CareTech Community Services Limited - 34 Porthill Bank

While 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, the practices in the service were not always meeting the principles. Registering the Right Support principles 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. In the majority of the cases people using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

While staff had continued to receive a range of training and supervision, the providers' systems and processes for supporting staff to gain relevant competences for their role were not robust. Not all staff had received induction and training in a timely manner. The manager had assessed people's needs and provided staff with guidance on how these needs were to be met. However, staff had not always consistently followed the plans to prevent incidents between people. There was no registered manager. A new manager had been employed and they were also managing two other services. People's relatives raised concerns regarding the management support at the home. People and their relatives had not been supported to share their end of life care preferences. We made a recommendation about end of life care.

Staff considered positive risk-taking approaches to enhance people's independence and well-being and new how to report safeguarding concerns. People were supported with the safe use of medicines. Staff had received training in safe medicines management and had access to national guidance and best practice. Staff had been safely recruited and employment checks carried out.

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. They sought consent before delivering care. Some improvements were required to ensure

documentation was kept on how the use of restraint was in the best interest of people where it was required to keep people safe. We made a recommendation about mental capacity assessment and best interest records for the use of restraint.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. While people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent, this was not always consistently meet.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met. Staff consulted with specialist professionals and reviewed people's needs regularly. There were arrangements to maintain regular communication between relatives and staff. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident their complaint would be listened to and acted upon quickly.

The manager and the deputy manager showed they were committed to improving the service. They displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.