Taylor Road

Taylor Road is a residential care home providing personal care to up to seven people with a learning disability, physical disability, sensory disability and/ or autism. The accommodation is provided across two linked bungalows and at the time of the inspection seven people were living in the home.

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

The service did not consistently apply the full range of 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 did not fully reflect these principles and values because people did not always receive safe, person-centred care according to their individual needs and preferences.

Risks to people in relation to their environment and their health needs were not always fully assessed or managed. This included how people received their medicines. These safety concerns had not been identified or acted upon by the provider.

People did not always receive care that met their individual needs. Where advice had been provided by specialist teams on how to meet their needs, this was not routinely followed by staff.

Whilst people were able to undertake some activities, there needed to be greater focus on this and on ensuring people pursued their own goals and interests.

Care records and information on how to meet people’s needs were held in various locations and were not always easy to find or follow. Oversight of care delivery and record management had not been adequate. However, at the time of the inspection, a range of new measures were being put in place to address this, including observational supervisions and enhanced auditing of records. Recent improvements had been made to the cleaning schedules within the home.

Most people were provided with appropriate support in relation to their eating and drinking and input from healthcare professionals was arranged for people, as required.

Staffing levels were appropriate and staff were mostly up to date with their training. Staff interacted well with people and we saw caring, friendly and warm interactions. There was some good care planning relating to the management of people’s behaviour. People were treated with respect and where possible were involved in making decisions about their care. There was evidence that staff promoted people’s independence.

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.

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 Requires Improvement (report published on 23 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence that the provider needs to make improvements. We have identified breaches in relation to safe treatment and governance at this inspection. Please see the full report.

You can see what action we have asked the provider to take at the end of this full 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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Following the last inspection, the service submitted an action plan telling us what action they were going to take to improve the service. They have kept the action plan up to date. At our latest inspection on the 16 October 2018 we found some improvements have been made but still identified a few areas of concern in relation to records and care.

The service can accommodate up to seven people who have a learning disability, physical disability, sensory disability and, or autism. Most of the bedrooms are on the ground floor and accommodation is provided across two separate dwellings which are interconnected. At the time of our most recent inspection there were four people living at the service and a fifth person was due to move in.

Taylor Road 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. It does not provide nursing care.

The care service has not 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. We have identified some concerns about people's opportunity to access the community and engage in everyday activities.

The service had 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.

The service was working hard to improve the quality and safety of the service and provided mainly good outcomes for people. They had met the previous breaches of regulation identified at the last inspection.

Further though needed to be given to the deployment of staff and the range and availability of appropriate activities for people. There were enough staff to support people with their physical care needs but there was not always sufficient opportunity for people to go out as they wanted as they needed one to one support which was not always provided due to existing funding arrangements.

There was a plan of care for each person but their daily notes did not clearly show how people’s needs were being met in line with the plan of care. Care records were not kept in sufficient detail and did not clearly establish clear objectives and how these would be measured. We could not see if people were being supported in the way they wished and in line with their goals and preferences.

Staff understood how to support people lawfully in line with legislation relating to mental capacity.

Risks to people’s safety were identified and there was a plan in place to reduce the risk. This was clearly documented but we raised concern about a lack of documentation in relation to lap belts. We also asked the registered manager to seek further advice about having integral bumpers to protect a person with bedrails from the risk of entrapment and injury. Records were not always robust in demonstrating how a change in need had been identified and addressed.

People were supported to take their medicines as intended and there were robust systems in place to help ensure medicine errors did not occur and if they did these were quickly identified.

People were well supported with their health care needs and physical care needs and staff knew people well and were able to deliver effective care. Staff worked with other health care professionals and made referrals and acted upon advice where appropriate.

Staff had a good understanding of how to keep people safe and how to respond to any allegation of abuse. There were adequate recruitment processes in place to ensure staff recruited were safe to work in care.

People were supported to eat and drink sufficient to their needs and any risks associated with eating and drinking had been identified.

Staff were caring and spent time with people actively listening to people and helping them to reach day to decisions. They provided the necessary emotional support and were skilful in their approach.

The service had an accessible complaints procedure. There were no recorded complaints but the service recognised the need to record any concerns even if they were not an official complaint. This enabled them to address things in a timely way.

The service had an experienced, registered manager who had very good interpersonal skills and was proactive in supporting their staff and people using the service. Most staff had worked at the service a long time and had a lot of skill in supporting people well.

The service required improvement in relation to its record keeping and auditing processes. Care records need to be more personalised and clearly account for how staff were supporting people with their assessed needs and providing holistic care.

Taylor Road provides accommodation and care for up to seven people with a learning disability. People living in Taylor Road may also have a sensory impairment or physical disability. At the time of our inspection, there were seven people being supported.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Some aspects of the service had deteriorated since our last inspection, when we rated it as good in all areas. We identified breaches of Regulations 12 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The safety of the service people received was compromised in some areas. This included risks to infection control within a kitchen area because of some damage that had not been repaired. There were also potential risks of accidentally swallowing or otherwise misusing toiletries including aerosols, a cleaning product and a thickening agent. The risks associated with insecure storage of these were in particular need of review following a change in the group of people living in the home. One person's risk of losing weight was not being fully addressed with remedial action in line with professional advice. Their risk of developing pressure ulcers was not consistently addressed and mitigated.

Systems for managing medicines needed some improvement to ensure prompt action was taken if anomalies arose. This included the need to respond more quickly to shortfalls in audits and to ensure medicines were always stored safely.

These concerns represented a breach of Regulation 12 for providing safe care and treatment.

We identified that there was also a breach of Regulation 10 for maintaining people's dignity and respect. The service was using monitors which broadcast what was happening in people's private rooms into a communal area of the home. This was not in line with the explanation the registered manager gave to us about its use and compromised people's privacy and dignity. We noted that there was some thoughtlessness in the use of the equipment as an intercom to communicate with one person in their room. Due to their additional conditions, this had the potential to cause confusion and distress. It was not respectful of the person's dignity or taking time to communicate with them properly, face to face.

You can see what action we have told the provider to take at the back of the full version of the report.

We found that the systems for assessing the quality and safety of the service were not robust in identifying the issues that we found in relation to people's privacy, care records and risk management. However, we concluded this did not amount to a breach of specific regulations for the management of the service and the registered manager took action promptly to address important areas of concern. The provider's representatives had also completed checks on the quality of the service and drawn up action plans for improving where necessary. The management team needed to ensure that they sustained the improvements.

Other aspects of the service continued to work well for people living in the home. There were enough staff who were trained and competent to meet people's needs. They knew how to recognise and respond to any concerns that people were at risk of abuse and their understood their obligations to report such concerns. Recruitment practices contributed to protecting people from the appointment of staff who were not suitable to work in care services.

Staff understood their legal obligations in relation to seeking people's consent to deliver care. Systems within the service supported their practice and staff understood the importance of following guidance about people’s rights and freedoms. They were aware of the importance of ensuring any action they took to support someone who could not make informed decisions, needed to take account of the person's best interests.

Many of the staff team had been in post for a long while and developed a good understanding of people's needs, preferences and what was important to them. This enabled them to deliver care appropriate to each person's wishes. They also understood any underlying health conditions affecting people's wellbeing and accessed advice from health and social care professionals to address these.

Staff spoke enthusiastically about their work and about current leadership arrangements in the service. They, and professionals providing support to the service, felt that the current registered manager was a good and approachable leader.

The registered manager understood their legal obligations in relation to issues they needed to inform CQC about and their accountability for operating the service properly.

As part of this inspection we spoke with two people of the six people who used the service. However, they had significant communication difficulties and were not able to tell us verbally what they thought about their care. We spoke with the registered manager and two other members of staff. We also carried out observations, reviewed records which included care plans for three people and their daily records. We reviewed medication administration records for all six people using the service and looked at some quality assurance monitoring records.

Below is a summary of what we found. The summary describes the information we gathered from records and what staff told us. If you wish to see the evidence supporting this summary, please read the full report.

Is it safe?

At our inspection in May 2014 we found that people's safety was compromised. This was because medicines were not being managed and stored properly and people's records were not accurate and up to date.

At this inspection we found that improvements had been made to the way medicines were stored. This included the provision of proper storage and recording for controlled drugs. These medicines require additional precautions in their management. We found minor omissions from the record of administration of medicines for two people which were addressed promptly by the manager while we were present. We concluded that people's safety was promoted because medicines were managed appropriately.

We also found that improvements had been made to records so that these were up to date. Staff knew where to find information and what they told us about people's needs matched what we found in their records. One inconsistency within a health action plan was put right while we were present so that it properly reflected changes in the person's health. We concluded that people's safety was promoted because accurate records about them were being kept.

Below is a summary of what we found.

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

Is the service safe?

People were treated with respect and dignity by staff. People responded well to the staff who worked with them.

Prescribed medicines were not consistently managed in a way that ensured people were protected from the risk of harm. This was because they were not always recorded accurately so that any misuse or errors in administration could be identified promptly. Controlled medicines, requiring additional precautions, were not stored as required by law. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe storage of controlled medicines.

The safety of the service was monitored. Regular checks were being made to ensure fire detection systems worked properly although a fire drill was slightly overdue. Systems were in place to ensure that health and safety within the environment was checked. This reduced the risk to people and helped the service to continually improve.

The home had procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We were given an example of how the manager had taken advice to see whether an application was needed regarding deprivation of liberty for someone living at the home. This meant people would be safeguarded as required. We provided information to the manager about a recent legal decision regarding DoLS so that further advice could be taken if required.

Is the service effective?

People received specialist advice regarding mental health, behaviour, dietary needs, and communication and swallowing difficulties where this was appropriate. It was clear from our observations and speaking with staff that they understood people's care and support needs. A survey completed by a visiting relative said that all the person's needs 'are met fully.'

However, we found that records were not always in place or kept up to date particularly in relation to people whose diet needed monitoring. This meant that staff would not know whether care delivered was effective and when to seek further advice. We asked the provider to tell us what they are going to do in relation to meet the requirements of the law in relation to record keeping.

Is the service caring?

We saw that people were supported by attentive staff. A relative commented in their survey that the person they visit 'is well cared for in a kind and compassionate environment.' Another relative's survey indicated they were impressed by the way the person 'is included in all conversations/discussions.'

We observed that staff respected people's privacy and knocked on bedroom doors before entry. Our discussions showed that staff understood the individual experiences of people living with dementia and how this mental health condition affected them.

Is the service responsive?

People were able to engage in activities inside and outside their home, with staff support as needed. One person had been on holiday and showed us some of the things they bought while they were away.

Staff were able to give us examples of where people's needs had changed and how they were arranging for further advice in relation to their care. Support plans reflected how people's concentration and ability fluctuated and that sometimes people may need higher levels of assistance.

Is the service well led?

The service had a quality assurance system so that the quality of the service could be improved where necessary. The manager had improvement plans in place to respond to any issues raised by the operations manager or from within the provider's health and safety audits. Relatives were offered regular opportunities to comment about service quality.

Staff spoken with were clear about their roles and responsibilities.

We returned to the service in January 2014 to see if they had made the improvements we told them to make. We found that staff now received appropriate professional development and were supported to do their job.

We found that there was care planning in place to meet people's needs and information about the person to help staff support them better. This information had been reviewed regularly. However, the provider may find it useful to note that there was no care planning for one person with regard to two aspects of their care that staff told us about.

We found that there were enough staff to meet people's needs. People were engaged in meaningful activity throughout the day by staff who understood their needs.

We found that staff had access to appropriate training in order to meet people's needs, including some specialist training to help them meet the needs of people using the service who were living with epilepsy. We found that staff did not always have access to regular supervision and annual appraisal. However, staff told us they felt well supported and could raise issues and problems with senior staff.

We found that the service had a complaints policy and procedure in place. This was provided to people using the service in an easy read pictorial format which they could better understand. The service had received no complaints at the time of visit.

We found that guidance for staff about how people were to be supported safely and the risks to which they were exposed, was not always up to date and did not always reflect people's changing needs. We also found that staff were not confident that a plan for supporting someone with eating and drinking was still current and did not consistently follow this to ensure the person's safety.

We found that although most staff were well trained, some were not always completing training promptly so that they could support people safely. Systems for ensuring their development needs were addressed needed improvement. However, the incoming manager had only taken over running the home a few weeks before our visit. There were good systems for monitoring the quality of the service. The manager was clear about the actions needed to improve had established a plan for achieving these.