Safeharbour (260 Hagley Road)

Safeharbour(260) is a residential care home providing personal care and accommodation for up to four people with learning disability. On the day of the inspection, four people were receiving support.

Services for people with learning disabilities and or autism are supported

The service has been developed 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.

The service consistently 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’s experience of using this service and what we found

People received support that was safe. The registered manager ensured people were safe by making sure all staff received safeguarding training to keep them safe from harm. Recruitment systems were in place so only suitable staff could support people. Where people needed support with medicines this was received as it was prescribed. Staff had access to PPE to ensure infection control procedures were followed. Systems were in place to monitor trends where accidents or incidents had taken place.

People received effective care. 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. Staff were supported so they had the skills to meet people’s needs. People’s nutrition and healthcare was maintained by staff who were trained to do so.

People received support that was caring, kind and compassionate. People were supported in line with their likes, dislikes and preferences. Staff promoted people’s privacy, dignity and independence.

People received support that was responsive to their needs. Care plans were in place to identify how people would be supported. The provider had a complaints process in place, so concerns could be raised.

The service was well led. The culture in the service was open, empowering and inclusive. Communication standards encouraged relatives to share their views by completing questionnaires and attending planned meetings. Spot checks and audits took place to ensure the quality of the service was maintained.

Rating at last inspection

The last rating for this service was requires Improvement (Report published 23 January 2019)

Why we inspected

This was a planned comprehensive inspection based on the previous rating.

Follow up

We will continue to monitor the service through the information we receive 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

The provider had failed to ensure that staff consistently obtained people's consent before any care or treatment was provided. This resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure relevant health and safety concerns were included in people's care and treatment plans and that medical attention was consistently sought when people were unwell. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure service users were protected from abuse and improper treatment in accordance with this regulation. This resulted in a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

Systems and processes were not in place to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of people living at the home. This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made but more work was required to ensure the systems and processes in place were embedded and sustainable.

Following the last inspection, we asked the provider to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe and Well Led, from inadequate to at least good. We also asked them to provide us with monthly reports outlining the actions taken and progress made against concerns raised. At this inspection, we found improvements had been made and systems and processes were in place to continue to monitor the delivery of care and support at the service.

Safeharbour 260 is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Safeharbour 260 accommodates up to six people in one adapted building. At the time of the inspection, four people were living at the service.

The care service has been developed and designed 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 learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a new manager in post who was in the process of making an application to become registered manager of the 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 about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, there remain some areas where improvements made need to be further embedded to evidence sustained improvement.

People were supported by a group of staff who had been trained to recognise signs of abuse and who understood their responsibilities to report on and act on any concerns. Staff were aware of the risks to people and were kept up to date in changes in people’s care needs. Recruitment processes were in place to ensure staff were safely recruited.

Systems were in place to ensure people received their medicines as prescribed. Staff had received training in how to administer medicines and had their competencies assessed.

Cleaning schedules were in place and aprons and gloves were available to staff to prevent the spread of infection.

Information regarding accidents, incidents, health and safeguarding concerns was collected and analysed on a regular basis to identify trends or lessons to be learnt. Action was taken using this information to improve service delivery and ensure people received safe and effective care and support.

Staff knew people well and had received and induction and training which provided them with the skills to support people safely and effectively. Staff felt supported in their role and were kept up to date with changes in people’s care needs. People were supported to choose what they had to eat and drink and make healthy choices where appropriate in order to maintain a balanced diet.

Staff were aware of people’s healthcare needs and how to support them to maintain good health. People had access to a variety of healthcare professionals and referrals were made quickly when health needs changes.

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 routinely obtained people’s consent and offered them choices throughout their day.

Staff were described as kind and caring and treated people with dignity and respect. Staff supported people to express their views and be actively involved in making decisions about their care and support.

People were involved in the planning and development of their care. There were a variety of activities people were encouraged to participate in that were of particular interest to them, both in and outside the home. Staff were improving their knowledge of people’s preferences when it came to their interests and were working towards sourcing new areas of activity people for people to participate in.

There was a system in place to report, record and respond to complaints. People were confident that if they did raise concerns, they would be listened to.

Staff had worked hard to respond to the concerns raised during the last inspection and had implemented a number of systems and processes to enable them to meet people’s needs. A wide variety of audits were in place which provided the manager and members of staff with oversight of the service. Where audits identified areas of concern, or trends in reporting, actions were taken.

Staff were confident that they changes being introduced to the service were making a positive difference in service delivery. Staff felt supported and listened to and proud of the service. Relatives were complimentary of the service, the hard work put in by staff and the difference this had made to their loved one’s lives.

Safeharbour is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Safeharbour accommodates six people in one adapted building. At the time of the inspection, five people were living at the service.

The care service has been developed and designed 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 learning disabilities and autism using the service can live as ordinary a life as any citizen. The service did not consistently comply with Registering the Right Support and the registered manager was not aware of the policy.

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.

People were not fully protected from harm and abuse. Accidents and incidents had taken place and had not been reported to the appropriate authorities. Potential safeguarding concerns had not been recognised and acted on appropriately. Systems were not in place to collect this information and learn lessons.

Systems in place to respond to behaviour that may challenge did not provide staff with enough detail on how to use de-escalation or distraction techniques. Restrictions were in place which significantly limited people’s choice and control regarding their participation in daily activities.

There was a lack of good governance and oversight of the monitoring and administration of medication. Staff competencies in administering medication were not assessed, protocols were missing and medication audits in place had failed to identify areas of concern.

Systems were not in place to ensure staff had the skills, knowledge and experience to deliver effective care and support. Not all staff had received training in specialist areas and staffs competencies were not being assessed.

People were supported to maintain a healthy diet and staff were aware of people’s dietary needs and preferences. People were not always supported to maintain good health. Staff did not routinely obtain healthcare advice or guidance when people were unwell.

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

Staff were described as kind and caring but for some people, communication systems in place were not effective and did not provide staff with the information and training to communicate with all people effectively.

People were not routinely involved in the planning and development of their care. People were supported to access a wide variety of activities during the day, but did not always have their wishes respected if they did not want to participate in some of the activities.

People’s care records provided staff with detailed information about them, but were repetitive and difficult to navigate.

Relatives were confident that if they raised a complaint, it would be dealt with appropriately.

There was a lack of oversight of the service by the provider and the registered manager. There was a distinct lack of audits in place that would provide the registered manager with a view of what was happening at the service. The audits that were in place were ineffective, inconsistently completed and did not highlight the areas of concern that came to light during the inspection.

The provider had not informed CQC of important events that occurred at the service, in line with current legislation.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they did not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a manager in post and she was present during our inspection. 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 and associated Regulations about how the service is run.

At our last inspection in November 2015 we found that the provider was meeting the regulations of the Health and Social Care Act 2008. However some improvements were needed which we found had been made at this inspection.

Relatives we spoke with told us they thought their family members were safe and protected from harm by the staff and the systems that were in place. Staff were aware of their responsibilities to report any concerns about people’s safety, and they confirmed they had received training in relation to safeguarding people from abuse. People were supported by sufficient staff in accordance with the requirements of the funding authority. We found that people received their medicines safely. We identified some areas where improvements could be made to the medicine procedures in place. The registered manager took action to address these at the time of our visit.

A training programme was in place which ensured staff had the necessary skills and knowledge for their role. Workshops were provided to staff to discuss strategies staff used to support people. Staff told us they received support that enabled them to deliver care safely.

Staff sought people’s consent before providing support. Where people were unable to consent to their care because they did not have the mental capacity to do this, decisions were made in their best interests. Staff knew which people had their liberty restricted to keep them safe, but they were unsure about any conditions attached to the authorisations in place.

People were treated with kindness, and respect and staff promoted people’s independence and right to privacy. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health or well-being. People were supported to eat and drink in accordance with their preferences and dietary requirements.

There was a complaints policy in place and staff were aware of the signs to look out for which may indicate people where unhappy. Records showed how complaints had been responded to and the actions taken. Relatives we spoke with all knew how to raise any concerns they may have, and they had confidence that any issues would be addressed.

Relatives and staff told us the service was managed well and in people’s best interests. Systems were in place to gain feedback from these people to enable the service to make any required improvements. Audits were undertaken regularly to monitor the quality of the service provided.

The provider is registered to accommodate and deliver personal care to six people who lived with a learning disability or associated need. Five people lived at the home at the time of our inspection.

The manager was registered with us as is required by law. 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.

Medicines systems did not fully demonstrate safety or always confirm that people had been given their medicines as they had been prescribed.

Not all staff had received the training they required to fully equip them with the skills they needed to support the people in their care, but this was being addressed.

Staff were available to meet people’s individual needs. Staff received induction and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff knew the procedures they should follow to ensure the risk of harm and/or abuse was reduced. Recruitment processes ensured that unsuitable staff were not employed.

Relatives felt that people were supported by an adequate number of staff who were kind and caring.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

Systems were in place for people and their relatives to raise their concerns or complaints.

Relatives and staff felt that the quality of service was good. The management of the service was stable. However, registered manager and provider had not undertaken regular audits to determine shortfalls or see if changes or improvements were needed.

The representatives we spoke with told us they were happy with the care and support provided to their relatives. One relative said, 'We are really happy with everything. We attend the reviews and contribute to the way the support and care is provided. We have no concerns.' Another relative said, "We are very happy with the care provided."

We found that systems were in place to ensure people's consent was always obtained before any support was provided.

We saw that people's needs were assessed, and support plans were developed in consultation with people's representatives. Staff we spoke with were able to tell us about people's needs. This ensured they received support in a way they preferred and in their best interests.

We found that systems were in place which ensured people received their medication as required.

The recruitment procedures that were followed ensured that only suitable staff were employed to work in the home.

The provider had a complaints procedure in place to enable people and their representatives to share their concerns.

We saw that that staff encouraged people to be independent and make choices about their day.

Relatives spoken with told us they were happy with the support provided by the home. One relative told us, 'The staff are respectful, approachable and provide excellent support. I am involved in the discussions about my relatives support plan, and the staff keep me informed. I am very happy with the way they are looked after'. Another relative said, 'I am impressed and happy with the service provided, they meet my relatives needs and maximise their independence'.

We found that people's needs were assessed, and support plans were developed in consultation with people's representatives. Staff spoken with were able to tell us about people's needs. This ensures they receive support in a way they prefer.

We found that arrangements were in place to ensure that people were safeguarded from harm.

Staff spoken with told us they felt supported by the management team. They confirmed they have regular training opportunities. This ensures staff are able to deliver care to an appropriate standard.

We found that systems were in place for assessing and monitoring the quality of service provided.