S E L F Limited - 15 Park View

About the service

S E L F Limited - 15 Park View is a care home and provides accommodation and support for up to eight people living with a learning disability. There were eight people living at the service when we visited.

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

Right Support

Since the last inspection, practices and the culture within the service had significantly improved. The provider had employed a new manager who supported people to live free from unwarranted restrictions. People, including those unable to make decisions for themselves, now had as much freedom, choice and control over their lives as possible. Staff effectively managed risks to minimise restrictions.

The provider and manager had improved staffing levels and ensured enough staff were on duty. Where people had support, they told us this was flexible, available when they needed it and to the level they needed. People were supported safely with medicines and infection prevention and control practices reflected good practice. Staff managed the safety of the living environment and equipment well through checks and action to minimise risk. Work had been completed to repair the heating system.

The manager had worked with staff to improve the quality of record-keeping. Staff now kept clear and detailed care records, which were accurate, complete, legible and up to date. People were involved in discussions about their support and given information in a way they understood.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received additional training around how to recognise and report abuse. The provider had significantly improved how they looked after people’s money and all spending could be easily accounted for. Wherever possible people looked after their own money. People now had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations. People, those important to them and staff reviewed plans together regularly. Staff now ensured decisions about any routines in the service were based on people’s choices.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff enabled people to access specialist health and social care support in the community. People who lacked capacity to make certain decisions for themselves now had decisions made by staff on their behalf in line with the law. People benefitted from reasonable adjustments to their care to meet their needs, and their human rights were respected. This was because staff put their learning into practice.

People received support to eat and drink enough to maintain a balanced diet. People were involved in choosing their food, shopping, and planning their meals. Mealtimes were flexible to meet people’s needs and to avoid them rushing meals.

Right culture

Since the last inspection the management team has changed. The previous team were found to have created a closed, controlling and restrictive culture in the service, which had failed to promote people’s human rights. The provider critically reviewed the service and put effective measures in place to radically change the ethos in the service. The service was now open to new ways of working and practices were introduced to promote independence and inclusivity.

People received good quality care, support and treatment because trained staff could meet their needs and wishes. The new manager ensured staff placed people’s wishes, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people's care.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 17 December 2021). We identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and good governance.

Following the inspection we issued the provider a warning notice and served requirement notices. The provider was required to provide actions plans detailing how these breaches would be addressed.

Why we inspected

We undertook this focused inspection to check whether sufficient action had been taken in response to the warning notice and requirement notices we served following our last inspection.

The provider completed an action plan after the inspection to show what they would do and by when to improve dignity and respect, safe care and treatment, safeguarding service users from abuse and improper care and staffing levels. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 inadequate to good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

S E L F Limited - 15 Park View is a care home and provides accommodation and support for up to eight people living with a learning disability. There were eight people living at the service when we visited.

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

Risks to people were not always safely managed, monitored or assessed. The service did not have effective systems to protect people from the risk of financial abuse. COVID-19 protocols were not always followed, and the service did not have effective systems to prevent and control the spread of infections.

We found restrictions had been placed on people including holding people’s cash cards, allocated time slots for smoking and vaping and fixed timings for mealtimes and administration of medicines. The provider took immediate action to support people’s fundamental human rights in line with legislation when we brought this to their attention.

Quality assurance systems were not effective, lacked detail and did not include all aspects of the service. The issues we found during the inspection had not been recognised. Some of the managerial duties had been delegated to another manager. The registered manager and provider had not maintained an oversight of the service, which facilitated a poor culture and allowed poor and unlawful practices to be established and embedded.

The service did not ensure enough staff were deployed to meet people’s needs. Staffing rotas did not always reflect the number of staff on duty and the provider’s expected staffing levels were not achieved.

Record keeping was poor. Maintenance, infection control and people’s clinical records were not always completed, and audits failed to identify this.

People’s confidential records were not always accurate and complete and were not held securely.

A training programme was in place. Staff received supervisions and appraisals. However, the majority of staff told us that they were not free to discuss issues at their supervisions as it resulted in a negative impact on them or the rest of the staff team.

Medicines were managed safely. People were referred to health professionals when required.

People gave mixed feedback about the service. Some people told us they were happy whilst others expressed their dissatisfaction about the restrictions placed upon them.

Social work professionals we spoke with were positive about the service and told us people were happy and settled.

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

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.

Based on our review of the key questions of safe, effective and well-led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Restrictive, controlling practices had been adopted within the service. Peoples’ choices had been removed in certain aspects of their lives.

Right care: People did not receive person-centred care and support and the service did not promote people’s dignity, and human rights.

Right culture: Attitudes and behaviours of the management team did not ensure people using services lead confident, inclusive and empowered lives.

Care staff were compassionate about ensuring people lived full lives. They recognised the issues at the service and repeatedly raised concerns with the management team.

The provider is conducting a full investigation into the failings and has put actions in place to address restrictions immediately.

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 good (published 20 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people using the service, staffing levels and management of the service. A decision was made for us to inspect and examine those risks.

An initial inspection took place on 2 September 2021 to establish that people were safe. We inspected and found there was a concern with staffing levels and the management of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

This report only covers our findings in relation to the key questions safe, effective and well-led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.

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.

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 overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection, the provider has taken action to mitigate the risks. The provider was receptive to our feedback and has implemented new systems and procedures in response.

Enforcement

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

We have identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 have arranged to meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

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

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

The care service had 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’s experience of using this service: People told us they were happy and felt safe living at 15 Park View. The service had made improvements around the way it dealt with safeguarding concerns. Risks to people's well-being were recorded and updated when their circumstances changed. Changes had also been made to the provider’s auditing systems. Whilst audits were basic, we found them to be effective.

People received support to take their medicines safely. Sufficient staff were deployed to enable people to go out and access the community when they chose to. The provider ensured staff employed were suitable with the right skills and experience to support people living at the service. Training was designed around people’s needs.

Health and safety checks were regularly conducted to make sure people lived in a safe environment.

Staff were supported by a well established management team who had a clear vision for the service which placed the needs of people first. Staff told us they were proud to work at the service.

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.

People were complimentary about their staff and the positive relationships they had with them. We observed many positive interactions between people and staff. Staff clearly knew people well and were knowledgeable about people’s life histories, family structures, preferences and, care and support needs. We observed staff seek permission before supporting people.

Care plans provided guidance for staff to follow to support people in accordance with their preferences and wishes. Healthcare professionals were regularly involved in supporting people to develop care plans and setting goals. People had access to health care professionals when required and supported with any ongoing care and support needs.

Information throughout the service was available in an appropriate format for people to understand the care and support they received. People were supported to take part in activities and interests they enjoyed. The service also supported people to develop life skills, literacy and numeracy.

The service actively sought feedback from people, relatives, healthcare professionals and staff.

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

Rating at last inspection: Requires improvement with breaches in regulation 12 and regulation 17 (report published on 22 May 2018).

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

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good.

We previously inspected SELF Limited - 15 Park View (‘15 Park View’) in September and October 2015, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

15 Park View 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. 15 Park View provides care and support for up to eight people who have a learning disability. Nursing care is not provided. There were eight people using the service at the time of our inspection. The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the CQC individually we found that there were areas that were common to all three services. For example, training programme and delivery, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 management of a recent safeguarding concern, which had the potential to impact on people who used the service and staff, was not robust in terms of establishing clear outcomes, nor was the investigation process sufficiently accountable.

Risk assessments did not always set out clearly enough how to protect people who may be at risk of absconding, and who presented particular risks to themselves

Medicines administration practices were safe and in line with good practice although staff did not always ensure confidential information was appropriately locked away, or that keys to the medicines storage units were securely stored.

Auditing processes had not identified some of the areas identified on inspection and the provider needed to review how they managed the auditing of the service in the longer term, both in terms of the efficiency of individual audits and who these responsibilities may in time be delegated to.

The majority of risk assessments were sufficiently detailed with clear strategies in place for staff to help protect people in a way that also did not unnecessarily restrict them.

People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.

There were sufficient numbers of staff on duty to meet people’s needs and staff were aware of their safeguarding responsibilities.

All areas of the building were clean and processes were in place to reduce the risks of acquired infections. The registered manager agreed their response to a flood could have had more regard to people’s individual hygiene. The premises were generally well maintained, with external servicing of equipment in place.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. These checks were refreshed after three years after external advice.

People had accessed external healthcare professionals such as GPs, dentists and nurses to get the support they needed. Staff liaised well with these professionals.

Staff received a range of mandatory training and training specific to people’s needs.

People were encouraged to have healthy diets and were protected from the risk of malnutrition, with staff adhering to external advice from dietitians.

The premises were appropriate for people’s needs and there were ample communal areas and bathing facilities.

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.

Relatives and external professionals confirmed staff had formed good relationships with people, in part thanks to a continuity of care and a keyworker system.

People were encouraged to access their local community, which reduced the risk of social isolation.

The atmosphere at the home was communal and relaxed. Person-centred care plans were in place and regular house meetings took place. Care plans were reviewed regularly with people’s involvement.

The service had good links with a local farm, stables and college, and people pursued a range of activities and hobbies meaningful to them.

People who used the service, relatives and professionals we spoke with gave positive feedback about the hands-on approach of the registered manager and the personal interest they took in ensuring people’s day to day goals were met. The registered manager and staff had maintained a caring, person-centred culture within which people were supported to develop their independence.

We found the service was in breach of regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance).

You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and knew who they would go to if they were worried. We observed staff assisting the people living in the service with their usual daily activities; including helping with domestic tasks. Staff were sensitive to people's individual needs and were discreet when making suggestions about them needing personal care such as going to the toilet. The atmosphere in the service was quiet and calm and the staff were focusing on the people they were supporting.

Staff were recruited and selected using a robust process which made sure they were fit to work with vulnerable people and had the skills and knowledge to deliver the service.

Records such as care records and staff records were detailed, up to date and kept securely. They records contained enough detail to make sure the care and welfare needs of the people living in the service were met and that the staff had the skills, knowledge and experience to safely meet those needs.

We spent time with the people in the communal areas and we observed them being supported by staff on an individual basis and in group activities. People engaged in a positive way with the staff including gentle teasing of a member of staff which they initiated and enjoyed. All interactions were maintained in a professional and respectful way which ensured their needs were met. Two people spent time showing us their bedrooms telling us that they were happy with the decoration and that they had been supported to make it personalised to their tastes. The activity session we observed gave people the opportunity for them to be positively engaged and spend time together in a meaningful way.

We saw the people looking to the staff for reassurance when we spoke with them. Staff provided this support without it being intrusive or inappropriate. Staff were assisting the people with their usual daily activities and responding to their needs in a professional and pleasant way and this was recorded in their care records. The atmosphere in the service was lively but settled and the staff focused on the people they were supporting.