Archived: County Road

County Road is a residential care home providing personal care to six people with learning disabilities at the time of the inspection. County Road accommodates up to seven people with learning disabilities in one purpose-adapted building. The service is located in Swindon and has easy access to the local town centre. People are accommodated on the three floors of the building.

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.

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

People, their relatives and professionals cooperating with the service consistently praised the quality of the personalised care and support provided to people living at County Road.

Risks to people were identified and managed safely by staff who understood their responsibilities to protect people from abuse and avoidable harm. A sufficient number of staff with the required skills and knowledge provided people with personalised care. Staff administered people's medicines safely. We found the environment of the care home was clean and had been well maintained. Accidents and incidents were reviewed by the registered manager to identify trends and to ensure necessary learning was shared with staff.

Staff were supported through training and meetings to maintain and when needed enhance their skills and knowledge to support people. People were supported to eat a varied diet which met their needs and preferences. People attended regular appointments and annual health reviews. Staff worked with other professionals for advice, guidance and support.

Staff supported people to make day to day decisions and be in control of how they spent their time. 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.

People received personalised care and support from caring staff who respected people's privacy and dignity and understood the importance of people’s independence. People were supported by staff to make decisions about their care and support. Staff used their knowledge of people's preferred ways of communicating to assist people to make their own choices.

People had opportunities to take part in a variety of activities. People were supported to maintain contact with their relatives. People, their relatives and staff were encouraged to make any suggestions for developing the care provided further.

The provider and the registered manager checked the quality of care provided through quality audits. The registered manager completed thorough investigations into any concerns and acted to improve the service.

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 (and update)

The last rating for this service was ‘requires improvement’ (published 3 October 2018) and there were two breaches of our regulations. 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.

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.

County Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

County Road accommodates up to seven people with learning disabilities in one purpose-adapted building. There were five people living at the service during our inspection. The service is located in Swindon and has easy access to the local town centre. People are accommodated on the three floors of the building.

The care service has been developed and designed in line with 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 a life as any citizen.

There was no 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. The service was run by a manager who was to become registered with the Care Quality commission (CQC).

Maintenance and cleaning of the property was not always carried out promptly and the décor required updating.

Environmental checks such as lighting checks had not always been completed in accordance with the provider’s policy.

People were not always provided with opportunities to engage in meaningful activities, which depended on the availability of staff.

There were not enough of staff on shift to keep people safe and to provide them with meaningful activities. There were mixed views from staff and the relatives of people using the service on the frequent use of agency staff.

The provider failed to put effective systems into effect to assess, monitor and improve the quality and safety of the service. Audits undertaken had not identified the issues of infection control, lack of activities provided to people and gaps in the records that we found.

Some staff told us that due to recent changes on the managerial level it was sometimes difficult to contact the manager who had to split time between three services.

Records kept by the service were not always available, accurate or complete.

Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures in place to follow in case of an allegation of abuse.

Appropriate risk assessments were in place to keep people safe. Medicines were managed and stored safely.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People's needs in relation to nutrition and hydration were documented in their care plans. People received appropriate support to ensure they received sufficient amounts of food and drink. Meals, drinks and snacks provided to people suited their dietary needs and preferences.

People were supported to maintain good health and they either attended appointments themselves or were visited by healthcare professionals. Appropriate referrals were made when required.

Staff were supported by the management team and received regular supervisions, which helped to identify their training and development needs.

The service had prepared appropriate care plans to ensure people received safe and relevant care and support. Each person had a personalised care plan containing information about their likes and dislikes as well as their care and support needs.

Staff knew people well and interacted with them in a kind and compassionate manner. People’s privacy and dignity were respected by staff who supported them.

People and their relatives knew how to raise concerns and make complaints. Complaints were recorded, investigated and the outcome was fed back to the complainant.

We found breaches of regulation 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have advised the provider to take at the end of this report.

County Road is a care home providing care and support for up to seven people who have learning disabilities. There were five people living at the home at the time of our inspection. The service is located in Swindon and has easy access to the local town centre. People are accommodated on the three floors of the building.

The service had a registered manager in place at the time of our inspection. 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 felt safe at the service. The registered manager knew how and under what circumstances they should share information with the local authority. Staff knew how to respond to incidents and what sorts of incidents needed to be reported. They also knew what abuse was and how to recognise its signs. This meant there were systems in place to protect people from the risk of abuse.

Sufficient numbers of suitably competent staff were deployed in the home to meet the needs of the people who lived there. Staff received appropriate training and support and the registered manager ensured their skills and knowledge were kept up to date.

People’s prescribed medicines were safely managed by staff. Relevant systems and protocols in place ensured people received their medicines as prescribed. Staff’s competence was reviewed regularly to ensure medicines were administered safely at all times.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had completed the required training and was aware of their responsibilities. We found the provider to be meeting the requirements of the DoLS.

Staff had been provided with relevant training and showed an understanding of safeguarding adults from abuse, according to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The provider made arrangements for people to use advocacy services where required.

People were provided with sufficient amounts of food and drink, with all recommendations from health care professionals being followed. People had access to healthcare professionals should this be necessary. Care plans contained details of people’s specific conditions and guidance on how to identify any problems each condition entailed. Appropriate health services were contacted when necessary to help people maintain their health.

Care plans were developed with people being involved to identify how people wished to be supported and which outcomes they wanted to achieve. These care plans were regularly reviewed and updated if necessary. Support delivered to people promoted their dignity by ensuring people were valued and treated with kindness and respect.

Activities were arranged for people who use the service and were planned specifically to meet their preferences and interests. People were supported to meet their social care needs.

The service had a complaints procedure in place. Complaint letters were available in an 'easy-to-read' version to help people understand how to raise any concerns they might have.

There was an open culture in the home; relatives and staff told us that they were encouraged to speak freely with the registered manager if they had a concern. People were involved in sharing their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

This is the summary of what we found:

Is the service safe?

People who used the service told us that they 'feel safe'. They said that staff were 'kind' and available to help them.

A system was in place for managing risk, which included the identification of hazards, and the action needed to reduce the risk of harm occurring.

People who used the service described the things that they do to promote their personal safety. They told us they would feel comfortable talking to staff if they had concerns.

Staff had been trained in the administration of medication and their competence was assessed each year. Effective systems were in place to ensure safe storage and administration of medication.

Is the service effective?

People who used the service told us that they liked where they lived.

Care records showed that people's needs had been assessed and included the support that staff need to provide. Records were regularly updated to ensure information was up to date.

People who used the service had access to a range of healthcare professionals. Records showed staff were aware of the advice given, and ensured that appropriate equipment was provided to support people.

Is this service caring?

We observed staff supporting people in a kind, patient and respectful manner.

People who used the service told us that staff supported them to make choices. We observed staff using visual and verbal prompts to help people. Records showed staff were aware of their responsibilities regarding mental capacity. People who used the service said they were able to make decisions and that staff 'listen to what you want to do'. Staff said that that people 'get to do anything that they want to'.

People had lived together for many years and were supportive of each other. Records highlighted relationships that were important to them and staff supported people to maintain contact with each other.

Staff said that they felt valued by people that used the service.

Is the service responsive?

We observed staff responding to the needs and wishes of people. Staff supported people in a timely manner.

Records were person-centred and included people's preferences. Care records detailed the individualised support that people wanted and included their personal aspirations for the future. The wishes of people directly influenced the running of the service. Staff supported people to achieve their aspirations.

People said that they felt listened to. We saw staff supporting people to spend their time as they wished.

Records showed staff shared information appropriately with other agencies to ensure that peoples' changing needs could be met.

Is the service well led?

Staff said they felt 'absolutely supported' and they 'could go to [the manager], with anything'.

Staff had regular team meetings, supervisions and appraisals, and said there was 'excellent communication'.

Staff said that the manager 'allowed people to develop and recognised their skills.'

Systems were in place to monitor the quality of the service being provided. Regular audits were completed and any issues requiring attention were followed up.

The manager was accessible to people who used the service, and was responsive to their wishes and needs.

Staff said that they felt valued and appreciated.

We found that the home had sufficient staffing on duty to meet people's needs and that additional staff could be arranged for specific activities. We saw that the staffing arrangements were monitored and the levels maintained through the use of the homes own relief group of staff.

The provider had safe and correct procedures in place to recruit staff. We found that staff were well supported by each other and were receiving regular supervision and annual performance appraisals.

We found that the home was a safe place to live and that people felt able to report concerns and issues that might concern them.

We found that staff were well motivated to provide personalised care and support and were appropriately recruited, supervised and trained.

The provider had effective systems in place to monitor and audit the quality of service being provided and actively sought the views of the people living in the home and the staff who worked there.