Six Acres

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

There were systems in place to ensure staff were aware of risks of people choking. Risk assessments were reviewed and updated where required. Staff confirmed they were kept up to date about changes to people’s care plans and risk assessments. Risks were discussed during team meetings and group supervisions. The provider also carried out checks to ensure staff were following guidance.

People were protected by infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE]. Specific risk assessments had been put in place to support people relating to COVID-19. We identified an area of the home, which was not visibly clean, the registered manager took action to address this. Some staff were not engaging in the recommended COVID-19 testing programme. The provider was encouraging staff to engage in this and had measures in place to mitigate risks.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture. This was because the service was originally set up as a campus setting. There were five other registered care homes set in the grounds of Somerset Court in close proximity to Greatwood House. The service was registered with us prior to the guidance being implemented. The provider had plans in place to address this and could demonstrate they were making progress.

Rating at last inspection

The last rating for this service was requires improvement (published 04 April 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staff following guidance relating to eating and drinking assessments. A decision was made for us to inspect and examine those risks. We also reviewed the infection control procedures as part of our current methodology.

We did not find evidence during this inspection that people were at risk of harm from this concern.

Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had not originally been developed and designed in line with the Registering the Right Support guidance. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Greatwood House. The Registering the Right Support Guidance was implemented in 2017 after the service had registered with us. The registered manager had since personalised the service to reflect the Registering the Right Support Guidance.

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

There were measures in place to minimise risks to people involving the risks relating to choking and individual health needs. Staff were aware of the control measures in place. Systems had been implemented to ensure all staff working in the service were aware of the risks and how to mitigate them. Risk assessments were reviewed and updated where required. Staff confirmed there had been learning following a choking incident in one of the providers other homes.

Specific risk assessments had been put in place to support people during the COVID 19 lock down, and for managing the return to socialising in the wider community safely.

People were protected by infection control policies and procedures. Staff had received training in

infection control and the correct use of personal protective equipment [PPE]. Staff had taken into

consideration the affect wearing PPE might have on people living in the home.

Rating at last inspection

The last rating for this service was requires improvement (published February 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about a choking incident that occurred at a different location run by the provider. A decision was made for us to inspect and examine those risks. The information the Care Quality Commission (CQC) received about the incident investigation indicated concerns about the management of choking across all of the providers services. This inspection examined those risks and the management of health-related risks. We also review the infection control procedures as part of our current methodology.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Greatwood House is a large detached bungalow situated in the extensive grounds of Somerset Court which is owned by the provider. The home accommodates six people who have autism and complex support needs. Up to four people live in the main part of the home; two people live in two self-contained flats attached to the main house. People living at Greatwood House can access all other facilities on the Somerset Court site which include various day services. At the time of the inspection six people were living at the home.

The service had not originally been developed and designed in line with the Registering the Right Support guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Greatwood House. However, the service mitigated the negative impact of this by ensuring people accessed the local community and had opportunity to engage in activities of their choice.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People had individual care plans that detailed their care and support. Although care plans were personalised they did not always contain accurate and complete information. Risks relating to people were identified, however some required additional information and reference to people’s specific guidance and protocols. Whilst governance systems in place identified improvements required, identified actions had not always been completed.

Staff supported people to manage their medicines safely. There were enough staff available to support people. Staff were recruited safely. Relatives commented about the consistency of staff and changes in the staff team. The manager had plans in place to address this.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their needs. Staff received one to one supervision and told us they felt supported.

People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.

People were supported by caring staff who worked towards promoting their dignity, privacy and independence.

Where relatives and people had raised concerns and complaints, these were listened to and responded to.

People and staff commented positively about the manager and leadership of the service. People’s relatives commented there had been changes in management of 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 28 February 2019) and there were breaches of regulation 12, (Safe care and treatment) and regulation 17, (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection there were five people living in the home; three people in the main house and both flats were occupied. The people we met had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with relatives and staff to help form our judgements

People’s experience of using this service: People were supported by a consistent staff team who were kind and caring. Staff had good relationships with people and knew them well. People were encouraged and supported to maintain their independence.

The provider and senior staff had completed audits on the home to support quality checks. However, for some areas these had not been undertaken as required and had not prevented shortfalls in the quality of service provision. This was in respect of safe care and treatment and good governance.

Medicines were not always managed safely and measures to prevent infection control did not meet relevant guidance.

Care plans were personalised but did not always contain accurate and complete information. Corresponding records such as health action plans and hospital ‘grab packs’ contained different information and did not correlate.

There were sufficient staff to support people. Staff felt supported by the manager and the provider. Staff had received training to support their role however supervision had not taken place as frequently as required.

People had good health care support from professionals. When people were unwell, staff had raised a concern and taken action with health professionals to address people’s health care needs. Staff followed guidance provided to support people with their care.

People enjoyed their meals and their dietary needs had been catered for. This information was detailed in their care plans. Staff were aware of people's routines and preferences and they used this information to develop positive relationships and deliver person centred care. Relatives told us that they felt people were well cared for by staff who treated them with respect and dignity. People participated in/enjoyed person centred activities on offer and staff encouraged people to participate in things of interest to the them.

The manager worked in partnership with health and care professionals and the local community. The provider had displayed the latest rating at the home and on the website. Statutory notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that the quality of service required improvement.

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.

Greatwood House is a large detached bungalow situated in the extensive grounds of Somerset Court. The home accommodates six people who have autism and complex support needs. Four people live in the main part of the home; two people live in two self-contained flats attached to the main house. People living at Greatwood House can access all other facilities on the Somerset Court site which include various day services.

At the time of our inspection there were six people living at the home. The people we met with had complex learning disabilities and were not able to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff to help form our judgements.

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.

The registered manager was available on both days of our inspection. Staff and people’s relatives described them as being open and approachable.

People were generally safe however; there were some potential risks associated with the management and administration of people’s medicines.

Staffing levels were good and staff understood people’s needs and provided the care and support they needed. There were sufficient staff available to people to enable them to take part in a range of activities according to their interests and preferences.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People lived in a safe environment and were supported by a staff team who had the skills and experience to meet their needs and help to keep people safe.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made. Staff were skilled at communicating with people, especially where people were unable to communicate verbally.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure people’s legal and human rights were protected.

There were effective systems in place to monitor and improve the quality of the service provided.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. Due to the nature of people's disabilities we were only able to gather limited comments with the support of staff.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The acting manager informed us that they were covering maternity leave.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found the service was safe because staff we spoke with where able to tell us about the different types of abuse and were aware that they should report any concerns to an appropriate person. Staff records demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

Each of the people living at Greatwood House had personal emergency evacuation plans and there was also a disaster recovery plan in place for dealing with foreseeable emergencies. A member of the Somerset Court management team was available on call in case of emergency.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that people were subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure and that policies and procedures were in place.

Is the service effective?

Speaking with staff it was evident that they understood individuals' care and support needs. We saw that support plans were based on people's assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People living in the home had complex needs and some people were unable to fully express their views. During our visit we observed that staff provided support and engaged with people positively. We saw that people appeared relaxed and comfortable with staff and saw staff treated people in a sensitive, respectful and professional manner. In people's support plans we saw that there was detailed information about what they needed help with and how staff should support them. We asked one person if they liked living at the home and they replied 'Yes thank you'.

Is the service responsive?

People met with staff on a one to one basis every Sunday week to discuss any issues and to plan what they wanted to do the following week. People were also involved in planning their regular person centred planning reviews and were able to invite their relatives or representative.

Is the service well-led?

The home had quality assurance systems in place. These included audits undertaken by the provider's representative and quality monitoring audits undertaken by registered managers for other homes ran by the provider. The home undertook regular quality assurance surveys with the people who lived at Greatwood House, their relatives and professional who supported them. Incidents all incidents were recorded and monitored which helped staff monitor patterns in people's behaviour's.

There were appropriate arrangements in place to assess people's capacity to make specific decisions such as a need for medical treatment. People were empowered to make choices about their daily living arrangements and in achieving goals and aspirations. Where people were assessed as not being able to make informed decisions best interests meetings had been held. Decisions had been made on their behalf in consultation and discussion with other professionals and people's representatives. People had access to independent advocates to help them in making decisions and ensuring decisions had been made in people's best interests.

Comprehensive assessments had been completed to ensure people received a consistent and reliable service. Assessments were in place to address potential risks to people's health and welfare and provide support to staff in responding and alleviating identified risks.

There were appropriate and safe arrangements for the administering and management of people's medicines. We saw there were individualised plans in place for the effective administering of medicines.

Staff told us they felt well supported and had regular individual supervision. We found some inconsistencies in the frequency of individual supervision. However we were told an audit tool had recently been put in place to monitor the frequency of supervision. There were appropriate arrangements for staff to undertake the appropriate training so they had the necessary skills and knowledge to fulfil their role and responsibilities effectively.

There were effective systems in place to monitor and review the quality of the service. The agency was proactive in learning from incidents and seeking support from professionals to alleviate risks to people. There were a range of quality assurance audits which had identified areas for improvement. The service had put in place action plans to address the identified areas and these were in progress.