgeable about the people they supported. They were aware of their preferences and interests, as well as their health and support needs.

The provider ensured the right mix of staff with appropriate knowledge and experience were readily available to make sure people’s needs were met.

Staff had received safeguarding training and were knowledgeable about how to protect people from abuse.

The provider continued to maintain an effective recruitment process. People were involved in the selection and interviewing of potential new staff members.

Training and development was up to date and staff told us they received regular supervisions and appraisals.

Where risks were identified they were assessed and managed to minimise the risk to people who used the service and others.

The provider had a thorough continuity plan in place to ensure people would continue to receive care following an emergency. Checks were in place to maintain the safety of the home.

People were supported to receive their medicines in a safe manner. Medicines records we viewed were complete and up to date.

Feedback was sought from people, relatives and staff in order to monitor and improve standards.

People were provided with a choice of healthy food and drinks to help ensure that their nutritional needs were met.

Relatives and people told us staff were kind and caring. We observed many happy interactions between staff and people living at the service, people were comfortable in the company of staff.

The service planned activities around the wishes of people staying at Bisley Drive. Staff told us they ran the service like a hotel.

The service had an easy to read complaints and compliments procedure was in place. This explained how to make a complaint and what would happen.

Staff told us they felt supported by the manager.

This inspection took place over 21, 27 and 30 June 2016. We gave the service 24 hours’ notice about the visit.

Bisley Drive is a short-break service providing care and support during a holiday-style stay for people with a learning disability, some of whom may have physical disabilities. The service is registered to provide seven places. There were five people staying there at the time of this inspection. The service does not provide nursing care.

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.

For some people there were no capacity assessments or best interest decisions recorded for restrictive practices, for example use of bedrails or wheelchair straps. This meant they were potentially restricted without the proper authority to do so.

Some people’s individual care records did not accurately reflect their needs or were incomplete. This meant that it was not always possible to be clear if a person was supported in the right way.

During this inspection we identified two breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe and comfortable at the service. They said they enjoyed their holidays at Bisley Drive and regularly stayed there. A relative said, “My [family member] has been using the service for years. They like it and we’ve had no problems with it. They’re well looked after.”

People, relatives and staff felt there were always enough staff to help people to have an activity-based holiday. The registered manager said staff were “very accommodating” and flexible to work at short notice if more staff were needed to meet guests’ needs.

Staff were vetted before they started work at the service to make sure they were suitable to work with vulnerable adults. The staff managed people’s medicines in a safe way for them. Staff were clear about how to recognise and report any suspicions of abuse. There were clear systems for staff to be able to raise concerns.

People told us staff were “good” at their jobs and relatives told us staff were competent and skilled. One relative said, “The staff training is good. A lot of them have worked there for years and they’re very experienced – I can’t fault them.”

Staff told us they felt they received sufficient training to carry out their roles. One support worker told us, “I had lots of induction training before I even started. They make every course available to you and then mandatory training is annual.”

People’s views about the service were very positive. One person told us, “I like it very much. I really enjoy it.” Relatives told us, “All the staff are very nice,” and “it’s small and friendly”. One relative commented, “The atmosphere is very good. They keep it well decorated and furnished so it’s a nice place to stay.”

There were friendly relationships between the people who were staying there and the staff members. One person commented, “I really like the staff, they’re all lovely.” Staff felt their colleagues were caring and supportive towards people. One newer staff member told us, “I can honestly say I’ve never met a nicer group of care staff. They’re so patient and understanding.

People said there was a range of activities to choose from during their stay. People said they were asked what they would like to do before they stayed at the service and this was arranged for them. Relatives and staff felt activities could be a bit limited for some people since the service no longer had a vehicle.

People were able to show if they were unhappy about a situation. Relatives had information about how to make a complaint and said they felt able to raise any issues.

Relatives felt the organisation was well run and that the registered manager was “open and approachable”. Staff felt supported by the registered manager and said they did a “fantastic job”.

Staff felt valued and informed by the provider. Their comments included, “The organisation makes me feel like it’s a worthwhile job that we do” and “they keep us informed”. The provider had a quality assurance system to check the quality and safety of the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the relatives of people at the service, staff supporting them, and from looking at records.

Is the service safe?

The service was safe. During the planning of this visit we received some concerns from a relative about the moving of staff from another of the provider's locations to 18 Bisley Drive. People were concerned staff may lack accurate knowledge of the people they were caring for and families had not been properly consulted or involved before a decision was made. We were unable to substantiate and confirm these concerns at this visit.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications had been made to notify the CQC of issues involving the Deprivation of Liberty safeguards the home manager was aware of the recent Supreme Court decision to clarify what constitutes a deprivation of liberty. She agreed to re-assess all of the people using the services at 18 Bisley Drive and forward on any relevant notifications to the CQC. We saw a copy of the safeguarding adults policy and a guide for staff on how to report safeguarding incidents. Staff had received safeguarding training and understood how to safeguard the people they supported.

Is the service effective?

The service was effective. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, however not all of the support plans and risk assessments were signed by the person using the service or their representative and not all were signed and dated by all members of staff. We found that people who used the service were receiving the care and support they needed. The staff we spoke with could describe how they met the assessed needs of the people they were providing with care.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. Relative's feedback from surveys said 'We think the staff are very caring and they have a good understanding of her needs.'

Is the service responsive?

The service was responsive. Records showed that people's preferences, interests and needs had been taken into account and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with relatives and make new friends. People knew how to make a complaint if they were unhappy. One person told us 'I am very satisfied coming here.'

Is the service well-led?

The service was well-led. The home was being managed by a person who had been in post since March 2014, and was collating all of the necessary documentation to submit her application to the CQC as the registered manager for this service.

The provider undertook regular audits to check the quality of service, including the views of family members and professionals responsible for the care of people. The provider may find it useful to note that some of the shift handover notes had not been fully completed and gaps we noted in some people's records had not been picked up during the audit process.

The manager held regular team meetings with staff and asked people and their relatives their opinions on how the service was run. Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.