Archived: Samuel Close (1,2,3)

Samuel Close (1,2,3) is a residential service of three adjoined houses accommodating up to 16 adults in total, who require personal care. Each house, or unit has separate adapted facilities. People living there have a range of needs including learning disabilities, physical disabilities and/or autism. At the time of the inspection 13 people were using the service.

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

We found considerable improvements had been made at the service since the last inspection and the issues we had found then had been acted on. However, the oversight and support from the provider needed some improvement to ensure they remained aware of changes and that improvements continued. In a small number of areas work was still in progress partly due to the effect of the pandemic and because positive changes to the culture of the service needed more time to become a consistent routine for all staff.

We have made a recommendation that the provider seek guidance around the setting of safe staffing levels.

Families told us they felt their loved ones were safe. Staff understood their roles in safeguarding people from harm. Risks to people had been assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

There were safe recruitment practices that followed legal requirements. Medicines were safely administered and managed. The service had policies and procedures to respond effectively to Covid-19. Staff mostly followed appropriate infection control practices to prevent or minimise the spread of infection.

Staff received training and support to meet people's needs. People's nutritional needs were assessed and met. Staff liaised with health professionals to meet people's health needs. Work had been done to improve the décor of the building.

Relatives said staff treated people with care and kindness. Training had been provided to staff on how to improve the way they communicated with people. Staff treated people with dignity, respected their privacy and encouraged their independence. Assistive technology had been considered to enhance people's independence in their daily living skills. People were now more involved in aspects of their daily care.

People had personalised plans for their care. These were up to date and reflected their needs. They were involved in a range of personalised activities that met their needs. People's needs in respect of their protected characteristics, such as their ethnicity or disability were assessed and supported.

There were systems to monitor the quality and safety of the service. Staff worked in partnership with relatives, health and social care professionals and voluntary organisations.

Staff asked for people's consent before they provided care or support. 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people. The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The setting of the service as a large residential home was in the process of being addressed, through the decision by the provider to register each unit separately with its own registered manager. This process had been started at the time of the inspection.

Work had been undertaken to improve the model of care to increase people’s choice, control and independence. Further work was planned in this area.

Right care:

Overall care was person-centred and promoted people’s dignity, privacy and human rights. People were being encouraged to be as involved in their care and independent as possible. Work had been done to improve staff communication and interaction with people.

There were limitations to the building which had a clinical design and was not best suited to increasing people’s independence. This was under consideration in liaison with the local authority and health professionals.

Right culture:

Considerable improvements were evidenced to the ethos, values, attitudes and behaviours of staff. It was observed that the culture was more open and inclusive. This was in the process of being embedded at the service.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published December 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

However, we have found evidence that the provider needs to make some further improvement. Please see the Safe and Well-led sections of this full report. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 and 20 November 2019. Breaches of legal requirements were found and we took enforcement action serving two warning notices. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Samuel Close (1,2,3) on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Samuel Close (1,2,3) is a residential service accommodating up to 16 adults who require personal care across three separate homes in the same road, each of which have separate adapted facilities. People living there have a range of needs including people with learning disabilities and/or autistic people. Some people also had physical disabilities. At the time of the inspection 15 people were using the service.

As part of the inspection we checked to see how far the service was working towards the principles of Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. These principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

At this inspection we found some areas of improvements but some risks to people were not always adequately assessed. Other risks in relation to people’s physical and mental health were not always identified and there was insufficient guidance for staff to follow to reduce these risks. Systems to manage risks in relation to aspects of the premises and procedures for dealing with emergencies were not robustly operated.

Systems to monitor the quality and safety of the service continued to be ineffective in some areas. Accurate records of people’s care were not always maintained or securely stored. Authorisations for Deprivation of Liberty safeguards were not always complied with as conditions included on the authorisations were not always complied with.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people’s involvement in the way the home was run and their engagement in the community needed improvement. People did not always have personalised goals to help increase their independence or participation in community activities.

Improvement was needed to ensure all minor issues or near misses were reported and acted on in a timely way and that safeguarding processes were fully embedded. The provider had carried out some work to improve the culture of the service, but further progress was needed to achieve a fully open culture where all staff understood and promoted the values of the service. Improvements had been made to suitability of the premises, but some further improvements were identified.

Staff supported people in their best interests; the policies and systems in the service supported this practice. However, the records related to these decisions needed some improvement to ensure they were accurate and personalised.

People and their relatives told us they felt safe at the service. Staff had received recent training on how to identify abuse or neglect. There were enough staff to support people’s needs.

People and their relatives told us staff were kind, caring and treated them respectfully and we observed this to be the case. There were enough staff to meet people’s needs. People were supported to be involved in day to day decisions about their care. Improvements had been made to the activities provided to engage and stimulate people. The provider had a complaints procedure which was displayed within the service.

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 requires improvement (published 25 April 2019). There were multiple breaches of regulations in relation to the assessment of risks, the lack of a visible complaints process and lack of person-centred care, the suitability of the premises and the systems for managing the quality and safety of the service.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was meeting three of these regulations in relation to complaints, person centred care and the suitability of the premises. However, we found there were continued breaches of two regulations and a new breach of another regulation.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and treatment. A decision was made for us to inspect earlier than planned to examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective responsive and well led sections of this full report.

Enforcement

We have identified breaches in relation to how the service monitored Deprivation of Liberty safeguards (DoLS) authorisations, the management and assessment of risks, accuracy of records, the way the service was led and the systems to monitor the quality and safety of the service.

Please see the action we have told the provider to take at the end of this report. 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

•Care plans and risk assessments were not updated following the agency changing its name in November 2017.

•Risks were not always identified in relation to falls and risk management plans were not in place to manage these safely.

•Risks were not reviewed on a regular basis.

•People were not involved in planning their care and support needs.

•People's medicines were not always safely managed.

•The providers quality monitoring systems were not effective.

•People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse.

•Accidents and incidents were appropriately managed and learning from this was disseminated to staff.

•People were protected from risk of infection because staff followed appropriate infection control

protocols.

•There were enough staff available to support people's needs.

•Assessments were carried out prior to people joining the service to ensure their needs could be met.

•Staff were supported through induction, training and supervision to ensure they carried out their roles effectively.

•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.

•People were supported and encouraged to eat a healthy and well-balanced diet.

•People had access to healthcare professionals when required to maintain good health.

•People told us staff were kind and respected their privacy, dignity and promoted their independence.

•People were involved in making decisions about their daily care needs. For example, what to wear and what to eat.

•Staff understood the Equality Act and supported people's individual diverse needs if required.

•People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

•People were aware of the home's complaints procedures and knew how to raise a complaint.

•The service was not currently supporting people who were considered end of life, if they did this would be recorded in their care plans.

•Regular feedback was sought from people and staff about the service and acted upon if necessary.

•The provider worked in partnership with key organisations to ensure people's needs were planned and met and deliver an effective service.

•Relatives, people and staff were complimentary about the registered manager

Rating at last inspection: Requires Improvement (report published 14 March 2018).

Why we inspected: This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we had found at our inspection in January 2018.

Enforcement: Please see the 'actions we have told the provider to take' section towards the end of the report.

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.

Samuel Close (1,2,3) 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.

Samuel Close (1,2,3) accommodates up to 17 adults with learning disabilities who require personal care across three separate homes, each of which have separate adapted facilities. At the time of the inspection, 15 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.

During this inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not receive person centred care and were not being engaged with meaningful activities. Staff tended to be more task focused and we observed instances where staff were not caring and did not treat people with respect.

People were supported to maintain a balanced diet. However, people did not experience an enjoyable and sociable experience during their mealtimes.

The homes were clean and tidy. However, the decor was not suitable for people with learning disabilities and sensory needs. We made a recommendation that the service seek advice and guidance from a reputable source about adjustments required to meet the needs of people using the service.

The system in place to manage people’s finances was not robust as there was a lack of external auditing conducted to ensure people were not at risk of financial abuse.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, and specific to each person and their needs. Care plans were regularly reviewed and were updated when people's needs changed. Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risks to people were identified and managed so that people were safe.

Systems were in place to make sure people received their medicines safely.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from the management team.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act 2005 (MCA). Best interests decisions were made where people lacked capacity to make specific decisions for themselves, in line with the MCA. People were supported to have 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.

People were supported with their nutritional and hydration needs. Staff were aware of people’s dietary requirements and the support they needed with their food and drink.

Procedures were in place for receiving, handling and responding to comments and complaints. We saw evidence that complaints had been dealt with appropriately and in a timely manner.

Staff told us that they received up to date information about the service and had an opportunity to share good practice and any concerns they had at team meetings. Staff spoke positively about working for the service.

The quality of the service was monitored and regular audits had been carried out by management. There were systems in place to make necessary improvements when needed.

Samuel Close provides accommodation and personal care for up to 17 people with learning disabilities. It is set in a small cul-de-sac and is made up of three units. At the time of this inspection the service was providing care and support to 15 people.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 relatives of people using the service told us their relatives were safe and that staff treated them well. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. Risks to people were assessed and care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of the people they supported and they received regular supervision and annual appraisals of their work performance. People were provided with sufficient amounts of nutritional food and drink to meet their needs. People had access to a GP and other health care professionals when they needed them. The manager and staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation.

People and their relatives, where appropriate, had been involved in planning for their care needs. Relatives told us they were aware of the complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The manager recognised the importance of regularly monitoring the quality of the service provided to people. Staff said they enjoyed working at the service and they received good support from the manager. There was an out of hours on call system in operation that ensured management support and advice was always available when staff needed it.

We saw that staff spoke with people in respectful and appropriate ways. People's rooms had been personalised. Support plans detailed the ways people communicated, individuals likes and dislikes and how to work with individuals to minimise risks. Relatives were "happy" with the services provided, saying "very pleased", "they're at the best place", "staff keep us informed", "we attend annual reviews and are involved in care planning" and "staff provide appropriate care and support". One person said "staff are always changing, you just get used to one and they leave, this can be hard for people".

Staff said they had the required recruitment checks, induction and the training and support that they needed to carry out their role. Generally staff felt that there were enough staff but said that having "more permanent staff would be better for the people who used the service".

We saw the three houses were managed in the same way but operated differently to suit the needs of the people that lived there. Staff worked with people in the best ways to meet their needs, although this was difficult due to the environment and the number of people with autism and challenging behaviours. Staffing levels in the houses were seen to be sufficient during our visit.

The new registered manager appointed in November 2012 and was currently reviewing the home's procedures and some changes to improve the service had been introduced.

There were processes in place to assess and review the care and support provided for people on a regular basis and observed that there was a schedule of monthly meetings with key workers which had been introduced in the last three months. Staff had knowledge and understanding of the individual needs of the people using the service. We observed staff supporting people in a professional and respectful way. We saw that there were processes and procedures to ensure that their safety and protection was maintained.