26 St Barnabas Road

impairments.

The care home accommodates six people in one adapted building. People live on one of two floors, each with their own bedrooms. Communal facilities include bathrooms, lounge room, dining room and kitchen.

There is a large, attractive garden that surrounds at the back of the building.

We found the following examples of good practice:

The registered manager and deputy manager knew how to effectively manage infection prevention and control. The building was clean. There were sufficient supplies of personal protective equipment which were appropriately stored.

Hand hygiene points in bathrooms were clean, accessible and fully stocked. The service ensured that visitors were screened for possible signs of had COVID-19 and checked they had a negative lateral flow test checked before they were allowed entry to the building. This ensured people's protection from the risk of infection.

When people needed to self-isolate, staff supported people's wellbeing by maintaining people's links with families and friends and through using sensitive communication and planning suitable indoor activities

whilst people had to remain indoors.

Appropriate risk assessments and policies were in place to reduce any impact to people staff who may be disproportionately at risk of COVID-19.

26 St Barnabas Road is a residential care home providing personal care to six people with a diagnosis of learning disabilities and associated health needs at the time of the inspection. The service can support a maximum of six people. It offers bedrooms and communal space over two floors. The ground floor homes three bedrooms, a purpose built wet room, a smoke room, communal dining room and lounge with fully accessible gardens and kitchen. The second floor accommodates a further three bedrooms, a staff sleep in room and a communal bathroom.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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 designed so to ensure 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 received safe care and treatment. Risks were appropriately recorded and assessed highlighting when the risk was most likely to occur, and what action to take to prevent the risk from occurring. Details were also written on what action to take should the risk occur. These were reviewed on a regular basis. People were kept at the forefront of each risk assessment, ensuring their desire to complete activities or tasks was not minimised as a result of an identified risk. Staff received training and had a comprehensive understanding of their duty of care to keep people safe from risk of harm and abuse. Staff were able to identify what action they would take including blowing the whistle.

The provider reinforced the importance of retaining people’s safety by creating a dedicated hotline for whistle-blowing. We found that medicines were administered safely, with records demonstrating people received their medicines in line with their prescription and best practice guidelines. Staff medication training and competencies were up to date. Required learning was identified from accidents and near misses, with a trigger analysis being completed as required by the provider. Staff files although noted some items missing, including gaps in employment and full working history, these were rectified to meet the legal requirements.

People were encouraged to be involved in the writing and reviewing of their health and social care needs. Staff were trained and supported to ensure they had the necessary knowledge and support to safely and effectively care for people using the service. Where required specialist external input was sought, and people’s needs were met.

The staff and people had a positive relationship which was built on trust and compassion. People were treated with respect and dignity. Their abilities were celebrated and everyone was treated as equal. Activities were designed around people’s preferences and encouraged integration in the community.

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. Care plans were reflective of this and key worker sessions clearly documented the drive to achieve choice and independence for all people using 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.

Rating at last inspection

The last rating for this service was good (report published on 21 March 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The home provides a residential service to people with a primary diagnosis of learning disabilities with a secondary health related issue. The service was operating at full occupancy with six males, some of whom have been at the service since it has opened. Registered to provide accommodation for persons who require nursing or personal care, the home aims to support people to maintain their independence and increase their skills.

The home is required to have a registered manager. A registered manager was in place, who was employed under 12 months. 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.

At the previous inspection in March 2016 we found that the service needed to make improvements in the areas of safe, responsive and well-led. During this inspection we noted that the provider had made the necessary improvements in these areas.

The provider’s recruitment processes were robust ensuring appropriate people were employed at the service.

Communication with people had improved and was reflected in their activity and menu choices.

The registered manager had delegated many duties, freeing up time to complete monthly audits and review all paperwork related to the service.

Staff were aware of the necessity to report abuse or any safeguarding concerns if these were observed. Training records indicated that staff had undertaken all company mandatory training, and were rebooked on all refresher courses as required. Competency checks were completed to ensure staff were able to understand both theory and practice of the training received.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely by using a monitored dosage system. This reduces the possibility of medicine error. Where a person required medicine on an as needed basis, guidance was available for staff to ensure this was appropriately administered. The Medication Administration Record (MAR) sheets showed that there had been no medicine errors and that as required medicines were not administered too frequently.

We observed good caring practice by the staff. People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided support by a staff team who knew them well. Care plans and health care documents were reflective of people’s care needs.

The quality of the service was monitored regularly by the provider, and the operations manager. A thorough quality assurance audit was completed quarterly with an action plan being generated, and followed up on during identified timescales. Feedback was encouraged from people, visitors and stakeholders, with responses provided by the manager on how changes had been actioned.

The home provides a residential service to people with a primary diagnosis of learning disabilities with a secondary health related issue. The service at present has one vacancy, with five males residing at the home, some since the home opened. Registered to provide accommodation for persons who require nursing or personal care, the home aims to support people to maintain their independence and increase their skills.

The home is required to have a registered manager. A registered manager was in place, who was employed over 12 months ago. 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. We were informed during the inspection that the registered manager had resigned from his post and would be leaving the company by the end of March 2016. A recruitment drive had commenced to find a replacement manager. The deputy manager will act up in the interim and be supported by the operational manager.

Staff knew how to keep people safe by reporting concerns promptly through procedures that were made available to them. Training records indicated that staff had undertaken all company mandatory training, and were rebooked on all refresher courses as required. Competency checks were completed to ensure staff were able to understand both theory and practice of the training received. For example, medicine administration.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely. Where a person required medicine on an as needed basis, guidance was available for staff to ensure this was appropriately administered. This was reflected by staff describing the protocol, and the Medication Administration Record (MAR) sheets showed proportionate usage.

We observed good caring practice by the staff. People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty.

People who use the service were not always kept safe. Appropriate measures had not been taken to ensure fit and proper persons were employed to support people. We found that not all staff recruitment files contained references, explained gaps in employment or had evidence of a check in relation to suitability to work with vulnerable people. This was a breach of Regulation 19, Health and Social Care Act (HSCA) 2008, Regulated Activities (RA) 2014.

In one file we found that a person who needed specialist medicines with agreed guidelines by a medically qualified practitioner, had these written by the registered manager. Whilst there had been consultation with a relevant practitioner initially, this involvement was now out of date.

People were provided support by a staff team who knew them well. However, care plans and related support documents were not accurate or reflective of people’s changing health and care needs. There was insufficient evidence to illustrate people were being offered activities. We observed people being left alone for long periods of time, some falling asleep. This was a breach of Regulation 9 (HSCA) 2008, (RA) 2014, as the service was unable to illustrate personalised care was offered to all people using the service.

The quality of the service was monitored regularly by the provider, and the operations manager. A thorough quality assurance audit was completed quarterly with an action plan being generated, and followed up on during identified timescales. Feedback was encouraged from people, visitors and stakeholders. However there was no evidence of how this was used to improve and make changes to the service. The registered manager completed audits of documentation related to the service. These failed to pick up discrepancies in practice. This was a breach of Regulation 17 (HSCA) 2008, (RA) 2014. You can see what action we told the provider to take at the back of the full version of this report.

We previously identified concerns about people's personal records, because they were not being stored securely. At this inspection we found that records had been appropriately archived and were now stored securely within the home.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us how they regularly reviewed plans of care and were knowledgeable of people's individual needs and how to meet those needs.

There were effective recruitment and selection processes in place. We looked at the personnel records of three members of staff. The records showed evidence all of the relevant checks had been completed.

The provider had taken steps to provide care in an environment that was suitably designed, but not always adequately maintained. Some areas of the premises had been maintained to a suitable standard. However, people who use the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises because there was inadequate maintenance in some areas of the home.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. We spoke with two members of staff. They confirmed they felt well supported by managers and they had enough training to enable them to meet the needs of the people they support. One member of staff said they felt 'definitely well supported' by managers.

People's personal records including medical records were accurate and fit for purpose. However, when we toured the premises as part of our inspection we noted people's records being stored in an unlocked shed in the garden. There was a risk that people's records would not remain confidential, because they were not being stored securely.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register.

People told us that staff supported them with their social and heath care needs, for example one person told us 'I like to go horse riding every week and staff go with me to help me.' People we spoke to told us they felt safe and well looked after by staff and described relationships with the staff as good. One person told us 'I like it here and all the staff treat me well.'

Staff told us the training had helped them to identify indicators of abuse and know what action should be taken as a result.