Archived: 92 Carlton Road

Updated 11 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 6 and 7 September 2018. We gave the service 48 hours’ notice of the inspection visit because it is a small home supporting people with learning disabilities, autism and mental health issues, who can display behaviour which can be described as challenging. We wanted to give the home time to inform and support people before our visit. One inspector completed the inspection.

Before our inspection the provider completed a provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the service. We looked at the statutory notifications the home had sent us. A statutory notification is information about important events, which the provider is required to send to us by law.

We contacted the local authority safeguarding and commissioning teams. Details of their feedback is included within the main body of this report. We also contacted Manchester Healthwatch who did not have any information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spoke with one person who used the service and observed people and staff interactions as five people living at the service could not verbally communicate with us. We also spoke with one relative, four members of care staff, the manager, deputy manager, quality manager and service director.

Following the inspection, we also contacted two specialist professionals involved with the service and two members of the night care staff team.

We looked at records relating to the management of the service such as the staffing rotas, policies, incident and accident records, four staff recruitment files and training records, two care files, meeting minutes and auditing systems.

Updated 11 October 2018

This inspection took place on the 6 and 7 September 2018. We gave the service 48 hours’ notice that we were coming as it is a small home supporting people with a learning disability, autism and mental health issues. This was the first inspection of 92 Carlton Road since they were registered with the Care Quality Commission (CQC) in August 2017.

92 Carlton 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.

The home accommodates up to six people over three floors. Each person has their own living space, including en-suite shower. Communal kitchenettes are on each floor to make drinks and snacks, with the main kitchen and dining room located on the basement level.

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 time of our inspection the manager had been in post for three months and was in the process of registering with the CQC. 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.

Clear risk assessments and guidance was in place for staff to follow to support people with their complex needs. Positive behavioural support plans were detailed and provided strategies and distraction techniques for each person. Any physical intervention techniques that could be used were specified in the positive behavioural support plans. These were reviewed each month or following an incident.

The manager had provided additional training for staff in the recording of incidents to increase their level of detail. These were seen to now included a full description of the incident and any distraction techniques or physical intervention used by staff.

All incidents were reviewed by the manager to identify any patterns in the incidents. De-brief meetings were held with the staff involved to review the incident and discuss what, if anything, could be done differently in future to reduce the risk of further incidents occurring.

Newly recruited staff were trained in physical intervention before starting a week of shadow shifts to get to know the people they would be supporting. Staff training in a range of courses was seen to be up to date. Courses were tailored to meet the individual needs of the people living at the home.

Staff were knowledgeable about people’s needs and how to support them to minimise their anxiety levels. Staff told us they enjoyed working at the service and felt well supported by the manager, deputy manager and senior care worker. Regular supervisions and team meetings were held.

A new grade of level 2 care worker had been introduced to provide more leadership on each shift. The level 2 care workers completed a monthly key worker report, summarising the person's daily records, incidents, goals and ensuring all health appointments were planned. The deputy manager or senior care worker now worked at weekends to provide additional support for the staff team.

Observations of practice had been introduced for the care team to ensure they were following the agreed support plans.

Each person had a communication passport in place which provided information about how people communicated their feelings and needs both verbally and through body language. People were assisted to communicate through picture cards and Makaton signs. ‘Easy read’ symbols were used to try to involve people in their care plans.

Medicines were managed safely at 92 Carlton Road. Clear protocols were in place for the use of medicines that were not administered regularly.

There were sufficient staff on duty to meet people’s assessed needs. A recruitment system was in place to ensure staff were suitable for working with vulnerable people.

People were supported to maintain their independence where possible and were encouraged to complete any tasks they could do for themselves.

People’s health, nutritional and dietary needs were being met by the service. Other professionals, for example learning disability team and psychiatry services were involved in supporting people and the service where needed.

The service was meeting the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decision meetings were seen in people’s care files.

Relatives told us they were involved in discussing their relatives care plans and were kept up to date by the staff team about any changes in their relatives’ wellbeing. The service sought the views of people, their relatives, staff members and professionals involved with the service through annual surveys. The results we saw were positive and a report was written highlighting any areas for the manager to respond to.

Each person had an activity planner in place with what they were doing each day. The manager recognised that activities, both within the home and in the local community, needed to be increased.

A quality assurance system was in place at the service. The manager and deputy manager completed checks for medicines, finances, the environment and health and safety. The provider’s quality manager completed nine different audits per year. The manager completed a monthly report giving an overview of the service.

People’s wishes at the end of their life and in the event of their death were recorded in advanced care plans.

A complaints policy was in place. Complaints had been investigated and responded to appropriately.

People’s cultural and religious needs were being met by the service.

The home was visibly clean with no malodours. Equipment was maintained in line with national guidelines. The manager planned to personalise people’s rooms with pictures of their choice and re-decorate their living space in colours of their choice.