St Philips Close

Updated 21 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors, an Expert by Experience and a regulatory officer. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Philip’s Close is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Philip’s Close is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, during the inspection we received a notification the registered manager would be absent from the service for 28 consecutive days or more. The provider notified us a regional support manager and operations manager would support the service during this time.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 25 April 2023 and ended on 06 June 2023. We visited the location’s service on 25 April 2023 and 26 April 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 4 people, 5 relatives and an advocate, about their experience of care. An advocate is a person that may be appointed to act on someone’s behalf if they lack capacity to make certain decisions. We spoke with 9 staff including the registered manager, deputy manager, operations manager and regional support manager.

We reviewed a range of records. This included 4 people's care records and multiple medication records. A variety of records relating to the governance of the service, including policies and procedures were reviewed.

We continued to seek clarification from the provider to validate evidence found following the inspection. We looked at 4 staff files in relation to recruitment. Supervision data and quality assurance records. We reviewed feedback from professionals involved with the service and records held by the provider about people.

Updated 21 June 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

St Phillips Close is a residential care home and is registered to provide accommodation and personal care. The building is purpose built and provides facilities and living accommodation for up to 8 people who live with a learning disability and/or a physical disability. There are two separate buildings which accommodate 4 people in each.

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

Right Support:

People’s risk were assessed in a person centred way, however, these were not reviewed on a regular basis. Care planning did not routinely involve the person and their relatives as appropriate. People who may become anxious or distressed had positive behaviours support plans, however, these had not been reviewed for some time. People were generally encouraged to make choices and decisions in accordance with their level of understanding.

People had their own bedroom and shared facilities. Staff took action to ensure people’s care and support was in a safe, clean and well-maintained environment. However, staff told us concerns raised with the landlord and senior managers were not being addressed in a timely way.

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.

Right Care:

Staff had completed necessary training to meet people’s needs. However, they did not always recognise risk of harm to people and did not always escalate concerns as required. During the inspection staff raised a whistle blowing concern, the provider began a process of investigation.

Right Culture:

The culture of the service supported people and staff in an inclusive way; enabling people to live their day to day lives as they chose to. Staff told us that the culture of the service had greatly improved as a new team had been formed. However, quality assurance systems to assess and monitor the service were not always being routinely used. This meant the provider did not have enough oversight of the service to ensure it was being managed safely and quality maintained. Therefore, we could not always be assured people always receive high quality care.

There were missed opportunities for staff to involve people in day to day activities such as cooking, cleaning, laundry. There were long periods of time when people were not spoken to, particularly people who did not seek staff attention. One person spent all day in bed due to not having appropriate equipment in place to enable them to access the rest of the house.

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

Rating at last inspection

The last rating for this service was good (published 31 March 2020).

Why we inspected

We received concerns in relation to governance and risk management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well led only.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Philip’s Close on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection. We have made recommendations about safe recruitment, medicines storage and ‘as needed’ medicines.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.