Elysium Care Partnerships Limited - 21b Upper Brighton Road

Elysium Care Partnership Limited – 21b Upper Brighton Road is a residential care home for up to seven young people with learning disabilities and/or autism. There were six young people living there when we inspected.

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

The service was safe for people to live and staff to work in. People’s relatives told us that they enjoyed living at the home and the staff were kind, nice, and supportive. Risks to people were assessed and this enabled them to take acceptable risks, enjoy their lives and live safely. Accidents, incidents and safeguarding concerns were appropriately reported, investigated and recorded. Suitable numbers of trained and appropriately recruited staff were available to meet people’s needs. Medicines were safely administered. Health care professionals felt the home was safely run.

The home’s culture was open, positive and honest, with transparent management and leadership. The organisation’s vision and values were contained in the statement of purpose and understood by staff. Areas of responsibility and accountability were identified, within the home and service quality frequently reviewed. The home carried out thorough audits and records were kept up to date. Good community links and working partnerships were established. Registration requirements were met. Health care professionals were positive about the way the home was run and staff provided care.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People received person-centred care in a setting that enabled them to have maximum choice, control and independence and promoted their dignity, privacy and human rights. The positive culture, ethos, values, attitudes and behaviours of leaders and care staff ensured people using service lead confident, inclusive and empowered lives.

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

The last rating for this service was outstanding (published 14 February 2019).

Why we inspected

The inspection was prompted by anonymous concerns received about management, staffing levels, people’s best interest choices, medicine record keeping and people’s care and safety. A decision was made for us to inspect and examine the risks associated with these issues.

The Care Quality Commission (CQC) has introduced targeted inspections to follow up on previous breaches and to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook a targeted inspection approach to review the key questions of Safe and Well-led where specific concerns were raised about management, medicine record keeping and people’s care and safety.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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 coronavirus and other infection outbreaks effectively.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

We found the following examples of good practice:

The provider had robust systems to ensure visitors to the service were aware of the additional measures in place to reduce the risk of coronavirus infection. There was personal protective equipment (PPE) available for visitors to use at the main gate of the premises and signs alerting visitors to the measures in place. Staff accompanied visitors to the newly-constructed visiting pod in the home’s back garden, which was fitted out as a comfortable space for people who lived in the home to see their visitors. Prior to seeing their loved one, visitors were required to undertake a lateral flow test and complete a symptom checker questionnaire. Lateral flow tests for coronavirus return a result in 15 minutes, reducing the risk of a visitor bringing the virus into the home.

There was plenty of PPE available at the service for staff and visitors to use, and for people living in the home to use when they went out (to use public transport or visit the shops, for example). We observed staff wearing PPE according to government guidelines. Staff audited PPE twice per day and a full stocktake was undertaken weekly, so supplies could be replenished quickly.

People who lived in the home had their risks relating to coronavirus assessed, and clear measures were in place for staff to mitigate these risks. The registered manager had also developed a range of robust risk assessments for staff and the service as a whole to reduce these risks, and had an action plan they were working towards to further ensure people’s safety. The infection prevention and control policy had been very recently updated when we visited.

Not all of the staff and people who live in the home had consented to regular testing, or were able to participate in a regular testing programme. The registered manager and the provider organisation had a clear plan in place to reduce the risks associated with this, in line with employment law. The registered manager had sought advice and guidance from appropriate stakeholders to support them to respond to these concerns. For example, a doctor had visited the home the week before our visit to support staff to better understand testing and vaccination for coronavirus, and why these were essential to reduce risks.

Staff supported people who were required to isolate with stimulating activities, taking into account their emotional and social needs. The registered manager told us about one person who had responded very positively to the unusual quiet and calmness of the home during the period in which they were required to isolate. The person had started speaking in words in place of their usual vocalisations, and the registered manager told us this was because staff were able to spend more quality time with the person using intensive interaction techniques without the interruption of their usual daily activities. When people were required to isolate, staff supported them to maintain contact with their loved ones using phone and video calls.

The home was spotlessly clean when we visited. Records showed that cleaning schedules had increased to ensure particular attention was paid to areas of specific high risk of transmitting the virus, such as light switches and door handles, as well as daily deep cleaning of communal areas. There were signs throughout the home to encourage people who lived there, staff and visitors to wear appropriate PPE and maintain distance.

21b Upper Brighton Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides care for up to seven young people including people with learning disabilities or autistic spectrum disorder. It is located in the Surbiton area of Surrey.

The service had a registered manager. 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 and associated Regulations about how the service is run.

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.

At the last inspection in June 2016, the home was rated overall good with safe, effective, caring and well-led being rated as good and responsive as outstanding.

Younger adults with learning disabilities or an autistic spectrum disorder received a service from the home. They had moved from residential schools, other care home placements or parental homes where their support needs could no longer be fully met. The move had massively impacted on their lives in a positive way that was reflected in their progress, personal achievements and opportunities to try new experiences.

There were numerous, varied activities that the young people benefited from, in the community, at home and elsewhere. Staff took great pains to support and help the young people to make their activity choices, based on the interests they had and things they liked to do. Whilst people did not verbally comment about the activities they pursued, their body language showed us they enjoyed them with lots of smiling, laughter and enthusiasm. This had an impact of people thoroughly enjoying their activities and developing bonds and friendships, through them, with staff, each other and others, outside the home.

The home’s positive impact on the young people was further demonstrated by a significant reduction in incidents and situations where people may display behaviour that others could interpret as challenging. Where people displayed anxiety or anger through aggressive behaviour, staff were available and understood how to defuse situations. They understood that this behaviour was a way of expressing people's needs, emotions, feelings and communicating them. Staff were skilled at turning people’s negative behaviour and frustrations into positives by calming situations, finding out what was wrong or what people wanted and addressing their needs. This was achieved by having a thorough knowledge of each person and their likes and dislikes based on trial and error and growing positive relationships and bonds with them.

Due to people’s limited verbal communication, relatives mainly spoke on their behalf. Relatives told us the home had a warm, welcoming and friendly atmosphere. They said staff treated the young people's safety as a priority. This was whilst still acknowledging that people must be enabled and supported to try new experiences and pursue opportunities by taking acceptable risks. Staff weighed up the benefits of activities with the young people in relation to the risks involved. This was demonstrated by the number of new experiences and activities people safely had whilst continuing with those that they previously enjoyed. This meant people received a service that was individual to them. The service and activities were flexible and changed with people as their needs changed and skills and confidence developed, resulting in more fulfilling and enjoyable lives. Staff said the home provided a safe place for people to live and them to work.

Relatives told us people were extremely happy and enjoyed living at the home. We saw how much people enjoyed the care and support provided by staff, which was reflected in their positive body language and interactions with staff and each other. Staff enabled people to make progress by adopting a very person-centred approach. They recognised people’s achievements, highlighted them and supported the young people to also recognise and celebrate them. This was achieved by staff having a thorough knowledge of people's individual communication and sensory needs and meeting them in a patient and measured way.

People had support plans that were comprehensive and individualised to them. The plans encompassed all aspects of people’s lives that included their social, leisure, educational and life skill development needs. These were reflected in and met by the structured and spontaneous activities that people chose enabling them to live their lives the way they wanted to. Staff paid great attention to people's health, emotional needs and people were encouraged by staff to discuss and meet any health and appropriate sexual needs they may have. The depth of planning and cooperation and its impact was demonstrated in the support plans and files we looked at. People’s support plans were regularly reviewed and updated. This enabled staff to support people in an efficient and professional way. The records kept were up to date and covered all aspects of the care and support people received. The home worked in co-operation with health care professionals in the community.

People were protected from nutrition and hydration associated risks by staff encouraging and supporting them to have balanced diets that also met their likes, dislikes and preferences. Staff also used meal selection to develop people’s life style and decision-making skills in an effective way.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) required the provider to submit applications to a ‘Supervisory body’ for authority. Appropriate applications had been submitted by the provider and applications under DoLS been authorised, and the provider was complying with the conditions applied to the authorisation.

The home was very well-maintained, furnished, clean and adapted to meet people’s individual requirements, to a high standard.

Staff received excellent structured training that was organisation, service and person-specific. The quality of the training was demonstrated by the high-quality care practices staff demonstrated and followed throughout our visit. They were very knowledgeable about the field they worked in, had appropriate skills, knew people and their relatives well and understood people's needs in great detail. Their knowledge was used to provide care and support in a professional, friendly and supportive manner, focussed on the needs and wishes of the individual. Our observations showed people knew and trusted the staff that supported them.

Relatives told us that the registered manager and staff were accessible to them, very communicative, worked well as a team and provided them with updated information as needed. The registered manager was responsive, encouraged feedback and consistently monitored and assessed the quality of the service.

Staff told us that the organisation was an excellent place to work and they really enjoyed working at the service. They received top quality support and there were opportunities for career advancement. They felt enabled and supported to develop their skills and progress their careers. Individual skills were acknowledged, harnessed to further practice development and incorporated within the way the service ran. The service and organisation enabled staff to contribute effectively in developing people's individual support as well as developing new ways of working and procedures. Staff also felt their ideas were listened to and implemented.

The organisation’s quality assurance and monitoring systems were geared for continuous improvement and required staff to constantly monitor individual care and support and feedback from people. They also supported staff to reflect on how their actions impacted on people and how people’s lives could be made better and more enjoyable. The records system was well thought through, clear and usable. Staff also recognised the importance of these records as a source of quality improvement and whilst they were very detailed this was not allowed to detract from the care and support people received.

The culture of the service, staff and organisation was open, progressive and transparent. There was a commitment to continuous improvement with care and support being person centred. Relatives felt people and themselves were valued as did staff who considered themselves integral members of the organisation. The National Autistic Society had accredited the organisation and recognised the high quality of the person-centred care and individualised support provided. The organisation worked well with other stakeholders, seeking their opinions and checking if they were satisfied with the service provided.

The healthcare professionals that responded were very positive in their comments about the support the home provides for people.

London Care Partnerships Limited – 21b Upper Brighton Road provides accommodation, care and support to up to seven males with a learning disability and/or autism. Some people also had a diagnosis of epilepsy. At the time of our inspection six people were using the service, as one person was on social leave visiting their family.

The service had a registered manager. 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 received the support they required from staff. People’s relatives were grateful for the support provided and felt their family members were well cared for. Staff assessed people’s needs and provided them with the level of support they required. People were supported to develop their independence and learn new skills. A system was in place to encourage people to identify what goals they wished to be achieved and what steps would need to be completed to work towards these goals. We saw that some of the goals set had been achieved. People were being supported to develop their daily living skills and were able to undertake some household tasks. Some people were accessing college courses and staff were currently supporting people to identify employment opportunities, to further develop their skills.

People had made progress since being at the service. Through the support provided by staff and the provider’s behaviour analyst we saw that incidents when people behaved in a way that challenged staff and others had reduced, meaning there was less reliance on the use of ‘when required’ medicines. Relatives also said that people’s communication skills had improved since being at the service. Staff supported people to make individual progress, including managing holidays abroad and supporting people to structure their day.

Staff had built trusting and positive relationships with people. We observed staff adjusting their communication depending on who they were interacting with so that the person could understand what was being communicated. Communication plans and pictorial communication methods were used to further support people to communicate effectively.

Staff supported people with their individual needs. This included in regards to positive sexual health, race, religion and culture. People were supported to maintain contact with those who were important to them. This included supporting people with overnight visits to family, and regaining contact with previously distant family members.

People received the level of support and input from staff they required. This was based on people’s needs and those related to their behaviour. This process was proactive and as people started to show signs which were known to be precursors to incidents where people might behaved in a way that challenged staff and others support was provided by staff to defuse situations. Staff also supported people to receive support with their health through contact with specialist healthcare professionals. Many people had regular contact from dieticians, physiotherapists and speech and language therapists. Care records showed that people were making progress in line with the advice given. Safe medicines management processes were followed and people received their medicines as prescribed.

People were supported to remain safe. Assessments were undertaken to identify any risks to their safety and management plans were in place to minimise these risks. Staff were aware of the potential risks to people at the service and in the community. Some people were deprived of their liberty in order to keep them safe, and staff accompanied them when out in the community. The provider followed the appropriate processes under the Mental Capacity Act 2005 to help ensure people’s rights were upheld. Staff were aware of their responsibilities to safeguard people from harm and were aware of the provider’s safeguarding adults procedures.

There was the knowledge and skills within the staff team to meet people’s needs. Staff received regular training and supervision to review their performance and to ensure they performed their tasks to a high standard.

There was open and honest communication amongst the staff team. Staff felt able to express their opinions and felt listened to. People, their relatives and visiting professionals were asked for their opinions about the service through meetings and completion of feedback surveys. A complaints process was in place and any concerns raised were dealt with efficiently.

Processes were in place to review the quality of service delivery, based on the Care Quality Commission’s five key questions and associated key lines of enquiry. We saw that where improvements were required that these were completed promptly. The service had successfully retained their autism accreditation with the National Autistic Society.

The registered manager regularly liaised with the registered managers of the provider’s other services, and local services for people with learning disabilities to share learning and good practice.

The registered manager adhered to the requirements of their registration with the Care Quality Commission, and submitted notifications about key events that occurred as required.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such incidents, patterns of challenging behaviour, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People might not be protected against the risk of poor care because the staff we spoke to did not have a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS), and their responsibilities in relation to them. Staff explained how they would support a person with a behaviour that challenged the service, which could be a deprivation of the person's liberty. We saw that no applications for DoLS had been submitted, although the provider is considering making an application.

Recruitment practice was safe and thorough to make sure only suitable people were chosen to work with people who use the service. Staff felt well supported and disciplinary action was taken when necessary by management.

Is the service effective?

People were involved when their health and care needs were assessed, and in writing their plans of care. Specialist behavioural management support had been identified in care plans where required.

The premises has been sensitively adapted to meet the needs of people with autism and learning disabilities, with large, open spaces, private bedrooms with en-suite facilities, and two communal lounges.

Is the service caring?

People were supported by attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented that they like living in the home and like the staff. We saw that staff were not rushed and spent time with residents talking to them or in activities.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own car, which helped to keep people involved with their local community.

The service had responded appropriately to allegations of misconduct by staff, as well as to safeguarding allegations.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The manager and area manager monitored and assessed quality within the home in various ways. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service.

"I am really happy here. I can go to anyone for help".

People who did not use ordinary speech to communicate were also able to demonstrate how they felt involved and consulted in the home by the manner in which they engaged with care staff and how staff responded to them.

People were able to tell us who their key worker was and let us see the types of activity they enjoyed.

Staff we spoke with showed that they had a sound understanding of people's needs and that they understood the best way to support people. This was reflected in care records and other documentation, such as details on people's likes and dislikes at mealtimes and the areas where people needed most support.

The service was knowledgeable in its responsibilities towards safeguarding people from the risk of abuse. The service was able to demonstrate that it complied with all requirements relating to making notifications and involving appropriate authorities if there was a concern. This included ensuring they liaised with the local authority social services teams, health services and Care Quality Commission.

Staff were able to demonstrate that they received training in areas of their work, such as awareness of disabilities, training in autism, medicine management, safeguarding and working with challenging behaviour.