Background to this inspection
Updated
26 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
Richardson Partnership for Care 2/8 Kingsthorpe Grove is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We looked to see if statutory notifications had been sent by the provider. A statutory notification contains information about important events which the provider is required to send to us by law. We sought feedback from the local authority, the fire service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service about their experience of the care provided. We also spoke with five members of staff, including the registered manager and care workers. We reviewed six people’s care records, including assessments, care plans, medicine records and daily recordings. We also reviewed a variety of records relating to the management of the service; including policies and procedures, staff recruitment, accident and incidents, training, complaints, safeguarding and quality assurance audits.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
26 November 2019
About the service
Richardson Partnership for Care 2/8 Kingsthorpe Grove is a residential home registered to provide personal care and support for younger adults with learning disabilities or autistic spectrum disorder. The home can support up to 18 people, and at the time of inspection 18 people were using the service. The accommodation consists of two adapted houses with shared access to one another; one house has ten bedrooms and the other eight bedrooms. Each house has its own living space, kitchen area and garden.
The service's building had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. 18 people were living at the service, and this is larger than current best practice guidance. However, the care and support people received 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.
People’s experience of using this service and what we found
People told us they felt safe living at the service. However, we found concerns in relation to safe medicine administration and infection control. Systems in place to monitor the quality and safety of care were not robust enough to identify the issues we found, and people were placed at possible harm from poor practice as staff did not always follow the guidelines and policies in place.
The providers systems in place for oversight of the service were not consistently carried out or effective to provide quality assurance. Since the inspection, the registered manager has told us the current audits in place will be discussed amongst their team and reviewed.
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; however, the systems in the service did not always support this practice. The provider had not evidenced Best Interest meetings had taken place where people did not have capacity to make decisions about their care or treatment. This had been identified prior to our inspection and the registered manager told us meetings were being planned.
People had detailed, personalised risk assessments and care plans in place. Staff had good knowledge and understanding of the needs for people they cared for. However, systems in place were not effective in ensuring the information in care records was up to date and in line with the current care being provided.
People received care in a kind and caring way, promoting their dignity, privacy and independence. We saw examples of this during our inspection. The provider had systems in place that encouraged and responded effectively to any complaints or compliments from people, staff and those involved with the service.
People were supported to follow healthy nutritional plans and were provided with choice at meal times, respectful of cultural and dietary needs for everyone.
Staff received training to ensure they had the skills to effectively care for and support people using the service. Staff felt supported by the management team and received regular supervision and appraisals.
The service had good links with the local community within which people lived. This promoted social inclusion, equality and diversity for people using the service.
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 Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
We found the service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
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 20 April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment 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.