About the service:

186-188 Lowdell Close is a residential care home providing personal care to four adults with learning and physical disabilities. The service is managed by Life Opportunities Trust, a charitable organisation running care homes in London and the South East of England.

People’s experience of using this service:

¿ There were not enough staff deployed to meet people's needs or keep them safe. This meant that they did not always have varied or meaningful activities, their personal care needs were not always being met and their choices were not always considered. A high proportion of the staff supporting people were temporary staff sourced from agencies. Whilst the provider tried to source the same regular workers, this was not always the case, and many of the staff were unfamiliar with people's needs.

¿ People's needs were recorded in care plans, but these needs were not always being met. People did not participate in social or leisure activities and did not access the community. Their personal care needs were not always being met. The staff showed limited understanding about meeting people's sensory needs or supporting people with their communication.

¿ The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support. People's care was not person-centred or proactive. The support from staff did not focus on promoting people's choice and control in how their needs were met.

¿ The staff did not always have the skills or experience to provide effective care. They had received some training in order to provide safe care. However, they had not received support and information to help them understand about the different and more complex needs of people living at the service. They did not reflect on their practice to look at ways in which they could improve the care being provided.

¿ Some of the time, staff did not show care or respect toward the people they were supporting. They did not always offer choices or take time to consider what the person was trying to communicate.

¿ One of the hoists used for accessing a bath was broken and had been for over two months. This meant that three of the four people who lived at the service had not had access to a bath during this time.

¿ The provider's systems for identifying, assessing and mitigating risks had not always been operated effectively. The provider and staff carried out audits of the service but these had failed to ensure that people were always safe and that their needs were being met.

¿ Feedback from one person's relative was positive. They said that they felt the person was safe and well cared for.

¿ There was a calm atmosphere at the service and the staff were gentle when they approached people and when supporting them. People looked at ease in the home and with the staff.

¿ Some of the principles and values of Registering the Right Support were being followed. People were supported to access the healthcare services they required. There was evidence that the provider had sought guidance and support from different healthcare professionals to make sure they were providing care which met people's health needs.

¿ People were given enough to eat and drink. Meals were freshly prepared at the service and the staff offered people choices.

¿ The provider had acted in line with the requirements of the Mental Capacity Act 2005. They had made appropriate applications for the legal authorisation to deprive people's liberty for their own safety. They had also tried to explain different aspects of the service to people and gain their consent for specific care interventions. The provider had involved people's families and other representatives when making decisions about their care.

Rating at this inspection:

We have rated the service as requires improvement for all of the key questions. This was because the service was not always safe, effective, caring, responsive or well-led. The overall rating o

Lowdell Close is a residential care home for four people with a range of needs including learning and physical disabilities. There are two floors with one bedroom on the ground floor.

At the last inspection in 2014, the service was rated Good.

At this inspection we found the service remained Good. The service met all relevant fundamental standards.

The service is rated Good as it continues to provide safe person centred care and support to the people using the service. There were sufficient numbers of staff working to meet people’s needs.

People had a range of needs and communicated in different ways to the staff team.

There were systems in place to ensure people safely received their medicines.

Staff are supported with regular training and support.

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

We received limited verbal feedback from people using the service and so we carried out observations to see how they were being supported and cared for. We observed positive interactions between the staff and the people using the service.

People’s welfare was checked throughout the visit and staff ensured people were happy and comfortable.

People had the opportunity to engage in activities and see their family when they wanted to.

People’s care records continued to be informative and guide staff on how to care and support people appropriately. People’s health and nutritional needs were assessed to ensure they maintained good health.

The staff team understood people’s individual needs and how they communicated and their personal preferences.

Some people were able to make a complaint if they were unhappy and they also had the support of their family members who could also represent their views.

The registered manager had worked in the service for several years and also regularly worked directly with staff on shift so that they could see how the service met people’s needs.

Checks on the building and how people were supported continued to be in place to ensure the quality of the service was monitored and improvements made where necessary.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 15 and 16 December 2014. A breach of a legal requirement was found as there had been shortfalls in how the service was being maintained to ensure people lived in a pleasant and welcoming environment. After the inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach.

We undertook this short notice announced focused inspection to check that the Provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lowdell Close on our website at www.cqc.org.uk

We gave the registered manager notice the day before we carried out the focused inspection to ensure, as it is a small service, that they would be available to meet with us.

There was a registered manager in post. 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 this focused inspection we saw that improvements had been made in the service. The downstairs main hall, living room and dining room had new carpets and these rooms had been painted. This made the service lighter, cleaner and welcoming for the people using the service. There was also a new fire door leading out from the living room so that people could safely evacuate the building in the event of an incident or fire.

The registered manager informed us that the upstairs stairway and hall were also due to be painted in January 2016.

There were ongoing discussions between the provider and the housing provider as to who was responsible for the upkeep and maintenance of the service. This had yet to be fully resolved and the registered manager confirmed they would develop a maintenance plan so that they knew what works would need carrying out each year. This could assist the provider in future planning and talks with the relevant housing provider to ensure the delays in getting work completed did not occur again.

We spoke with three members of staff, one relative and two people using the service. We also obtained the views of an occupational therapist who visits the home. The acting manager also provided us with additional information after the inspection visit.

At the time of our inspection the provider did not have a registered manager in post.

We could not speak with some people as their complex needs meant they were unable to share their experiences with us. We observed care, spoke with staff and looked at records to find out about their experiences.

We found that people and their relatives were involved in their care and where possible, people were supported in making daily decisions about their lives. People's needs were assessed and care plans developed so staff knew what action to take to meet these. People were also supported to access healthcare professionals and any risks to their welfare had been assessed.

We observed positive interactions between staff and people using the service. One relative commented that “the staff are caring, I have no concerns”.

Systems were in place to report safeguarding concerns and staff received training and information about this subject.

There were sufficient staff working in the home to meet people’s needs safely. One relative told us that they felt there were not always enough staff working at any one time. The acting manager confirmed that there were two staff vacant posts. One was due to be filled in the next week and would offer more flexibility in providing people with extra opportunities to engage in outside activities.

The home had a complaints procedure in place and if people were not able to raise a concern then their relatives or a befriender who could represent their views.

We carried out this inspection to check whether the home was complying with outcome 16 of the essential standards of quality and safety. The previous inspection visit on 3rd September 2012 found there was a lack of regular audits and checks in the home to ensure people's needs were being met safely and appropriately.

During this follow up inspection we found that the provider was complying with this outcome area. A temporary acting manager who had recently started working in the home was in the process of reviewing the systems in place and working to identify where the home could make improvements for the people using the service.

We saw that overall improvements had been made to ensure more regular reviews of the service were taking place. Checks on medication were in place and health and safety checks and maintenance checks had been carried out. This meant that people could be satisfied that the care and support they received was checked and the premises they lived in routinely looked at and monitored by staff.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had different needs and abilities which meant they were not able to fully tell us their experiences. We spoke with two people who lived in the home and observed interactions between staff and the people living there. In addition we spoke with the relatives of two people and obtained the views of one advocate. Both relatives and the advocate told us they were kept informed of any changes about people's needs. We also spoke with three members of staff during the visit.

One person said "I like going out" and we saw that people had a choice regarding how they spent their time. One person told us they would talk with staff if they were unhappy about something in the home. We saw positive interactions between staff and the people living in the home. As people communicated in different ways we saw that staff adapted how they asked people to make a choice. For example we saw staff showed people different types of drink so that they could point or say yes to what they wanted.

Staff confirmed they discussed people's needs and they shared their experiences and views with each other so that people were supported in a safe and appropriate way. However although there were some systems in place to monitor the quality of the care people received these were not always regular or detailed in identifying where the home needed to be improved.

186-188 Lowdell Close is a care home that provides accommodation for up to four people who have learning disabilities.

The inspection took place on 15 and 16 December 2014 and was unannounced. The last inspection took place on 23 September 2013 and the provider had met the regulations we checked.

There was an acting manager in post and they had begun the process to register as the manager of the service. 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.

Some parts of the environment were not well maintained. In some communal areas the carpets were stained and paintwork was chipped and marked in some rooms.

We found this was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the suitability and maintenance of the premises.

You can see what action we told the provider to take at the back of the full version of the report.

Relatives said they would talk with the manager if they had a worry or concern. Staff were aware of what to do if they were concerned about a person’s welfare and had received training on safeguarding people from abuse.

There were enough staff on duty to meet people’s needs and staffing levels were increased when there were social events or if people had appointments to attend. Recruitment checks were carried out before new staff started working in the service.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). The safeguards if applied for would enable the service to lawfully impose restrictions to keep people safe. Staff understood their role was to support people in making decisions where possible about their lives and assess if restrictions needed to be put in place for their safety. This included people being asked what food they wanted to eat and supported to decide how they spent their time.

Arrangements and checks were in place for the safe management of people’s medicines.

The staff team considered and assessed people’s nutritional needs by making sure they received a choice of food and drinks that met their individual needs.

Staff received training and one to one support through supervision meetings and appraisals.

Staff were caring, and treated people with dignity and respect. Care plans were detailed and informed staff how to support people safely and appropriately.

Throughout the inspection, we observed that staff cared for people in a way that took into account their right to make choices about their lives.

There was a clear management structure at the service and people, staff and relatives told us that the management team were approachable and supportive. Staff showed an understanding of people’s individual needs.

There were effective systems in place to monitor the quality of the service so that areas for improvement were identified and action taken to address these.