69 Chartridge Lane

69 Chartridge Lane is a residential care home providing personal care for up to six people. The service provides support to people with a learning disability, autistic people and people with a mental health condition. At the time of our inspection there were 6 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

We found the service had made many improvements since the last inspection. The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support

People received personalised care and support built around their needs and wishes. People had a consistent staff team who knew them well.

Staff were trained to deliver care and support in line with people’s assessed needs. People were relaxed and comfortable with the staff who supported them. Staff now supported people with their medicines in a safe way.

Staff assisted people to take part in activities and hobbies they had stated they enjoyed both inside and outside of the home. People's achievements were recorded and celebrated.

People’s communication needs were being met and staff understood each person's communication style.

The service ensured that there were a suitable amount of trained and skilled staff working at the service to meet people's individual needs. The provider carried out employment checks to ensure that staff were recruited safely and had the right skill mix to support people who lived at the home.

People had their rooms personalised to their individual preference. The living environment had been updated and kitchen refurbished.

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.

Right care

People received kind and compassionate care. Staff were understanding and responded well to people's needs. We observed, and relatives told us, people were treated with kindness and their privacy was respected by staff.

People's care and support was recorded in their support plans, which reflected their support needs and promoted their wellbeing and quality of life.

Staff were able to demonstrate how they protect people from potential risks, poor care and abuse. The provider ensured that measures were in place to help prevent the spread of infections.

Right culture

There had been significant changes in the home's management team since the last inspection. We found the new management had made many improvements in making the necessary changes to improve the service to good. This included, creating a positive culture where people, relatives and care staff felt supported and safe. There was ongoing training and supervision for staff to make sure practice always followed best practice guidelines. Relatives told us they had renewed confidence in the management of the home and felt appropriately involved and updated regularly.

The provider and registered manager consistently assessed, monitored and improved the quality of the service where possible. People and those important to them were involved in planning their care.

The service carried out a range of audits to ensure a good quality service was provided. This enabled people to receive a good service, which empowered people and the care was tailored to their individual support needs.

The service was clear on their responsibility to work with other agencies to ensure people were 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 inadequate (published 28 September 2022). 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.

This service has been in Special Measures since 10 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

69 Chartridge Lane is a residential care home providing regulated activities to up to six people. The service provides support to people with a learning disability, autistic people and people with a mental health condition. At the time of our inspection there were six 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 not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support

The service did not effectively support people in relation to recognised models of care for people with a learning disability, autism and behaviours that challenge, such as positive behaviour support approaches (PBS) and support to engage people in relation to their communication needs. As a result, whilst we saw features of positive support, including choice, participation, and inclusion, these were not consistent.

Right care

People were not protected from abuse. The provider had not always recognised or identified that certain incidents needed reporting and investigating to see if further risks could be reduced.

Staff did not always have the relevant skills or experience to ensure people received the appropriate care. Training had not been completed in line with people’s assessed needs.

There was no evidence of how people, or the people that were important to them, were involved with their care.

Right culture

People were not always supported by a management team and staff who fully understood the holistic needs of supporting people with learning disability and autism. The culture of the home restricted people as the ethos, values and attitudes of the management team and staff were not empowering.

The service had not taken the necessary action to address concerns such as risk of fire since the previous inspection.

Staff and managers had not received training in managing behaviours that challenge and how to support and reduce anxieties and triggers for behaviours. Staff and managers had not explored the importance of communication in both engaging people in making decisions and in helping people to manage distress and anxiety which could lead to incidents of harm to themselves and others.

The failure of the provider to fully meet the underpinning principles of Right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

People's medicines were safely stored and generally well recorded. However, we were not assured that all staff had received the training and had their competency assessed before administering medicines to people.

Staff training records showed that the provider’s required mandatory training had not always been recorded as having taken place. Staff told us they had not received training in people's specific needs, such as mental health, communication, autism and positive behavioural support.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 provider had enlisted the services of a Care Consultancy who had identified these issues before this inspection and had developed an action plan. However, at the time of the inspection not all necessary actions identified had been completed so we could not be fully assured of the effectiveness of these actions.

The provider and Care Consultancy were in regular discussions with relevant external bodies to provide an overview of improvements to ensure people’s safety.

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 (published 4 April 2020.

The overall rating for the service has now changed to inadequate based on the findings of this inspection. This service was rated as requires improvement at previous two consecutive inspections. 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received in relation to the provider’s management of risk. A decision was made for us to inspect and examine those risks.

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 monitor the service and will take further action if needed.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. The service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

69 Chartridge lane is a residential care home providing personal care up to six people with mental health and/or learning disabilities and autistic spectrum disorder.

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.

Six people were using the service at the time of our visit. 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

People told us they felt safe living in the service. Risks had been identified but action had not always been taken quickly to address and minimise the risk. We were concerned the staffing levels for night time were insufficient. We have made a recommendation about responding to the findings of risk assessments in a timely way.

Care documents were not always up to date or accurate, the registered manager had been away from the service for six months in 2019, a new manager was in post during this time. When the new manager left the service, the registered manager returned. They told us since their return some records had gone missing. Records were not always explicit in their detail, this meant it was difficult for the registered manager or others reviewing the information to get a clear picture of what care had been provided.

Improvements had been made to the storage and administration of medicines since our last inspection in 2017. At this visit we found the storage, administration and records related to medicines were safe.

Staff understood and practiced good infection control. Staff had received training in safeguarding people. Staff understood their responsibilities in protecting people from abuse. Safe recruitment processes were in place to ensure people were protected as far as possible from being cared for by unsuitable staff.

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.

Staff received support, training, supervision and appraisal in order they could provide care to a high standard. Care plans identified people’s food and drink preferences. Specialist professionals and agencies were involved in care provision where required, People were supported to healthcare appointments when needed.

The building was well maintained. People were able to personalise their own rooms with their chosen decorations and accessories.

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. From our observations and through discussions with staff, we ascertained care was person centred and focussed on people’s needs rather than the needs of the service. People were treated in a respectful and caring way by staff. Staff completed training in diversity and equality. This enabled them to understand the importance of respecting others.

The service was meeting the requirements of the Accessible Information Standard (AIS). People who had sensory losses such as a hearing loss or sight loss, had equipment to assist them to communicate with others

People were supported to participate in community activities and resources to fulfil their ambitions and interests. These included attending adult education classes and college, doing voluntary work at food banks and charity shops and enjoying social time in cafes, pubs and shopping.

People could live the life they had chosen. Staff offered them support to fulfil their own goals and aspirations.

The registered manager knew and understood their responsibility to implement duty of candour as part of the service provision. Staff and the registered manager understood the requirements of their roles and their responsibilities.

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 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe 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 69 Chartridge Lane on our website at www.cqc.org.uk.

Enforcement

We have identified a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because systems to assess, monitor and mitigate risks were not always effectively operated. Records were not always up to date and accurate.

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 previously inspected the service on 13 and 19 April 2016. The service was not meeting some of the requirements of the regulations at that time. This was in relation to staff recruitment practice, keeping the statement of purpose up to date and records of medicine administration. We asked the provider to make improvements to people’s care. They sent us an action plan which outlined the changes they would make. During this inspection we found improvements had been made in each of these areas.

69 Chartridge Lane provides support for up to six adults with learning disabilities. It was full at the time of our visit.

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.

We received positive feedback about the service. A relative told us “I am very happy” with all aspects of care that (name of person) receives at Chartridge.” Another relative said “We would definitely say that the home is providing safe, effective and compassionate care.” A third relative commented “I’m more than happy with the care.” They added “When I go to visit it’s like their home.” A healthcare professional had provided positive feedback to the home, saying “The residents are always well supported. The home is clean and tidy. The staff are always welcoming and helpful. My overall impression is that it is a warm and happy place, it is truly a home.”

We found there were enough staff to meet people’s needs and to support them to access the community. Staff had been recruited using effective procedures to protect people from the risk of harm. They were supported through supervision, staff meetings and a wide range of training. Staff understood their responsibilities to protect people from the risk of harm. They said they would report any concerns to the registered manager or provider.

Each person had a care plan which outlined the support they required. Risk assessments had been written to identify any potential areas where people may be injured or harm. Measures were then put in place to reduce those risks. Staff supported people to attend healthcare appointments to keep healthy and well.

We looked at medicines practice. We noticed medicines cabinets had been moved since the previous inspection and were no longer affixed to a wall; instead they were free standing within a lockable stationery cupboard. We advised the registered manager this arrangement may not be secure. We also noticed some medicines were stored in a plastic crate at the bottom of the stationery cupboard. Action was taken whilst we were at the home to improve arrangements. After the inspection, we were sent photographic evidence of the cabinets now secured to the wall.

We also found staff had not noticed a medicine had expired and had continued to use it three months after the manufacturer’s expiry date. The registered manager addressed this straight away. However, systems within the home and staff who administered medicines had not noticed this medicine was out of date.

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.

The building was well maintained and complied with gas and electrical safety standards. Regular fire safety checks and drills were carried out. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

The provider checked the quality of care at the service through visits and audits. Required records were maintained by staff. Most records were kept securely in the office when not is use. We advised the registered manager to fit a lock to an archived records cupboard to prevent unauthorised access to people’s personal records.

We previously inspected the service on 13 February 2014. The service was meeting the requirements of the regulations at that time.

69 Chartridge Lane provides support for up to six adults with learning disabilities. It was full at the time of our visit.

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.

We received positive feedback about the service. Comments from people included “Staff have been absolutely tremendous,” “It’s superb here,” and “Staff support me when I need help.” A relative described the service as “It’s like a family home.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service to enable people be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care.

People’s medicines were not consistently managed safely as records of medicines administration were not always accurate. Staff supported people to attend healthcare appointments to keep healthy and well.

Staff received appropriate support through a structured induction, regular supervision and staff meetings. We saw there were sufficient staff to meet people’s needs. We found staff had not always been recruited effectively to make sure they had the right skills and experience to support people safely.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs. The service listened to people’s views and involved them or their relatives in decision-making. People were supported to take part in a wide range of social activities.

There had not been any complaints about the service. People knew how to raise any concerns and were relaxed when speaking with staff and the registered manager.

The building was well maintained and complied with gas and electrical safety standards. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

The provider regularly checked the quality of people’s care through visits and audits. There were clear visions and values for how the service should operate and staff promoted these. Records were generally maintained to a good standard and staff had access to policies and procedures to guide their practice.

We have recommended the service follows good practice in relation to staff training before people are admitted to the home.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to recruitment practice and maintenance of accurate medicines records. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the home had not updated its statement of purpose. You can see what action we told the provider to take at the back of the full version of this report.

We saw that people were well cared for and treated with respect and dignity. People told us or indicated that they liked living in the home.

We found that people were prescribed medication by their doctor which was given to them safely and at the correct times. We saw that the medicines in the home were stored properly, in locked cabinets in locked rooms or cupboards.

We found that there were enough properly trained staff to meet people's individual needs. People told us or indicated that staff were good and one person told us that ' my staff are lovely'.

We found that the home had ways of looking at the care they offered so that they could make sure they maintained and improved it. We saw that they listened to the views of the people who lived in the home.

We saw that the home took health and safety seriously and kept people as safe as possible.

We saw that all staff had attended safeguarding of vulnerable adults training, and were able to clearly describe different types of potential abuse. The staff told us they would immediately inform their manager if they had any such concerns, and were confident it would be quickly and appropriately addressed. The home had access to an Advocacy service, although none of the people who live there had used it.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work and this protected vulnerable adults who use the service.

We noted staff had received appropriate professional development and had access to regular supervision. This demonstrated a commitment to improving the high level of care given to people at 69 Chartridge Lane.