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 the Care Quality Commission (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.About the service
Real Life Options–2-4 Bethecar Road is a care home providing accommodation and personal care for up to six people who live with learning disabilities, and may have mental health needs, sensory impairments and/or physical disabilities. At the time of the inspection there were four people living in the care home.
People’s experience of using this service and what we found
The service was not able to consistently demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture.
Right Support
The service people received was provided in a house, which was similar to the other houses in the area, and people living with physical needs had their bedroom on the ground floor. However, the décor of the interior of the home was very tired looking, some areas were not clean, and there were maintenance issues that had not been addressed. The lack of an attractive well maintained environment could impact negatively on people’s well-being, safety and comfort. Staff supported and encouraged people to make choices in all aspects of their lives. People’s independence was supported. Staff supported people to take part in activities they enjoyed, within and outside of the home. People were supported to safely access facilities and amenities within the local area. People’s care plans set out person centred meaningful goals that had been discussed and agreed with them.
Right Care
People received care and support that was person-centred and promoted their dignity, and human rights. Staff knew people very well. They had knowledge and understanding of each person’s individual needs, and involved them in all decisions about their health, care and day to day lives. Staff received the training they needed to provide people with the right care. During the inspection people’s privacy was respected. However, on the first day of our inspection, we found that one bathroom did not have a blind on the window, so people’s privacy was not protected. The manager promptly ensured that a blind was put in place.
Right culture
Staff engaged with people in a respectful and positive way. People spoke of the good relationship they had with their keyworkers, who met with them regularly to discuss a range of matters to do with their lives. Staff supported people to achieve their goals and aspirations. They recognised the importance of empowering people to live their lives in the way they wanted, and provided people with the support they needed to lead confident and inclusive lives. Staff understood how to protect people from poor care and abuse. They had training on how to recognise and report abuse and knew how to apply it. Staff told us that they would report without hesitation poor practise from staff.
Suitable and robust infection, prevention and control systems were not in place to ensure that all areas of the environment were clean to minimise the spread of infection.
Governance systems and processes had not identified the shortfalls in the service that we found.
There was positive and respectful engagement between staff and people using the service. People were treated with dignity and respect. People told us that staff were kind to them and provided them with the support and assistance they needed.
Relatives spoke highly about the staff and told us people's care and support needs were met by the service. They told us they were fully involved in all areas of people’s care. People’s care and support plans were personalised and regularly reviewed with them. They set out people’s needs and preferences and detailed how they were met. Support focused on people's wishes and their quality of life.
Staff understood their responsibilities in relation to safeguarding people, whistleblowing and reporting all concerns to do with people's safety.
People were supported with their medicines safely and to access healthcare.
Appropriate recruitment procedures were in place to help protect people from the risks of being cared for by unsuitable staff. Staff received the induction, training and support to enable them to competently carry out their roles and responsibilities.
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 good (published 6 September 2019).
Why we inspected
The inspection was prompted in part due to concerns found during an infection, prevention and control inspection carried out by us. A decision was made for us to inspect and examine those risks. As a result, we returned to the service and undertook a focused inspection to review the key questions of Safe and Well-led only.
We have found evidence that the provider needs to make improvements. Please see all the key question sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
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. The overall rating for the service has changed from good to requires improvement.
This is based on findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Real Life Options – 2-4 Bethecar Road on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified two breaches in regulation in relation to premises, infection prevention and control and good governance. 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 from 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.