East Court

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

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.

Right Support

The service design and model did not fully meet the principles of Right support, right care, right culture. This is because the service is larger than what is usually considered practicable to provide person-centred care and support. The service was registered with us prior to the Right support, right care, right culture guidance being implemented. However, the service was able to demonstrate they met these principles; people received person centred care and support.

People were supported by staff to pursue their interests. 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

Some areas of people’s medicines management needed to be improved. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people’s 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. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take risks.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

We made a recommendation relating to the management of some medicines.

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 27 November 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

East Court is a care home providing personal care to 17 people with a learning disability including autism. The service can accommodate up to 17 people. Accommodation is provided over two properties, with people living in the main house, a self-contained flat and a bungalow in the grounds.

The care service was registered prior to the values that underpin the registering the right support and other best practice guidance. “These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary life as any citizen.” Registering the right support CQC policy. During the inspection we saw that the service actively supported and respected these values.

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

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.

People told us they were happy living at East Court and felt safe. There was a very cheerful atmosphere in the home and people had a very good rapport with staff.

Medicines were managed safely and there were risk assessments in place to identify and manage any risk in the least restrictive way. People were supported by enough staff to ensure they were safe and able to live a full and active life.

People received effective care and support that was focused on the person, their needs and aspirations. Staff demonstrated a very good understanding of people’s needs and received training relevant to their role with a clear career pathway promoted by the provider. People were supported to enjoy a healthy balanced and nutritious diet based on their preferences and health needs.

People received support from staff who were kind and caring. Staff always respected people’s privacy and dignity. People told us they felt staff were kind and caring and respected their wishes. People were supported to express an opinion about the care provided and were involved in the day to day running of the home.

People received responsive support which was personalised to their individual needs, preferences and promoted independence. There was very clear guidance for staff on how to support people in line with their wishes. People had been supported to explore their end of life wishes.

People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the manager was open and approachable. All staff said they felt valued and respected. Staff morale was high, and staff told us how they, “Enjoyed coming to work,” and felt they were, “Part of a family.” One person said, “I love living here, they [staff] are all my family.”

There were effective systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and learnt from issues raised.

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 Good (published 20 February 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.

There is 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.

People told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. People and staff felt able to speak with the manager and provided feedback on the service.

The manager and provider undertook audits to review the quality of the service provided and made the necessary improvements to the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People were involved in making decisions about any risks they may take.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.

The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were made quickly to health services when people's needs changed.

People's identified needs were monitored and managed.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. Staff showed concern for people's well-being. People were as independent as they wanted to be. People told us, 'We have a choice of activities. I like drama, college and I play drums on Saturday' and 'They give me options, I have three choices.' Staff told us, 'People can choose their own holidays and day care activities' and 'People choose their daily activities and also choose their meals for the week.'

Is the service responsive?

We found the service responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation.

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met.

There was a clear set of values that included involvement, compassion, dignity, respect, equality and independence which was understood by all staff. Staff were motivated, caring, well-trained, supported and open.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement. The management team enabled and encouraged open communication with people, those that matter to them and staff. Staff knew and understood what was expected of them. People told us, 'I'd tell a member of staff if I wasn't happy' and 'I can tell staff if I don't want to do anything.'

We observed people were free to make their own choices regarding all aspects of their day to day living. One person said 'Within reason I can do what I want'.

People said they were happy with the care and support they received. One person said 'Staff look after me and take away my worries'. Another person said 'Staff support me to do what I want'.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. There was a much wider range of risk assessments and associated management plans in place than at our last inspection.

Care staff received training in the safe administration of medicines. They said they always checked to ensure the correct prescription and dose was given.

Staff told us they received ongoing training which gave them the skills and knowledge to safely support people. Many of the care staff had national vocational qualifications in health and social care. This meant people had access to staff with the skills and qualifications to meet their needs.

The provider had a complaints policy in place for ensuring complaints were recorded and fully investigated. We found most issues were resolved informally to the satisfaction of the person concerned.

In the care plans we looked at we saw that individual assessment of need and risk assessment was not comprehensively carried out. This meant that people's needs were not assessed and care and treatment was not planned and delivered in line with their individual care plan.

Safeguarding policies and procedures were up to date and in place. Staff were trained in safeguarding and knew how to raise any concerns. People told us they liked living at the service with one person also saying "staff are easy to talk to" and "if I didn't like the staff I'd say".

We found there were enough qualified, skilled and experienced staff to meet people's needs. We were told by people supported "I like the staff" and "the staff are nice".

The provider had systems in place to assess and monitor the quality of service that people receive. We found that these systems were used and that people's views were taken into account. We found the provider was learning from incidents and investigations, making changes where needed and implementing those changes.