We carried out a review of the data available to us about United Response - 66 & 66a Lemsford Road on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about United Response - 66 & 66a Lemsford Road, you can give feedback on this service.
United Response - 66 & 66a Lemsford Road is a residential care home providing personal care to 11 people who have a learning disability or autistic spectrum disorder. The home can accommodate up to 11 people.
The home provides accommodation over three floors with communal areas and access to outside space.
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 home, bigger than most domestic style properties. It was registered for the support of up to 11 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People told us they felt safe in the home and they liked living there. Risks to people’s health and well-being had been assessed and mitigated. People were involved as far as possible in understanding the risks and how to stay safe when they were out and about in the community. Staff received training and were knowledgeable about safeguarding procedures and also how to report their concerns. There were enough staff employed through robust procedures to ensure people’s needs were met safely.
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 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’s needs were assessed and support plans were developed to ensure their needs could be met effectively by staff. Staff were trained and had support from managers through supervisions and meetings to understand and carry out their roles. People’s dietary needs were met.
People and relatives were happy with the support people received. They told us that staff working at the home were long standing and knew people well. People said staff were kind and caring. People were involved in their care and enabled to take decisions affecting their day to day life.
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.
People and their relatives were given the opportunity to feedback on the service and their views were listened and acted upon. People received personalised care that met their individual needs. People were given appropriate support and encouragement to access and participate in meaningful activities and to pursue hobbies and individual interests. People were supported to share their views by commenting or to complain if they were unhappy with any aspect of the service and were confident, they would be listened to.
Audits done by the registered manager and the provider were effective in identifying areas in need of improvement and actions were taken to improve the quality of the service provided
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 19 August 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.
At the last inspection the service was rated good. At this inspection we found the service remained good.
People were unable to communicate with us due to their complex medical conditions. However relatives told us they felt their family members were safe living at the service. Individual risks to people were appropriately assessed, identified and managed.
We observed that there were enough competent staff to provide people with support when they needed it. Staff had been recruited through a robust recruitment process and had received appropriate training, support and development to carry out their roles effectively.
People received appropriate support to maintain healthy nutrition and hydration. Where required specialist diets were provided and professional input was sought.
The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible and the policies and systems in place at the service supported this practice.
People's relatives told us and we observed that people were treated with kindness by staff who respected their privacy and maintained their dignity.
People and their relatives were given the opportunity to feedback on the service and their views were listened - and acted upon.
People received personalised care that met their individual needs. People were given appropriate support and encouragement to access and participate in meaningful activities and to pursue hobbies and individual interests.
People were supported to share their views by commenting or to complain if they were unhappy with any aspect of the service and were confident they would be listened to. We saw feedback forms had been completed, for example a person was unhappy about a delay in food being served in a restaurant, and staff assisted them to complete a feedback form.
There was an open, transparent and inclusive atmosphere within the service. People and staff had regular meetings to take part in discussions around shaping the future of the service, along with a suggestion box to share ideas.
There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.
Further information is in the detailed findings below
United Response - 66 & 66a Lemsford Road provides accommodation and personal care for up to eleven people with physical and learning disabilities or autistic spectrum disorder. The building is in two parts with eight people living in one part and three people in the smaller building. The ground floor of the main building had been specially adapted for people who use wheelchairs, to ensure there is adequate space to accommodate their needs.
The inspection was carried out on 19 November and was unannounced. At the time of our inspection the service was providing support to eleven people.
The service provided personalised support to people and they told us they were happy living at Lemsford Road. Staff were aware of people’s needs and abilities and support was tailored around individual’s abilities to support and maximise their potential. Staff spoke about people they supported at the service in a kind caring and sensitive way. The registered manager and staff demonstrated an open and transparent approach to all aspects of the service.
We saw that there was adequate staff on duty at all times to meet people’s needs. People were supported with hobbies both within the home and to access activities in their local community. We saw that there were appropriate recruitment processes in place, which ensured that people who were employed were appropriate to work with vulnerable people. The staff group were diverse and this was representative of the people who lived at Lemsford Road.
We saw that people’s privacy and dignity was respected. Staff treated people in a way that was respectful and caring. We saw that staff went at a pace that people were comfortable with and did not hurry them.
We saw records which demonstrated that safeguarding incidents were appropriately reported and investigated and these had also been reported to CQC by the provider. The manager showed us the quality monitoring audits that were in place. This was an area that was undergoing some further development to strengthen the processes that were already in place.
The manager told us about the complaints process and showed us how people were supported to make a complaint or to raise a concern. We saw that the complaints process was available in an easy read format supported with pictorials to enable people to understand the process.
Staff had received training relevant to their roles and had regular supervisions with their line manager. Staff demonstrated they were clear about their roles and responsibilities and received support from the manager and staff also supported each other.
People were supported to do their shopping and to cook meals for themselves with support from staff. People and staff spoke positively and told us they had choices of what food and drinks they had. People were supported to maintain good health and staff accompanied them to attend appointments at the GP, opticians and other health related appointments.
CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The manager and staff were fully aware of their role in relation to MCA and DoLS and what they were required to do if people were at risk of being deprived of their liberty. No one at the service was being deprived of their liberty however staff did accompany people to events in the community to make sure they were kept safe.
We observed that staff supported people in a way that promoted their independence, and enabled them to do as much as they could for themselves.
People had personalised activity programmes, these were detailed on a chalk board in people’s bedrooms. People were supported to attend events in their local community including an ethnic specific facility, for people from a Caribbean background.
People had individualised care and support plans and these were regularly reviewed. We saw that there were risk assessments in place which were reviewed whenever there was a change to people’s abilities. People’s support plans ensured staff had all the guidance and information they needed to provide individualised care and support.
There were systems in place to monitor the quality of the service. The provider had obtained feedback from all stakeholders. This was used to enable the manager and staff to identify where improvement were required and to support continual improvements.
We found that the provider was now meeting the standards we had inspected.
We were unable to speak with people who used the service because they were unable to communicate verbally and some people were experiencing challenging behaviour on the day of our inspection and others had left the home to attend day centres.
People told us they were happy living at the service and that they liked staff and felt safe. One person told us, "All the staff are nice, there's no-one I don't like' and that, 'I go out a lot, to the park or the pub and to a local day centre, I also go to a local book club'.
Staff also told us Lemford Rd was a nice place to work and that they felt supported by management. We were also told that people's privacy and dignity was respected and that staff always close the doors when they're helping with personal care. We observed the home to be visibly clean on the day; all the people appeared to have had their personal care needs met.
During our visit we identified a number of concerns. We found that safeguarding referrals were not all being completed or reported to the Care Quality Commission. Staff had not attended an appraisal in line with agreed timescales and a significant proportion of training records were out of date. We also found that people's care plans and risk assessments were not reflective of recent changes and that one person was delayed in receiving their medication because medication had not been obtained from the pharmacy on a timely basis. Quality monitoring systems, for example, audits and incident reporting were not adequate.
People told they were happy living at the service and that they liked the staff and felt safe. One person told us, "I've lived here a long time and I love living here' and that, 'I like all the staff, they're always nice to me', 'I like going to town and to the library'. One of the people's relatives told us, 'the home does as much as they can, the carers have been really lovely, and I've never seen anything other than kindness and patience'.
Staff also told us Lemsford Rd was a nice place to work and that they felt supported by management. We were also told that people's privacy and dignity was respected and that staff always closed the doors when they helped with personal care. We observed the home to be visibly clean on the day of our visit; and all the people appeared to have had their personal care needs met.
Overall we found that standards were met although we found that care plans had not been updated regularly and that the quality monitoring arrangements failed to identify this.