Archived: Serenity House

Serenity House is a residential care home providing personal care to six people at the time of the inspection. The service can support up to 15 people. The service is registered to support older people, however people with a learning disability and autism were in residence. The service is not registered to support people with these needs.

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

The systems in place to assess, monitor and manage risks to people’s health, safety and welfare was fragmented and unsafe. Sufficient action was not taken in relation to fire safety risks and risks relating to the ongoing building renovations.

There were significant health and safety risks in relation to the premises and unsafe storage of machinery and equipment. Infection prevention and control procedures did not protect people and staff from the risk of contagious diseases.

People were at risk of harm because risk assessments were not always place for specific risks to people. System to monitor and review risks and support plans was not effective. People were not always involved in the process to assess, develop and review risks and their support plans.

Staffing levels were not always consistent. This meant people did not receive a person-centred approach which included the one to one support they needed. Systems and processes to protect people from the abuse and improper treatment was not robust.

People received their medicines as prescribed. However not all medicines were stored safely. The provider took action following our inspection visit to ensure medicines that needed to be refrigerated were stored securely.

People were mostly supported to have maximum choice and control of their lives and staff mostly supported them in the least restrictive way possible and in their best interests. Although policies were in place the systems were not robust to support 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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This was because the provider was not aware of the principles and lacked insight as to the model of care and environment to promote the lives of people with a learning disability. The service was only registered to support older people, despite supporting people with a learning disability and autism in residence. Staff required further training to support people with a learning disability and autism. Support plans were personalised but did not always involve people to ensure their wishes and aspirations were identified to enable staff to promote them to lead confident and inclusive lives.

The provider did not have oversight and systems and processes to assess, monitor and improve the quality of service remained ineffective. Quality assurance systems had not identified widespread issues and risks. This placed people at serious risk of harm.

The provider had not fulfilled their legal responsibilities. Breaches of regulations were found at our inspections of March 2021, November 2019, March 2021 and October 2017. This demonstrated the lack of lessons learned and limited action had been taken to improve the service as further breaches of regulations were found at this inspection.

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 April 2021). We issued a requirement notice in relation to regulation 12 (Safe care and treatment) and a Warning Notice and the provider was required to meet the requirements of regulation 17 (Good governance) by 31 July 2021. The service rating has deteriorated to inadequate. Breaches of legal requirements were found, and the service was placed in special measures. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the environmental and fire safety risks, health and safety risks and leadership of the service. We decided to inspect and examine those risks and to check whether the Warning Notice was met. This report only covers our findings in relation to the key questions of Safe and Well-Led which contained the Warning Notice. 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Serenity 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, infection prevention and control, safeguarding service users from abuse and improper treatment, premises and equipment and governance and quality monitoring. The provider had failed to keep their registration up to date and had failed to submit notifications to the CQC, which they are required to do so by law.

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

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.

Serenity House is situated in Gainsborough Lincolnshire. It can accommodate up to 15 people who experience learning disabilities and/or autistic spectrum disorder. It can also accommodate older people. On the day of the inspection four people were living in the home and two people were accommodated in hotels with Serenity care staff supporting them 24 hours a day and seven days a week. The service also operates a home care service supporting 33 people with personal care.

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

People did not always live in a safe environment. The local fire safety team had issued a prohibition notice which had necessitated the service to operate from the ground floor of the service until they had complied with urgent action. We saw the provider had complied with these actions. However, there were ongoing concerns around the governance of the service which had impacted on fire safety checks, staff training and the environment. The provider continues to work to improve these areas.

People told us they felt safe with the staff who supported them. Staff we spoke with had good knowledge of their responsibilities in relation to protecting people from abuse. Information in people’s care plans gave staff the guidance to provide effective support. People’s medicines were managed safely, and staff showed a good understanding of how to reduce the risk of infection for the people they cared for.

People and staff felt the care provided was person centred and the communications between the management team and people, staff and relatives were good. Staff enjoyed their jobs and were happy in their roles.

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.

Serenity House worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People received personised care, they were involved in planning their care to ensure the structure of their daily lives were as far as possible supported by their own choices.

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 22 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation fire safety at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

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.

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 serenity 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.

Serenity House is located in Gainsborough and is both a residential care home and a domiciliary care agency which provides care to people in their own homes. The residential home provides accommodation and personal care for up to six people. The domiciliary care agency provides personal care for up to 60 people who live in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service was in the process of being adapted and designed in line with the principles and values that underpin 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. The 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 and what we found

There were a lack of systems and processes in place to effectively monitor accidents and incidents. Risks associated with people’s health conditions had not always been identified and measures put in place to mitigate risk of harm. People received their prescribed medicines in the residential service. However, there was no evidence that staff who were administering medicine in the community were competent to do so. People felt safe using the residential service, however, people who received care in their own homes, felt unsafe at times. Safeguarding incidents had not always been identified and reported to the local authority. People were protected from infection.

We found a breach of Regulation 12, Health and Social Care Act, 2008 (Regulated Activities), Safe Care and Treatment.

Quality monitoring systems were not consistent. Audits did not always identify shortfalls and where shortfalls were identified, action was not always taken to resolve them. The provider had failed to notify us about an incident they were required to by law. There was an open, person centred culture in the service. There had been recent changes in the management team which had a positive impact on sharing a vision for the service. However, people, staff and relatives felt the registered manager was approachable and cared about people.

We found a breach of Regulation 17, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

People who used the residential service, had their needs assessed prior to admission. However, further assurance was needed that people who received care in their own homes were having their needs assessed before care packages were accepted. People who received care in their own homes did not always have their capacity assessed. There were extensive plans to develop the premises, but at the time of inspection areas of the service required immediate attention. Staff received ongoing training and had access to qualifications. People were supported to maintain a balanced diet. People who lived in the residential service had their capacity assessed where needed.

In the residential service, we found 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.

In the domiciliary care service, we found people were not always supported to have maximum choice and control of their lives. Staff did not always 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.

People were treated with kindness and staff were compassionate when interacting with them. People and staff had good relationships and staff knew people well. People felt their privacy was respected.

There were a lack of systems and process for handling and responding to concerns. People’s end of life care preferences had not been assessed in either service. Not all people receiving care in their own homes had an individual support plan in place. People living in the residential service had detailed, individual care plans in place. People had information accessible to them in different methods, so they were able to understand it. People were encouraged to maintain hobbies and had a variety of activities available to them.

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 16 May 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, enough, improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

During the inspection there was an event and notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

During the inspection we recognised that the provider had failed to notify CQC of notifiable events. This was a breach of regulation.

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.

The service also provides personal care to 50 people living in their own homes in Gainsborough and in Grantham.

The service had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

People’s experience of using this service:

There was not a system in place to carry out quality checks in either the residential setting or the homecare service.

Medicines were not consistently managed safely. Arrangements were not in place to store and manage medicines safely.

Risk assessments had not been completed for people living in the residential setting.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People said they felt safe. There was sufficient staff to support people.

People enjoyed the meals and their dietary needs had been catered for. Staff supported people to have a healthy diet.

Care plans for people living in the residential setting did not contain information about people and their care needs. Care plans for people receiving care in their own home were completed and included information to assist with the provision of personalised care.

Staff had received training to support their role. Staff had started to receive supervision and plans were in place to ensure people received this on a regular basis.

People had good health care support from professionals. The provider and staff worked in partnership with health and care professionals.

Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

People in the residential setting had access to a range of activities including participating in leisure pursuits in the local community.

The environment was not fully adapted to support people living with learning disability. A refurbishment plan was in place to address this.

The home was not clean in some areas and arrangements were not in place to manage the risk of cross infection.

The provider had displayed the latest rating on the website. When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection: Requires Improvement (Report Published). At our previous comprehensive inspection in October 2017 the service was rated overall requires improvement. We found a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010.

At this inspection we found a continuous breach of Regulation 17 and a breach of Regulation 12.

We have taken this into account in determining the rating.

Why we inspected: This inspection was a planned inspection based on the previous rating.

Follow up: We will ask the provider for an action plan to indicate when they will have consistently addressed all the issues. Please see the ‘action we have asked the provider to take’ section at the end of this report.

There were two registered managers in post. One for the residential home and another for the homecare service. 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.

On the day of our inspection staff interacted well with people in the residential home. People and their relatives using both parts of the service told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Systems for monitoring medicines were not consistent with national guidance. Arrangements were not consistently in place to ensure the safe administration and management of medicines.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had usually been completed.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day. Where people had special dietary requirements we saw that these were provided for.

There was usually sufficient staff available to meet people’s needs. Staff responded in an appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Some staff had received supervision however supervisions had not been completed for all staff in both areas of care. People were supported to access leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans put in place to address any issues which were identified. However the audits had failed to identify the issues found at this inspection. The provider had failed to fully address the issues raised at our previous inspection. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines records did not consistently confirm that medicines were administered as prescribed. Medication administration sheets (MARS) were not always fully completed.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. Risk assessments were completed in the residential home however there were gaps in risk assessments for people using the homecare service. People had access to healthcare professionals such as the GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. It was not easy for people to make choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were usually sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had not received regular formal supervision but felt supported in their roles.

Staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans were in place to address any issues which were identified. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us, 'It is entirely up to me what I wear. I come down when I want to and when you have breakfast is up to you.' Another person told us, 'I have help where I need it, but they don't push it at you. I wouldn't want to lose my independence.'

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. A person who used the service told us, 'I only have to press the bell and there is someone there. I am not made to feel a nuisance, they just reassure me. That is just what I need.'

We found the staff team were supported through training and the provider monitored the quality of the service and responded to people's views. A person told us, 'They do seem to be well trained, they are anxious to help without being intense.'