About the service:

83 Beaconsfield Villas is registered to provide accommodation and personal care for up to six people. Care is provided to adults with a learning disability. The home is situated in Brighton and is a large detached house. People’s bedrooms are located over four floors and three people each live in a self-contained flat. At the time of inspection six people were living at the home.

Rating at last inspection:

Good (published 11 October 2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People appeared happy and safe. Staff had a good understanding of people’s needs and preferences. Staff listened to what people wanted and acted quickly to support them to achieve their goals and aspirations. Staff were creative and looked to offer people solutions to aid their independence and develop their skills.

People had good community networks which were personal to them. This included college opportunities and therapeutic activities. People were supported to develop and maintain positive relationships with friends and family. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence and access to the community. The emphasis of support was towards enabling people to learn essential life skills. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life.

Families described the staff as caring, kind, compassionate and friendly and the atmosphere of the houses as relaxed and engaging. 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 and was in line with national guidance.

Leadership was visible and promoted good teamwork. Professionals, families and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, management and staff teams worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the management team was keen to make changes that would impact positively on people's lives.

The service met the values that underpin the 'Registering the Right Support' and other best practice guidance such as 'Building the Right Support'. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A full description of our findings can be found in the sections below.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 9 August 2016 and was unannounced.

83 Beaconsfield Villas provides accommodation and personal care for up to five younger adults with a learning disability or autistic spectrum disorder. The service specialises in working with people whose behaviour is complex and can be challenging. The service is situated in Brighton and is in a large detached house near the town centre. People’s bedrooms are located over four floors and there are two one person self-contained flats within the building. Communal areas include a kitchen/dining room and two lounges. There is a large garden for people to use. One of the self-contained flats also has its own private garden. Five people were living in the service at the time of our inspection.

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. The registered manager was not present during the inspection, however we contacted them after the inspection for clarification and further information.

The last inspection was carried out on 3 and 8 July 2015. We found a breach to the Regulations. This was in relation to safe storage and recording of medicines. We also found areas which required improvement in relation to where people had ‘as and when required’ (PRN) medicines the guidance for care staff to follow had not been updated. The regular checks of the fire equipment in between checks made by the external contractors had not been maintained. Staff training records had been updated and this highlighted care staff had not received updates of their training to meet the timescales of the provider. Where bank staff worked in the service there was not a record of the training they had completed. So it could not be assured that they had the necessary training to meet peoples care and support needs. The hot water checks had not been maintained to ensure the delivery of hot water at a safe temperature. People were supported to eat a healthy diet. However, records of what people had eaten and fluids consumed to inform care staff had not been maintained. Recruitment documents were not fully available for senior staff to access. Feedback and quality assurance systems were not fully in place. The provider provided the CQC with an action plan as to how they would address these issues. We looked at the improvements made as part of this inspection. At this inspection we found the provider had followed their action plan, improvements had been made and the regulations were now being met.

Relatives and the visiting healthcare professional told us they felt people were safe. One relative told us, “He is very safe. We are very pleased he gets his care there.” People were supported by care staff who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager. There were systems in place to assess and manage risks and to provide safe and effective care. People were supported through a risk management framework to access a range of activities. One member of staff told us, “We keep the guys safe. All five people are incredibly vulnerable, so we have to be vigilant as they could get into trouble. We give them a good quality of life, to be able to enjoy life and get new experiences. We are always thinking about new experiences for them all.”

People were supported to eat a healthy and nutritious diet. People had access to health care professionals. All appointments with, or visits by, health care professionals were recorded in individual car

There were four people who used the service at the time of our visit. We used a number of different methods to help us understand the views of these people, who had complex needs, which meant they were not able to tell us about their experiences. We observed the care provided, looked at supporting care documentation, we spoke with the registered manager who is referred to as manager in the report, three care workers and one relative and one representative of two people who used the service.

This told us people or their representatives had been able to express their views about the care provided if they wished to, and where possible people who used the service had been involved in making decisions about their care and treatment.

People’s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. One comment received was “My relative is completely correctly placed,” “I’ts a happy and content place,” “They look after him well,” and “The home is extremely well managed and the team work well together.”

The service’s own care workers and regular bank staff had a good understanding of people’s care needs.

People knew who to talk with if they had any concerns about the care provided.

The provider had systems in place to quality assure the care provided.

Because people living in the home have highly complex communication needs it was not possible for them to tell us about the care they receive. However, we observed people engaging with staff that were attentive, observed their wishes and treated them with dignity and respect.

This inspection took place on 3 and 8 July 2015 and was unannounced.

83 Beaconsfield Villas provides accommodation and personal care for up to five people with a learning disability or autistic spectrum disorder. The service specialises in working with people whose behaviour is complex. The service is situated in Brighton and is in a large detached house. People’s bedrooms are located over four floors and there are two one person self-contained flats within the building. Communal areas include a kitchen/dining room and a lounge. There is a large garden for people to use. One of the self-contained flats also has its own private garden. Four people were living in the service at the time of our inspection.

The service did not have 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. However, a new manager had been recruited and an application for a new registered manager for the service had been submitted to the CQC.

Since the last inspection staff members spoke of a significant period of change that they were still working through. There had been a complete change in the management team. There were a number of staff vacancies still being recruited to, which had led to a period of high use of the provider’s bank staff or agency staff to help cover the staff rota. However, where possible staff who had worked in the service before had been requested to provide cover and ensure continuity of care staff.

There were systems in place to manage medicine safely. However not all the medicines had been stored and the recording of administration of medicines completed to meet current requirements. Where people had ‘PRN’ (as and when required medicine) guidance as to when this should be given had not been updated. Medicines had been administered by staff trained to do so. However, this training had not been updated in line with the provider’s policies and procedures.

Systems followed had not all been maintained, for example quality assurance systems to identify areas in need of improvement. Work was in progress to review and update processes and procedures followed.

The premises were well maintained. There had been recent external works to the roof and windows. The environment was clean and spacious which allowed people to move around freely without risk of harm. Equipment and services such as gas and electric supplies had been checked by external contractors. However, regular checks of the fire system in between checks made by external contractors had not been consistently completed. Checks of the water temperature to ensure this was being delivered at a safe temperature to protect people had not always been maintained.

Some staff recruitment files were held at the providers head office, so were not available to view them at the start to the inspection. Therefore, it was not possible to establish how the manager had assessed that it was safe for these staff to work at the service, or that they had the skills and experience they needed to support the people that lived there.

There were sufficient numbers of suitable staff to keep people safe and meet their care and support needs. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. However, training records had recently been updated, and this highlighted that care staff had not all received training updates within the timescales detailed in the provider’s policies and procedures. Where bank staff worked in the service there was no record of the training they had completed and if this had been updated as required.

People were supported to eat a healthy diet. However, records of what people had eaten and fluids consumed had not been maintained. This had not ensured care staff were fully informed.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care and support provided was personalised and based on the identified needs of each individual. Where people were unable to make decisions for themselves staff had taken appropriate action to arrange meetings to make a decision in their best interests. People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. One relative told us, “I would not want him to go anywhere else.”

Relatives told us they felt people were safe. There were systems in place to assess and manage risks and to provide safe and effective care. People knew who they could talk with if they had any concerns, and felt they would be listened to. People were supported through a risk management framework to access a range of activities.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.