Alderwood L.L.A. Limited - Cransley

Alderwood Cransley is a residential care home providing personal care to up to 6 people. The service provides support to autistic people with learning disabilities. At the time of our inspection there were 6 people using the service.

People’s experience of the service and what we found:

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right 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. Mental capacity assessments had not been carried out robustly by the provider to ensure people were supported to have maximum control of their lives and supported in their best interest safely, the policies and systems in the service did not support this practice. The provider did not have effective processes or systems in place to safeguard people to ensure they were safe from harm. Staff did not understand when a safeguarding needed to be reported to appropriate bodies. People were not supported by staff who had been appropriately trained and were competent. People had not received their medicines safely.

Right Care

People's care plans and risk assessments did not cover their range of care and support needs. Staff were not guided to support people in line with legislation, good practice and their training. People had not been protected from harm and abuse. The provider had not always provided staff with information and guidance to support people who were expressing distress and emotionally distressed to ensure people had positive outcomes. Individual risks were not always assessed or managed well, and this placed people at risk.

Right Culture

The service was not well-led. The governance system was not effective in monitoring the quality of the service provided to people. The provider failed to recognise risks and concerns in relation to health and safety, safeguarding, completing records and medicine management. The provider did not always ensure staff deployed had the right employment checks and skills to support people safely.

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 15 February 2022.

Why we inspected

The inspection was prompted in part due to concerns received about management, safeguarding and staffing. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, person centred care, good governance, staffing and dignity. 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and 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 6 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.

We found the following examples of good practice.

• Alderwood LLA Cransley ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

• The registered manager had an organised approach to recording individuals COVID-19 vaccination status and COVID-19 test results. Detailed and up-to-date policies and procedures were in place.

• Alderwood LLA Cransley managed risk in relation to infection well, where people were unable to social distance regular observation checks were recorded and increased touchpoint cleaning was undertaken.

Alderwood Cransley LLA is a residential care home providing personal care to six adults with autism and learning disabilities at the time of the inspection.

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.

The service was a large domestic property. It was registered for the support of up to six people. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

People had extensively detailed care plans which provided information on their strengths and promoted their dignity and independence. Their life history and experiences were considered when planning their care. People's communication needs were assessed and recorded in detail. Staff used individualised person-centred methods to support people to express themselves.

People were empowered to identify and achieve their goals by staff who were enthusiastic about their progress. People took part in a wide range of personally chosen activities and were well-integrated in the local community. They were supported to build and maintain strong relationships with people who were important to them.

People received warm, competent care and support and relatives spoke extremely positively about staff and management.

People were safe and protected by staff who understood their responsibilities and how to keep people safe. Very detailed, regularly updated risk assessments kept people safe whilst supporting them to experience new things and build their confidence and skills.

Medicines were properly stored and administered by staff who were appropriately trained.

Safe recruitment practices were followed. There were enough staff to meet people's needs. Staff were well trained and understood the needs of the people they supported. We observed there was a calm atmosphere and people and staff had good, caring relationships.

The home was well equipped, clean and tidy and good infection control practices were being followed.

The home had good relationships with health and social care professionals. People had a healthy, varied diet and ate food they enjoyed.

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.

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 Outstanding (published 16 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The inspection took place on 15 March 2017.

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.

People's experiences of care were overwhelmingly positive. They told us that they were consistently looked after by staff that were exceptionally caring, understanding and compassionate. People felt like they mattered, they told us that staff were patient, and demonstrated empathy in how they spoke with them. The service had received numerous compliments for their caring ethos, which meant that people felt part of an extended caring family. Staff supported people and their relatives to fully engage in discussions about their care and support. They worked proactively to help people to make choices and decisions about their care and lifestyle, to be as independent as possible, find work and learn new skills. Staff knew each person as an individual and what mattered to them.

Privacy and dignity was respected by staff with whom positive relationships had been formed and who promoted individuality. Staff were committed to taking action, to uphold the ten good practice steps of dignity in care to demonstrate compassion and respect for people. Information was produced in easy read format to enable people to participate fully in their care. Staff intuitively explored alternative communication methods for those people who were non-verbal to enable them to be involved in their own care planning.

People's needs were comprehensively assessed and intervention and treatment plans gave clear guidance on how people were to be supported. Care was personalised so that each person's support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. People were supported to attend a range of educational, occupational and leisure activities as well as being able to develop their own independent living skills. The service was flexible and adapted to people's changing needs and desires, enabling positive outcomes for all concerned. Each person was treated as an individual and as a result their care was tailored to meet their exact needs.

People, relatives and staff were very positive about the leadership of the service and about the support they were able to provide for people with complex healthcare needs. Staff demonstrated a passion and commitment to providing excellent care that supported people to be independent. People told us the service engaged consistently and meaningfully with families. Relatives reported feeling involved and being part of an extended family. They told us that the service was responsive, open and transparent and they felt actively involved in all aspects of their family members care. We found the service had a positive culture that was person centred, inclusive and empowering.

The service was exceptionally well led by a dedicated registered manager, who was very well supported by a forward thinking and self-motivated management team. The culture and ethos within the service was transparent and empowering; staff told us that they were hugely proud to work for the service and wanted it to be the very best it could be.

Best practice guidelines were followed and the service used innovative approaches in its efforts to support people. The whole staff team was inspired to do their best and were very committed to their work, facing up to any form of challenge and finding ways to combat these. They advocated on behalf of the people they supported and obtained excellent results on their behalf. Staff used these qualities to deliver holistic and personalised care to each person they supported. Each member of the provider team had exceptionally strong values, with a shared vision to ensure people had the best possible quality of care.

The registered manager had a clear vision for the service and the direction of its future development. They wanted the service to be influenced by the needs of the people it supported, not financially driven and were committed to providing high quality care that was personalised to people's needs. Visions and values were cascaded to staff who attended regular meetings, which gave them an opportunity to share ideas, and exchange information about possible areas for improvements to the registered manager. Ideas for change were always welcomed, and used to drive improvements and make positive changes for people.

The service had a strong focus on protecting people from possible harm or neglect. Staff knew how to report any concerns about people's welfare to the appropriate authorities and worked in conjunction with a variety of agencies to ensure that people were safeguarded. Staff followed local authority policies and procedures in respect of both children and adults. Safeguarding concerns were taken seriously. People were empowered to take positive risks, to ensure they had greater choice and control within their lives. The positive risk taking approach demonstrated by the service showed that staff respected people's right for independence in conjunction with their entitlement to balance risks with their wishes and desired outcomes.

Staffing levels were sufficient to provide the level of care that people required. Arrangements were in place to cover staff sickness or absence and flexible working was encouraged to ensure that staff had a good work life balance and that the needs of people were met. Robust recruitment processes were in place to help ensure that staff were suitable to work with children and young adults. People were given the chance to be matched with staff who shared similar likes which demonstrated the provider's commitment to people's inclusion within their care planning.

There were suitable arrangements in place for the safe management of medicines. Staff were trained to administer medication and received regular checks on their competency to administer medication.

Staff received a good and robust induction programme with regular support. This included core training and shadowing which enabled them to be knowledgeable about their roles and responsibilities. They were also provided with on-going training to update their skills and knowledge to support people with their care and support needs. Further encouragement was given to enable staff to undertake additional qualifications, including Qualification and Credit Framework (QCF). People's consent to care and treatment was sought in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.

The service responded to complaints or concerns within the agreed timescale and encouraged formal feedback, using this to drive future improvement and make positive changes.