Strawberry Fields

We found the following examples of good practice.

Any visitors to the home were required to complete a lateral flow device test, have their temperature taken, their pulse and oxygen levels checked with an oximeter, and to fill in a COVID-19 questionnaire to confirm they were well. If a negative lateral flow device test result was received, then visitors were allowed into the home. All visits were made by appointment. This meant that the provider had taken all possible precautions to protect people from the risk of infection.

All staff working at the home were fully vaccinated. Staff had access to personal protective equipment, such as masks, gloves and aprons, to mitigate the risk of the spread of infection.

Staff and people living at the home had access to regular testing for COVID-19. When staff had contracted the virus, they immediately started a period of isolation and did not return to work until they tested negative for COVID-19. Whilst people did not understand the concept of social distancing, the layout of the premises meant that staff could encourage people to keep their distance from others. Communal areas were spacious, and the home was well-ventilated.

The home was extremely clean and hygienic. The registered manager and staff followed government guidance with regard to the management of COVID-19, and the provider’s policies reflected this guidance.

Strawberry Fields is a residential care home that provides accommodation and personal care for people who have learning disabilities and some associated physical or/and sensory disabilities. There were seven people using the service at the time of inspection.

The service was a large service, bigger than most domestic style properties. It was registered to support ten people which is larger than best practice guidance. However, the provider had clear plans to amend the size of the service and create a space better suited to people’s needs. This would include two self-contained flats and reducing from ten beds to seven.

People’s experience of using this service:

¿ The outcomes for people using the service reflected the principles and values of Registering the Right Support. This document describes what the Care Quality Commission (CQC) look for to help them decide if they can allow a service that looks after people with learning disabilities, to open. Care homes should ideally be small to allow for more personalised care and part of the local community to promote inclusion. The provider must also be able to demonstrate how they will help people to stay independent and make choices about what they want to do.

¿ There was a new manager in post that was spending time with people on shift to understand their preferences, routines and needs. Although they had only been in post for three weeks, staff, relatives and a professional were already optimistic about this change. The service had had three managers in the last year and concerns had been raised by the local authority about how this lack of continuity was impacting on people and staff. The manager had not yet registered with the Care Quality Commission (CQC) but was planning to do this. Despite positive feedback, the manager required more time to implement and imbed changes.

¿ People were kept safe and we could see they felt comfortable around staff they knew well. Areas of risk had been identified and assessments told staff what these were and how risks could be managed.

¿ There were enough staff to meet people’s needs and they had been recruited safely. Management had recognised improvement was needed to staff retention and had implemented several new initiatives.

¿ Due to the fact the new manager was spending time on the floor and observing people and needs, they had taken action to ensure incidents didn’t happen again. This was something they planned to continue moving forward.

¿ We saw medicines were given, stored and managed in a safe way.

¿ 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.

¿ Staff had received a variety of personalised training to meet the needs of people, particularly with regard to behaviours that challenged. Staff told us they felt well supported in their roles with regular supervision and team meetings. They felt their induction had given them the skills and knowledge to understand people and their routines, which were important to them.

¿ People’s nutritional and health care needs were met. They had continuous support from health and social care professionals to improve their well-being. This had a positive impact on their lives.

¿ Relatives and a professional told us staff were, “So very caring” and, “Know people extremely well.” We observed relationships had been built between people and staff based on mutual trust and respect. People’s privacy, dignity and independence was important to staff and promoted.

¿ People had their own bespoke activities timetables, based on their interests and preferences. They had choice and control over what they wanted to do each day. Staff regularly reviewed people’s choices and needs to ensure they were happy with the care provided. People also had choice of who they wanted to support them each day.

¿ Although the manager and operations lead were fairly new, they understood the historical concerns related to the service. They told us they were “Determined to turn the service around” and had been working closely with the local authority to address concerns. A peripatetic manager was working closely with the manager to ensure they had full support during their induction. We were told they would remain at Strawberry Fields, “As long as it took for the manager to be confident.”

Rating at last inspection:

At their previous inspection, Strawberry Fields were rated Requires Improvement overall. (Report published 22 June 2018) At this inspection, we found that significant improvements had been made. The service has now improved to Good overall.

Why we inspected:

The inspection was prompted in part by a series of notifications received by the provider regarding people's safety. However, the information shared with CQC indicated potential concerns about the management of risk and people's safety. This included managing incidents between people. This inspection looked at these issues to ensure people's safety.

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.

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

Strawberry Fields (Consensus) is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Strawberry Fields provides accommodation and personal care for up to ten people who have learning disabilities and some associated physical or/and sensory disabilities. There were seven people using the service at the time of inspection. The building was situated over two floors, with people’s bedrooms located on the ground floor. People had their own bathrooms attached to their bedrooms as well as alternative communal facilities. There was a dining-room, large lounge and smaller lounge for people to relax in. People also had access to a garden and used facilities at a day service, located next door to the home.

The service had a registered manager. 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. Due to the registered manager being new to the service, they received support from a peripatetic manager. This is someone who is an experienced and permanent manager within the company, who provides support to other services when required.

At our last inspection in July 2017, the service was rated 'Requires Improvement'. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection earlier than scheduled due to an increased amount of information from the provider related to people’s safety. We also wanted to check that the provider had followed their action plan and to confirm that they now met legal requirements. Many improvements had been made, however we still found some areas for improvement. This is therefore the third consecutive time that the service has been rated Requires Improvement.

At the previous inspection, it was identified that the premises was not suitable for its intended purpose. Strawberry Fields was designed, built and registered before ‘Registering the Right Support’ and other best practice guidance was published. We found that the building did not meet the guidance as it was a large setting, rather than small and homely and the loud atmosphere did not always meet people’s needs. However, the registered manager, operations managers and director were very aware of improvements required to the building to ensure that it was suitable for people living there. Improvements had been made to the environment but further renovation works were required to ensure that it was suitable for people and met their needs. The provider had a detailed action plan to address when these works would be completed.

People’s communication needs were not always met. Specific communication methods had been identified but were not always used to support people to make decisions. Observations of staff demonstrated that staff were also not always responsive to people’s needs. We have made a recommendation regarding this.

At the previous inspection, a requirement notice was served in relation to a lack of effective quality monitoring processes. We found many improvements during this inspection and the registered manager was consistently completing audits on a monthly basis. However, other issues identified suggest that these improvements need more time to be embedded fully.

At the previous inspection, a requirement notice was served as people were not always protected from abuse. During this inspection, we found that people were safe. Staff had understanding of how to protect people against harm and there were suitable levels of staff available to ensure people’s needs could be met at any time. Staff were recruited safely and appropriate background checks were made to ensure their character and skills were suitable to support people. There were individualised risk assessments for people and the environment and building they lived in, including emergency evacuation plans for in the event of an emergency such as a fire. Incidents were investigated within relevant timescales and appropriate actions taken to ensure they did not happen again. Medicines were managed in such a way that people received them safely. People were only supported by staff that were trained in administering medicines.

Staff received a wide range of training to ensure they could support people safely. Staff also benefited from taking part in regular supervision and appraisal to help them develop their skills and knowledge. Staff felt supported and encouraged in their personal development and relatives were clear that staff had the skills and knowledge to support people. Staff attended regular team meetings where they could discuss any concerns they had. There was a robust induction programme that involved shadowing of experienced staff, completing a qualification and developing a thorough understanding of people and their routines.

Relatives were unanimous in their view that people were supported by a kind, caring staff team. We observed staff and people to have built good relationships, based on mutual respect and trust. People’s dignity, independence and privacy was promoted and encouraged. Staff knew people, their preferences and support needs well. People had their own key-worker; this was a named member of staff who had a central role in their lives and would oversee their support needs and care plans. Each person had a clear and detailed care plan tailored to their individual needs. These highlighted specific support needs, risks and involvement from people, their relatives and health professionals. This included assessments for supporting people with managing anxieties and challenging behaviour.

People had choice and control over the activities they wanted to participate in each day. These were tailor-made to people’s likes and dislikes. Staff and the relatives were knowledgeable of the complaints procedure and confident they could talk to the registered manager about anything that was worrying them.

The management team, staff and relatives acknowledged previous issues at the service and felt that there had been a significant improvement. Staff morale was high and both they and relatives were complimentary of the new registered manager and the changes that had been made. The provider had responded to information from surveys regarding low staff retention and introduced several initiatives to address this. Feedback was also sought from people, their relatives and health professionals and success stories shared to the staff team through various forums and newsletters.

Further information is in the detailed findings below.

Strawberry Fields provides care and accommodation for up to 10 people with a learning disability. There were eight people living at the home when we inspected and they ranged in age from 24 to 52 years.

All bedrooms were single and each had an en-suite bathroom with a toilet. The home has two lounges and a separate dining room which people used.

The service was previously inspected on 31 May and 1 June 2016; the service was rated as Requires Improvement and we served three requirements notices regarding the following:

• People were not always protected from abuse.

• The premises were not well maintained, clean or suitable for their intended purpose.

• A lack of effective systems and processes for assessing, monitoring and improving the quality and safety of the service, including accurate record not being maintained.

This inspection was carried out to check on how the provider was making progress on meeting these requirements. The inspection was also prompted by notifications received by us regarding the safety of people and staff.

The provider sent us an action plan of how the requirements made as a result of the inspection of 31 May and 1 June 2016 would be met. At this inspection we found action had been taken to meet these requirements. However, this was not always sufficient as the safety of people at the service remained a concern. Adequate action had not been taken by the provider’s management in response to incidents to ensure the safety of people and staff. The service has been rated as Requires Improvement at the last two inspections as well as this one. There has been a repeated failure to meet Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding systems and processes to assess, monitor and improve the quality and safety of the service. There has also been a repeated failure to meet Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding the protection of people from abuse.

At the time of the inspection the service had a registered manager who was shortly to leave the service and would be applying to cancel their registration with the Commission. 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 provider had made arrangements for a new manager to take over on an interim basis. This manager was already in post at the time of the inspection and was experienced in care home management as well as being familiar with the service. The manager was due to apply for registration with the Commission.

For many people living at the service there had been a reduction in the number of incidents of challenging behaviour which required staff intervention. However, we judged that since the last inspection in June 2016 incidents of behaviour had not been responded to effectively and did not ensure staff and people were safe.

Liaison and communication with health and social professionals took place regarding the management and review of challenging behaviour.

People and their relatives told us that safe care was provided. During our inspection, one person complained about being hurt by another person at the home. The person was given assurances of action that would be taken and signed a form to acknowledge that their complaint was dealt with.

Incidents of aggression and violence did not always result in the timely review of care and staffing to ensure the safe care of one person. Staff expressed concerns about safety in the home. Staff did not feel the training they received in dealing with challenging behaviour fully equipped them to provide safe care.

The provider had not notified the Health and Safety Executive of one injury to a staff member within the required timescales as required by Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).

Improvements had been made to the environment since the last inspection but we found areas where further work was needed to create a suitable and safe environment for people. We have made a recommendation regarding this.

At our last inspection, we identified that the provider did not have systems and processes fully established to assess, monitor and improve the quality and safety of the service. At this inspection, we found that improvements had been made. There were audits and checks but these did not always result in improvements being made. There were continued risks to people’s safety. Whilst the provider said they had looked at their actions regarding the care of one person, and there was evidence of care reviews, this had not effectively prevented risk of harm to people at the service. We found improvements were needed to ensure that previous requirements were fully met and to ensure safety at the service.

The system for the induction of newly appointed staff included a period of shadowing more experienced staff as well as attendance at training courses. While staff confirmed they received an induction, they told us that this was not well organised and that shadowing did not take place as intended. We saw one staff member’s induction plan record that had not been fully completed, which meant that the provider could not assure themselves that all staff had the necessary induction to undertake aspects of their role safely. Staff received training in relevant courses and had supervision.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Risks to people were assessed and care plans devised on how to mitigate these, which included the management of people’s behaviour. We saw there were numerous examples of staff taking appropriate action to divert people from behaviours which were challenging. During the inspection we observed staff dealt appropriately and skilfully with two incidents of challenging behaviour as well as one person who was agitated. The staff actions were successful in calming people.

There had been vacancies at the home in the months preceding the inspection, and also new staff were used in response to the need to change numbers and deployment of resources following incidents of violence. Staff told us that they did not always consider there were enough staff. Staff and some other stakeholders expressed concern at the turnover and high use of agency staff as this could have an impact on the quality and continuity of care. The provider had taken action to recruit more staff and said there were no current vacancies at the time of this inspection. Staff were assigned to work with people on a one to one or two staff to one person. These arrangements were recorded on staff duty rosters. During our site visit, we observed there were sufficient staff to meet people’s needs and judged the service had enough staff to look after people safely.

People received their medicines safely.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity to consent best interests meetings were held in line with the MCA guidance.

People were supported to receive adequate food and nutrition. Specialist diets and support were provided where this was needed.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff demonstrated a caring attitude to people who they treated with kindness and respect. Staff were committed to the welfare and well-being of people who they cared about. People were able to exercise choice in how they spent their time.

Each person’s needs were assessed and this included obtaining a background history of people. Care was individualised to reflect people’s preferences. Most of the health and social care professional we spoke with were satisfied with the standard of care, but two professionals expressed concerns that they were not kept informed about relevant incidents in a timely way.

People had access to range of activities based on an assessment of their social and recreational needs. These included access to community facilities, outings and holidays.

The complaints procedure was provided to people and their relatives. People said they had opportunities to express their views or concerns, which were listened to and acted on. There was a record to show complaints were looked into and any actions taken as a result of the complaint. We observed the operations manager discussing a complaint with one person. The operations manager listened and acted on what the person said.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Strawberry Fields provides care and accommodation for up to 10 people with a learning disability. There were 9 people living at the home when we inspected and they ranged in age from 23 to 51 years.

All bedrooms were single and each had an en-suite bathroom with a toilet. The home has two lounges and a separate dining room which people were observed using.

The previous inspection report made four requirements regarding the following:

• People not receiving care and treatment which met their needs and preferences

• A failure to follow the guidelines of the Mental Capacity Act 2005 where people did not have capacity to consent to their care

• A lack of effective systems and processes for assessing, monitoring and improving the quality and safety of the service

• Staff not receiving appropriate training, supervision and appraisal

This inspection was carried out to check on how the provider was making progress on meeting these requirements. The inspection was brought forward from the planned schedule date of inspection due to concerns raised with us by the local authority safeguarding team about the safety of people. The provider sent us an action plan of how these requirements would be met. At this inspection we found action had been taken to meet these requirements but that further work was needed in a number of areas.

The service did not have a registered manager, but there was a new manager who had applied to the Commission for registration. 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 manager had been in post since February 2016 and whilst she has introduced a number of changes and improvements to the service these were not yet embedded and further work and time was needed in a number of areas.

The environment was in need of improvement and was not always clean. Communal areas were austere and institutional. Bedrooms were not always clean and staff did not follow safe hygiene practices when managing someone’s incontinence.

There had been a number of incidents related to the management of behaviours which may challenge which resulted in staff and people being assaulted by people using the service. Staff reported there had been a reduction in the number of the incidents but the service’s own records did not support this. Whilst these were addressed and reviewed, the frequency of their occurrence was not reducing which gave cause for concern.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Risks to people were assessed and care plans devised on how to mitigate these, which included the management of people’s behaviour. We saw there were numerous examples of staff taking appropriate action to divert people from behaviours which were challenging.

There had been a number of changes in the staff and management of the service which funding local authorities and the safeguarding team expressed concern about. Staffing levels were under review at the time of the inspection. The provider had assessed one person needed additional staff support and was in negotiation with the funding authority about this. For the remaining people sufficient staffing levels were provided.

People received their medicines safely.

Improvements have been made regarding the training and supervision of staff but this needed to be enhanced to ensure all staff had received the required training.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We found the provider and registered manager needed to update their knowledge as well as the service’s procedures where people did not have capacity to consent to their care or treatment and where DoLS were applicable. Where people lacked capacity to consent best interests meetings were held in line with the MCA guidance but the staff and manager did not have a system for assessing the capacity of people.

People were supported to receive adequate food and nutrition although we noted where one person needed to have their fluid intake and output monitored that this was not always done.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff demonstrated a caring attitude to people who they treated with kindness and respect. People were able to exercise choice in how they spent their time.

Each person’s needs were assessed and this included obtaining a background history of people. Care was individualised to reflect people’s preferences. Relatives and health care professionals gave mixed views as to whether the service met people’s needs or not. Two relatives said care needs were met but one said they weren’t. Three health and social care professionals said people’s care needs were met and three said they weren’t.

The provision of activities for people had improved and the staff and manger was looking at ways of expanding this. For example, two people had been on holiday supported by staff and there were plans for other people to do the same.

The complaints procedure was provided to people and their relatives. People said they had opportunities to express their views or concerns, which were listened to and acted on. There was a record to show complaints were looked into and any actions taken as a result of the complaint.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service which the provider used to make any improvements. However there were aspects of the service which required improvement that had not been completely addressed and some action plans did not have clear timescales for completion.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what people using the service and staff members told us, what we observed and the records we looked at.

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

Is the service safe?

People received appropriate care that met their needs based on a thorough assessment.

People were cared for in an environment that identified and minimised risk. Staff had received adequate training to quickly recognise and respond to emergency situations, and could provide care and treatment which promoted people's safety and welfare.

The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One staff member had a good awareness of safeguarding and whistleblowing issues.

Staff had attended relevant safeguarding training and were aware of how to access support when needed.

People using the service were being cared for safely by suitably qualified staff who were competent to carry out their role. Staff members followed a thorough induction and ongoing training process which enabled them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that the provider was in the process of submitting a DoLS application and the proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

One person told us that they were happy with the care they received and liked the home.

It was clear during our visit that staff knew people well and understood their care and support needs. Staff had received training to meet the needs of people living at the home.

Positive written feedback from staff and relatives demonstrated that the service was effective.

Is the service caring?

We found that people's routines were flexible and they were encouraged to make decisions about what they wanted to do. We saw that their choices were respected.

We saw that staff gave encouragement and support where needed to people using the service.

We saw staff members interacting with people in a positive way. We saw staff assisting people with activities and joining in with hobbies.

The general environment of the home was welcoming and relaxed.

Is the service responsive?

People's individual needs were assessed before they moved into the home. The care records that we looked at during our inspection confirmed that people's preferences, interests, aspirations and needs had been identified and recorded. Care and support had been provided that met their wishes.

People's preferences were recorded and acted upon and people were actively encouraged to pursue interests and hobbies. People were involved in various activities within the home and trips out.

Is the service well-led?

The provider had robust quality assurance processes in place which were overseen by the manager.

The manager was clear about their responsibilities for recording and dealing with complaints, incidents and safeguarding issues and we found that appropriate actions had been taken.

The manager discussed the importance of ensuring that people were encouraged to make choices and decisions about their care and influence how the service was run.

Due to the nature of peoples disabilities we were not able to speak to a number of people about their experiences. Instead, as part of this inspection we spent time observing the interaction between staff and people. This was seen to be positive and valuing. Staff spoke to people in a polite and supportive way when responding to their requests. We observed staff reacting to verbal and non verbal cues from people. They demonstrated a clear knowledge of people's needs.

Staff told us that they felt supported by the manager and provider to carry out their roles; they enjoyed working at the home and had a wide range of training.

We found that the provider had taken action to develop accurate and detailed support plans for people who use the service.

We found that people had appropriate, clean and well maintained accommodation and that they could personalise their private spaces to suit their tastes and personalities.

Staff received appropriate support and training to meet their needs and the needs of the people they support. The provider had an effective quality assurance system in place.

We spoke with four members of staff who worked at the home. They all said they felt well supported and suitably trained for their roles.

We looked at the care records of three people who lived at the home. We saw that for two of the people that their care had been planned and delivered to meet their needs. However, for one person their care and support was not always delivered in line with their individual needs.

We saw evidence that the people who lived at the home were being protected from the risk of abuse because provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. However the provider had not notified the Commission about incidents that affect the health, safety and welfare of people who use its services including injuries to people and allegations of abuse.