CareTech Community Services Limited - 15 Brooklyn Road

15 Brooklyn Road is a residential care home providing accommodation and personal care to up to six people with learning disabilities and autism. At the time of the inspection four people were living in the home.

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.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Improvements had been made to the provider's quality assurance systems to effectively identify and respond to shortfalls. There were a variety of audits completed to ensure the quality of the service was maintained and improved.

We were assured the service were following safe infection prevention and control procedures to keep people safe. People lived in a clean and pleasant environment, maintenance work was either underway or planned.

There was an open and transparent person-centred culture within the service. Staff were clear about their responsibilities told us they felt well supported, appreciated and valued.

Staff closely monitored people's risks and action was taken when people’s needs changed to continue to keep them safe. When safety incidents occurred, these were reviewed and action taken to keep people safe.

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 Requires Improvement (report published 17 October 2019) and we identified one breach of regulation 17 Good Governance. 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 in this area inspected and the provider was no longer in breach of regulations.

The service’s overall rating has improved to Good.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also 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 coronavirus and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CareTech Community Services Limited – 15 Brooklyn Road on our website at www.cqc.org.uk.

15 Brooklyn Road is a residential care home providing accommodation and personal care to up to six people with learning disabilities and autism. At the time of the inspection five people were living in the home.

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.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There had been a significant turnover of support staff, managers and senior management. Relatives expressed great concern over this and told us people’s needs may not have been met.

Professionals told us the service was ‘fragile’ and the loss of one or two key members of staff could potentially mean a crisis in the service.

Audits had not identified the hygiene and cleanliness requirements in the kitchen, shower room, toilets and communal areas.

The lack of robust, consistent management meant the providers service development plans had not been completed. Some key documents and care plans had not been signed as read by all staff and one notification had not been sent to CQC.

Care plans were person centred and had been recently reviewed. This meant information on how to appropriately meet people’s needs was up to date. There was only one exception to this, one person’s epilepsy plan needed to be updated following new treatments and outcomes for the person.

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 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.

The staff provided caring respectful and dignified care. Staff and people had positive relationships. People had their own private space and relatives were happy with the newly developed garden space.

The provider had recruited a new home manager. There was confidence from the locality manager and support staff that this would mean further improvements within 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 (and update) The last rating for this service was good (published 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

This unannounced inspection took place on 30 November and the 1December 2016.

15 Brooklyn Road is a care home without nursing care for five people with learning disabilities and autism. People who use the service may have additional needs and present with behaviours which can be perceived as challenging others. There are two communal lounges and a kitchen/ dining room. There was 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.

One relative told us they had no worries about the service and felt it was a safe place. The staff had the knowledge to protect people from the risks of potential abuse and report any allegations of abuse. Safeguarding incidents had been thoroughly investigated and reported in writing to the commissioners and the local authority safeguarding team. The correct action was taken by the registered manager to prevent further incidents between people. We have made a recommendation the service considered it’s responsibilities around meeting regulatory requirements for notifications.

Individual risk assessments were completed which minimised risk for people helping to keep them safe and as independent as possible. All accidents and incidents were recorded and had sufficient information to ensure preventative measures were identified.

We observed staff responding to people in a calm and compassionate manner consistently demonstrating respect. Staff knew peoples individual communication skills, abilities and preferences. Staff supported people to choose activities they liked. People had taken part in activities in the community and holidays with staff. People were supported by sufficient staff and they were able to access the community with them.

Staff were aware of the Mental Capacity Act 2005 (MCA) to protect people when they needed support for certain decisions in their best interest. Care plans included people’s mental capacity assessments and identified how choice for each person was displayed by them. Most people made everyday decisions as staff knew how to effectively communicate with them. The service was working within the principles of the MCA and Deprivation of Liberty Safeguards (DoLS) and conditions on DoLS authorisations to deprive a person of their liberty were being met.

A range of social and healthcare professionals supported people. They told us the support provided to individuals clearly reflected a person centred approach and staff were knowledgeable about people’s needs. Medicines were well managed and given safely. People’s care plans identified how people liked to take their medicines. People were supported by staff that had the skills and knowledge to meet their needs. There was a choice of meals and people went shopping with staff for fresh produce they could choose.

Quality checks were completed and examples told us that action plans identified where changes were made to address any shortfalls. Relatives and health and social care professionals were asked for their opinion about the service. The registered manager was accessible and supported staff, people and their relatives through effective communication.

Care records were concise and contained appropriate detail about people's needs and preferences. Staff were familiar with the content and followed the plans. Nutrition was well managed and people were encouraged to eat a balanced diet to achieve a healthy weight. People still had choices and could eat things they liked. Staff knew about people's anxieties around food.

Medication was well managed within the home. Work had been done to reduce the covert administration of medication and was ongoing to review potentially unnecessary medication. The use of 'as required' medication for anxiety was closely controlled.

Staff told us that they now felt well supported. There was a system for monitoring training and staff had received relevant training. Supervision meetings and appraisals were being undertaken to support development.

People and staff were being consulted about the quality of service provision. The issues identified were being addressed and monitored. The problems with the environment were being addressed.

We saw positive interactions between staff and people using the service. One person told us 'I like living here'. People were supported to be as independent as possible and staff worked well with most people to meet their social and physical needs. We could see that people felt comfortable with staff.

The home was safe but the bathrooms were old and much of the decoration needed renewing. Some of the flooring needed replacing to ensure cleaning can be effective.

A range of activities were open to people, including access to cookery at college, cake baking, knitting or shopping in the local area. There were planned activities and these varied depending on how well people felt. People were encouraged to take part in general tasks around the home such as cooking and washing.