Pathway House

Pathway House is a residential care home providing personal care to seven younger adults who may be autistic or living with a learning disability. The service can support up to 12 people.

People had their own bedrooms at the service and shared communal areas such as kitchens, lounges, bathrooms and gardens.

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

People were not always supported in line with their personal choices and preferences. Staffing levels at the service prevented people from following their preferred past times. People were not always being supported to communicate and understand information in ways that made sense to them. People’s home environment was not treated with dignity and respect. Several areas were visibly dirty and notices around the service gave it a feel of being a ‘care home’ rather than a service that had been personalised according to people’s choices. Staff did not always describe people with dignity and respect in records.

The service was visibly dirty in some areas and there was mouldy food in cupboards. Audits had not been effective in identifying these concerns. Other audits completed at the service had not been effective in picking up on the areas for improvement which we found at this inspection in areas such as incident reporting, staffing levels and person-centred care. People and relatives were not always asked for their feedback about the service. We have made a recommendation about collecting feedback about the service.

Improvements needed to be made to the way that incidents, including those where physical restraint was used, were recorded and reviewed. We have made a recommendation that the incident reporting procedure at the service be reviewed. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, responsive and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staffing levels at the service prevented people from having maximum choice and control in their lives. People’s living environment was not always treated with dignity and respect. The service was in a remote location meaning having staff support to leave the service was essential, however staffing levels did not always allow this. The provider was taking action to mitigate this by reviewing their staff recruitment procedures and by the registered manager and deputy manager supporting people directly on shift to leave the service if they chose to do so. The registered manager was also ensuring that occupancy at the service remained low so that people could be supported in line with their personal preferences as much as possible.

Despite the areas we found to be needing improvement, people and their relatives were positive about the support at the service. One relative told us, ‘‘The service is the best place that [family member] has ever lived at. [Staff] really do care.’’

Staff were trained in safeguarding and knew how to report concerns. Risks to people had been assessed and plans were in place to mitigate risks as far as possible. Whilst staffing levels were impacting on people’s choices, there were enough staff to keep people safe. Staff, including agency staff were trained and understood how to support people. Staff were recruited safely in line with legislation. People were supported safely with their medicines. Staff followed effective infection control measures with regards to COVID-19.

Staff knew people well as individuals and knew what their likes and dislikes were. Support plans were very detailed and gave a clear overview of how to support people in line with their preferences. People were happy and relaxed being supported by the staff team. People were positive about how staff supported them to take part in preferred past times when this happened. A complaints procedure was in place and people and relatives knew how to raise concerns.

Feedback about the registered manager and deputy manager was positive. They were trying hard to instil a positive culture at the service which achieved good outcomes for people. The registered manager responded immediately to concerns raised at this inspection and gave us assurances that areas for improvement would be taken seriously and actioned. The staff team linked and worked with external professionals to help achieve good 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 (report published 31 January 2018).

Why we inspected

We received concerns in relation to the care and treatment of people using the service in areas such as the management of incidents and being supported to achieve good health outcomes. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

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. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pathway House on our website at www.cqc.org.uk.

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.

We have identified breaches in relation to safe care and treatment, person centred care, dignity and respect and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We spoke with the registered manager about the CQC’s document ‘Registering the Right Support’, which asks care homes providing support to people with learning disabilities, to work within certain guidelines. We confirmed with the registered manager that they were aware of this document. They had considered whether they needed to make any changes and felt they were already working within the principles of this model of support.

At our previous inspection in November 2015 we rated the service as good in all five of the questions we ask. The first inspection visit to the service took place on 22 November 2017 and was unannounced. We arranged to return for a second visit on 5 December 2017.

This service requires a registered manager as a condition of its registration. 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. There was a registered manager in post who had been managing the service since it opened in July 2014.

During our first visit we found that medicines were not always being managed safely. The registered manager carried out a thorough and objective investigation into all aspects of medicines management. The actions they took meant that by our second visit people were receiving their medicines safely and as they had been prescribed.

People felt safe living at the service, with the staff and with the support the staff gave them. People were protected as far as possible from abuse and avoidable harm by staff who were trained and competent to recognise and report abuse. Assessments of all potential risks to people and to staff were carried out and measures put in place to minimise the risks, without limiting the freedom that people wanted to take risks appropriately.

There was a sufficient number of staff with the right experience, skills and knowledge deployed to make sure that people were kept as safe as possible. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed. Staff were clear about their responsibility to report accidents, incidents and concerns and they followed the correct procedures to prevent the spread of infection.

Holistic assessments of people’s support needs were carried out before the person was offered a place at Pathway House, to ensure that the service could provide that support in the way the person preferred. Technology, such as a mobile phone for use when people went out unescorted, was used to enhance the support being provided.

Staff received induction, training and support to enable them to do their job well. When required, staff supported people to cook a meal or to contact external healthcare professionals such as GPs. The service had been effective in supporting a number of people to achieve what they wanted to achieve and move on to more independent living.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives praised the staff, had good relationships with them and described them as caring, supportive and professional. Staff made people feel they mattered and knew each person, and the details about the support the person needed, very well.

People were involved in planning their support and information about advocacy services was available if anyone wanted an independent person to assist them with their affairs. Staff respected people’s privacy and dignity and encouraged people to remain as independent as possible. People could have been supported to be more independent with preparing their own, healthy meals.

Each person’s support plan was fully personalised, agreed with the person and gave staff sufficient guidance to support the person in the way that would help them attain their goals. People planned their own activities and outings, with staff support.

A complaints process was in place and people, their relatives and staff were confident that any issues would be addressed by the management team. End-of-life care was not provided at Pathway House.

The service had received a number of compliments from people and their relatives. Staff and external professionals told us they would happily recommend this service to others. The registered manager provided good leadership and ensured that staff were clear about their role to provide people with a high quality service, thus upholding the values of the service. Staff felt well supported and happy to be working at Pathway House.

A quality assurance system was in place, including a number of ways in which people, their relatives, staff and other stakeholders were asked to give their views about the service and how it could be improved. Audits and monitoring checks on various aspects of the service were carried out and action plans were in place to ensure that any shortfalls were addressed.

The manager was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters. The service worked in partnership with other professionals to ensure that joined-up care was provided to people.