Sheringham House

Sheringham House is a residential care home providing a regulated activity of accommodation for people who require personal care for up to 10 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 8 people using the service. The service was a large home and people's rooms were on the ground floor and first floor.

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

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.

Right Support: People were not always supported to have maximum choice and control during mealtimes. Some people at the service could take other people’s food and drink and this had not been consistently well managed. People had not always been supported to maintain a healthy weight, for example some people were identified as being overweight and there was not a clear plan in place to support these people. Staff supported people to achieve their aspirations and goals and these were regularly reviewed. The service gave people care and support in a safe, well equipped, well-furnished, and well-maintained environment that met their sensory and physical needs.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People’s care and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture: People and those important to them, including advocates, were involved in planning their care. Relatives told us since the last inspection the service has improved their communication with them. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

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 inadequate (published 01 December 2022). 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 the provider remained in breach of some of the regulations.

This service has been in Special Measures since 01 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. 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 ‘Sheringham House’ on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care and good governance at this inspection.

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.

Sheringham House is a residential care home providing a regulated activity of personal care for up to 10 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 9 people using the service. The service was a large home and people’s rooms were on the ground floor and first floor.

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

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.

Right Support: People were not always supported by staff to pursue their interests or supported to achieve their aspirations and goals. We looked at one care plan which contained no detail about what the person wanted to achieve in their life. Staff did not support people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. People did not take part in meaningful activities; this was in part due to the staffing numbers. One relative told us, “They [staff] always say they need more drivers to take people out, they do so little for [person].” Staff members told us people were not going out enough.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe. People were not always getting their one-to-one support hours and we observed on more than one occasion people being left alone without their one-to-one staff member. People who had individual ways of communicating, using body language, sounds and pictures cards were not always supported by staff to do so. We did not see staff using picture cards to interact with people whose care plan outlined this was a method they liked to use. People’s care and support plans did not reflect their range of needs and this did not promote their wellbeing and enjoyment of life. One relative told us, “[person] hadn’t been out for nearly a month.”

Right Culture: People did not consistently receive good quality care and support. We observed staff supporting a person in an unsafe way, which could cause injury. Our observations were shared with a senior manager. Staff had received manual handling training however some staff were using poor practice without questioning it or raising it as an issue. Staff turnover was high, which did not support people to receive consistent care from staff who knew them well. One relative told us, “[person] needs someone to take [person] out, they always say there is no drivers.”

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 inadequate (published 04 March 2022)

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 05 September 2022. Breaches of legal requirements were found.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing levels, providing safe care and the management of the service at this inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sheringham House provides accommodation and personal care for up to 10 people aged between 18 and 65 years, who have a learning disability and autism. At the time of our inspection, there were 10 people living at the service. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

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.

Right Support:

The provider could not show how they met some of the principles of Right support, right care, right culture. This meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Right Care:

The model of support did not always promote maximum choice and independence. The ethos, attitudes and behaviours of managers and staff did not always ensure that people led confident inclusive and empowered lives.

Right culture:

Although people told us they felt safe and were happy living at Sheringham House, the provider did not focus on people's quality of life, and care delivery was not person centred. Staff did not always recognise how to promote people's rights, choice or independence.

There were not sufficient staff to safely meet the needs of people. Supervisions with staff were not always taking place and were not effective in identifying shortfalls. Incidents of behaviours were not always recorded in sufficient detail to look for trends and themes.

People were not protected against risks associated with their care. The environment and equipment was not set up to meet the needs of people. The provider failed to ensure there was robust auditing to review the quality of care.

We did see instances where staff were caring and understood how to support people. People were supported with nutrition and hydration.

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

Why we inspected

This is the first inspection for this newly registered service. We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

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.

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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.