We carried out a review of the data available to us about LD Care on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about LD Care, you can give feedback on this service.
About the service
LD Care is a care home for up to nine adults with learning disabilities. Some people also had additional physical disabilities and autism. The service is managed by LD Care Limited, a private organisation providing care and support in four registered care homes in the London Boroughs of Hounslow and Richmond upon Thames. At the time of our inspection, nine young adults 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 the underpinning principles of right support, right care, right culture.
Right Support
The staff supported people to have maximum possible choice, control and independence. They used personalised communication strategies to support people to understand and make choices. They found creative ways to promote learning and for people to develop new skills. Staff focused on people's strengths so people could have fulfilling and meaningful lives. They saw people as individuals and planned care according to their personalities and interests. Staff supported people to pursue their interests and achieve aspirations and goals. They overcame barriers and found ways to help ensure people took part in a wide range of age appropriate social activities. Staff supported people to be valued members of the local community. Staff did everything they could to avoid restraining people. People benefitted from the interactive and stimulating environment which was adapted to meet their individual needs. Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Right Care
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. 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. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Staff supported people to take positive risks.
Right Culture
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs and rights at the heart of everything they did. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this focused inspection to assess that the service is applying the principles of Right support right care right culture.
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 good to outstanding. This is based on the findings 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.
Rating at last inspection
The last rating for this service was good (published 3 November 2017).
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.
There were suitable arrangements to keep people safe during the COVID-19 pandemic. These included well organised systems where allocated staff took responsibilities for overseeing COVID-19 testing, checking people's wellbeing and health daily and making sure the environment was clean.
There were suitable policies and procedures in place and the provider had assessed risks for people using the service and staff. There were regular infection prevention and control audits.
The staff undertook training and had the information they needed to support them in this aspect of their role. The provider set up learning sessions for staff where they discussed specific topics. These included COVID-19, the impact of the pandemic and infection control. The staff also shared information with friends and families to make sure they knew about changes in guidance as well as the procedures followed at the service.
The staff told us they had developed their knowledge and understanding during the pandemic. They had worked well as a team learning when things had gone wrong and supporting one another through difficult times.
The staff told us they felt a strong sense of community and support for one another, the people using the service and their families.
People using the service had continued to have active and full lives, even during periods of lockdown. The staff had used the home environment to create new activities, had helped people develop skills such as cleaning and cooking and had helped people develop their literacy and numeracy skills. People had continued to access the community in a safe way and had regular opportunities to see their friends and families.
At the last inspection on 6 October 2015 we rated the service Good in all the five questions we ask and overall.
At this inspection on the 19 September 2017 we found the service remained Good. The service has continued to meet all the required Regulations and has demonstrated outstanding practice in some areas.
People were safely cared for at the service. The staff understood how to keep people safe and followed guidance around this. There were clear risk assessments outlining how to avoid harm and support people in the way they needed and the staff followed these. The staff reflected on their own practice and discussed the most effective ways to support people. As a result, there was a reduction in incidents of physical challenges and harm.
People received their medicines in a safe way and as prescribed.
There were enough staff to keep people safe and meet their needs. The staff were well trained, supported and supervised. They had opportunities to discuss their work and learn from each other. They felt they had opportunities for career development and spoke about personal achievements which they felt had been made possible through their work at the service. The staff were recruited in a way which included checks on their suitability. The staff worked well as a team and felt there was positive and useful communication with each other which benefited the people who used the service.
People were unrestricted in their movement around the service and the activities they chose to participate in. The provider had acted within the principles of the Mental Capacity Act 2005. 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 with their healthcare needs. The staff worked in partnership with other professionals to ensure people received person centred health care and support. For example, supporting them with their fears and anxieties to be able to access the health care they needed.
People's nutritional needs were being met and the staff had worked hard to support people to achieve healthy weights and make positive choices about the food they ate.
The staff were kind, caring and thoughtful. They respected people's individuality and displayed empathy when offering support. People living at the service had complex communication needs and the staff had taken great care to understand these individual needs and ensure that people had information in a way which they understood and felt comfortable with. The staff were patient and did not rush people. They had adopted nationally recognised good practice techniques to develop their own understanding of what people were trying to convey. The time and dedication spent by staff in this area had resulted in people expressing themselves in ways they had not before and being able to accept support with their personal physical care needs which they had previously resisted.
The service adopted an exceptionally person centred approach. People's individual needs and preferences were clearly recorded and the staff knew them well. The staff reflected on their work and understood how people were feeling. They provided support at a pace which people felt comfortable with. Therefore they were able to help people to overcome fears and achieve personal objectives. People had learnt new skills and had developed their independence and confidence.
There was a positive and open culture where people felt listened to and valued. People's representatives and staff felt the service was well managed and the registered manager offered support and guidance. There were appropriate systems for assessing the quality of the service and making improvements. Records were in place and were up to date and accurate.
The inspection took place on 6 October 2015 and was unannounced.
The last inspection of the service took place on 15 December 2014 when we identified no breaches of Regulation.
LD Care is a care home for up to nine adults who have a learning disability. They also have a range of other needs including autism. At the time of our inspection nine people were living at the home. The home is run by a local organisation L D Care Limited, who own and manage two other care homes within the London Borough of Hounslow.
There was 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 and associated Regulations about how the service is run.
The risks people experienced had been assessed and there were plans to minimise these.
The staff undertook safeguarding training, procedures were available and the provider had taken steps to safeguard people from abuse.
People received the medicines they needed.
There were enough staff to meet people’s assessed needs and the recruitment procedures were designed to make sure the staff were suitable to work with vulnerable people.
People’s capacity to consent had been assessed and they were supported to make decisions about their own care. Where people were unable to consent, decisions about their care had been made in a lawful way and in their best interest.
The staff had the training and support they needed to care for people effectively
People’s health needs were assessed, monitored and met.
People had the right food and drink they needed to stay healthy.
People had good relationships with the staff. The staff were kind, caring and polite.
People’s privacy and dignity were respected. People’s care was planned and met in a person-centred way which reflected their needs and wishes.
People were able to make a complaint; these were appropriately investigated and responded to.
The provider, manager and staff undertook audits on the service which identified risks and led to improvements.
We last inspected the service on 10 June 2014. At this inspection we found people were not sufficiently protected from the risks of inappropriate care and treatment because the medicines were not handled appropriately. We also found the provider could not guarantee that people were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider told us they would make the necessary improvements by 31 July 2014. We visited on 15 December 2014 to see if the improvements had been made.
We spoke with four members of staff including the registered manager. We met five people who lived at the home, but they were not able to tell us about their experiences of living there. We looked at records relating to staff recruitment, training and supervision, how medicines were stored and records about medicines. We saw that people appeared relaxed and comfortable, the staff were kind and caring towards the people they were supporting. Medicines were appropriately managed and the recruitment procedures ensured that the suitability of staff was checked before they started working in the home.
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
Is the service safe?
The service was not always safe. People's needs were assessed and plans were in place to meet these needs. There were enough staff on duty to meet people's individual needs. The environment was clean and well maintained and there regular were checks on the safety and suitability of the building and equipment. However, people's medicines were not being managed in a safe and appropriate way. Therefore they were at risk of receiving inappropriate care or treatment.
Is the service effective?
In general the service was effective. People's health and care needs were assessed and planned. The provider had made improvements to the way in which people's care was planned and delivered. People were supported by a range of different health care professionals. However, the provider's failure to effectively manage people's medicines put people at risk.
Is the service caring?
The service was caring. The staff were kind, polite and respectful towards people. They communicated clearly and checked people had understood them. One of the external professionals who we spoke with told us they thought the staff showed genuine fondness towards the people they were caring for. There was clear information for the staff so they knew about people's individual needs and choices. Families of people living at the home told us they felt the service was very caring.
Is the service responsive?
The service was responsive. The provider had listened to the concerns we had identified at the last inspection and had taken action to put these right. The professionals who we spoke with told us the service responded to the suggestions they had made and this had helped to ensure people's needs were being met. Where people had experienced a change in their needs the service had responded by adapting the care they provided, for example people's diet had been changed to incorporate recommendations from the dietitian.
Is the service well-led?
There was a registered manager at the service. She demonstrated a good knowledge of the people living at the home and their individual needs. The staff who we spoke with told us they felt supported. They were aware of their responsibilities and accountabilities.
The provider had an effective system to regularly assess and monitor the quality of the service that people received.
We last inspected the home on 30 August 2013. We found that records had not always been accurately completed. The provider told us they would make sure these were accurate by 11 October 2013. At this visit we found that although some improvements had been made, some of the records were still inaccurate and therefore people were put at risk of unsafe and inappropriate care.
There had been improvements in the health and wellbeing of people who live at the home. However, not all of their needs were met. Sometimes the staff did not take into account their choices or respect their privacy and dignity.
The provider had not always carried out sufficient checks on staff suitability. There were not always sufficient staff on duty to meet the needs and ensure the health and safety of people who live at the home.
The provider undertook a range of regular checks to monitor health and safety. However, they did not have sufficient checks to ensure that records were appropriately maintained or that people's needs were met with dignity.
We were unable to speak with most of the people who use the service as they had complex needs and were unable to share their experiences with us. Therefore we used a other methods to understand people's experiences such as observation and we spoke with the local authority care managers of five people who use the service. We contacted two people's relatives. We also spoke with a behaviour analyst who had been enlisted by the home to provide support.
We saw that the people who use the service and the staff had developed positive relationships with each other and there was a relaxed atmosphere within the home. The relatives were pleased with the service and told us about how their relative enjoyed living there. They said people were always well presented and they were provided with adequate activities. Some of the care managers we spoke with said they felt there should be more activities for people.
We found the service did not maintain all records relating to the management and running of the service, in accordance with legal requirements. We found that this was affected by the lack of management oversight of the home.
The relative we spoke with told us that staff at the home treated their family member with respect and maintained their dignity. They said that staff had worked hard to understand their family member's needs and wishes so that they could provide support in the most appropriate way. The relative also told us that the home consulted and involved her when important decisions about her family member's care were being considered.
The healthcare professionals we spoke with confirmed that staff provided support in a manner that maintained the dignity and promoted the rights of people who use the service. They told us that the service is managed effectively and that people who live at the home receive good quality care.