St Anne's Community Services - Sutherland Court

About the service

St Anne's Community Services - Sutherland Court 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.

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

People were protected from risk of harm and abuse because safeguarding systems were in place and staff knew what to do if they thought somebody was at risk. The service was moving away from the risk averse nature of previous practice by supporting people to have choice and control of their lives. New formats for care plans and newly developed ‘This is me’ documents demonstrated an improving approach to holistic approach that recognised people’s individuality and skills.

Medicines were managed safely. How people preferred to receive their medicines was documented within their care and support plans and we saw staff followed people’s preferences.

There were enough staff to support people. Staff were following an ongoing training plan to support them in meeting people’s needs. Staff were being supported, through training and discussion, to change the culture within the service. This was in it’s early stages, but the support being given to staff was to enable them to make improvements in promoting people’s independence and supporting them to make choices.

Systems for managing Deprivation of Liberty Safeguards (DoLS) had been improved and information was in place to support staff in knowing what to do to meet any conditions associated with the DoLS.

People were supported to remain healthy. People enjoyed their meals and were able to make choices. Some people needed better support to make sure their diet met with their needs.

A new management and quality team had introduced governance systems to make sure people were safe and received good quality of care and support in line with their individual needs. Because the governance systems were new, we were not able, at the time of the inspection, to see how they would be used to affect change within the service.

We have made a recommendation the provider considers making changes to the way people’s feedback is analysed and summarised to reflect people’s views of individual services.

The service was able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture.

Right support

The new model of care aimed to maximise people's choice, control and independence. New documentation to support people’s communication needs and abilities promote independence and manage risks meant improvements were being made in making sure people were receiving the right support. People appeared relaxed and comfortable, we saw people choosing where to spend their time and engaging in activities they enjoyed or found comforting. People appeared to have a trusting relationship with staff.

Right Care

People were supported to choose their activities and contact with their families or advocates was promoted. The introduction of the ‘This is me’ documents showed staff were working with people and their families to identify what was important to them, what their goals and aims were and how they preferred to receive the care and support they needed.

Right culture

The management and quality team were supporting staff to change the culture in the service. The review of systems, better staff training and promotion of a less risk averse and more person- centred approach to care meant people were receiving the care and support they needed.

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 25 August 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Person-centred care, Need for consent, Staffing and Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For the key question not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. 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 St Anne's Community Services - Sutherland Court on our website at www.cqc.org.uk.

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 have found evidence that the provider needs to make improvements. Please see the relevant key question Safe, Effective, Responsive and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Anne's Community Services - Sutherland Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

This service has been in Special Measures since August 2021. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The premises were clean. All areas of the home were uncluttered so cleaning could take place effectively Hand sanitisers and PPE stations were situated throughout the building.

Staff were observed wearing appropriate PPE. There was signage and instructions promoting safe infection prevention practices.

The service had effective processes in place so laundry was managed safely.

St Anne's Community Services - Sutherland Court is a residential care home providing care to people with a learning disability and autistic people. The service can accommodate up to seven people. Five people were using the service at the time of the inspection.

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 supporting people with a learning disability or autistic people

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

The service could not show how they met the principles of Right support, right care, right culture.

The service did not focus on people’s quality of life and care delivery was not person centred. Staff knew people well and showed kindness, but they did not recognise how to promote people’s rights, choice and independence. People’s human rights were not always upheld. Care and activities were not planned in a way that met people’s individual needs.

People’s communication needs were not met and information was not shared in a way that people could understand.

The service had sufficient staff but they were not appropriately trained. Poor staff performance was not always recognised which placed people at risk of harm. Leaders were out of touch with what was happening in the service.

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.¿

People were not supported by staff who understood best practice in relation to learning disability and autism. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

People enjoyed the meals served which staff said were based on people’s preferences. However, staff chose what people ate rather than having planned meals which would ensure people’s nutritional needs and preferences were met.

People’s care and support was provided in a safe, clean, well-furnished and well-maintained environment which met people's physical needs.

People were protected from abuse.

People’s risks were assessed regularly and usually managed safely.

People had access to independent advocacy. Staff supported people to maintain links with those that are important to them.

The service had no confirmed positive tests from staff and people who used the service throughout the COVID-19 pandemic.

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 9 March 2019). The service has been rated inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 person-centred care, following a legal framework for making particular decisions, staffing and governance at this inspection.

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

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 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.

Sutherland Court is a care home and registered to provide a service to seven adults with learning disabilities. The service comprises of two large adjoining bungalows located in a residential area of Lightcliffe, Halifax and is close to shops, cafes, and leisure facilities. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. At the time of the inspection seven people were using the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The 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.

At our last inspection we rated the service good. At this inspection we rated the service as requires improvement; it is the first time the service has been awarded this rating. The provider had not breached regulation but improvements were required.

Staff understood safeguarding and whistle blowing procedures which included their responsibility to report any safeguarding concerns to the management team. Systems were in place to manage most medicines safely but staff were not following safe medicine practice when managing topical creams, nutritional supplements and fluid thickener. Checks were carried out by staff and external contractors to make sure the premises and equipment were safe although some environmental issues needed attention. Risks to people had been identified, assessed and effectively managed. Staffing arrangements ensured people were safe and the same workers provided support so people received consistent care.

Staff received training and support which equipped them with the skills to do their job well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People accessed services which ensured their health needs were met. People enjoyed the meals but the variety of food served was limited. There was a lack of information to show how people’s nutritional needs were met.

Staff knew people well and had a good understanding of how to provide person centred care. They used different approaches to meet people’s needs. We observed people looked clean and tidy in their appearance. People’s rights were promoted and systems were in place to ensure people were not discriminated against.

People received personalised care. Care plans were detailed and guided staff on how to deliver care and support. People had opportunity to engage in leisure activities. The provider had a formal procedure for dealing with complaints although none had been received. Some people had complimented the service.

The registered manager knew people who used the service well and worked closely with the staff team. They were responsive and took prompt action when issues were highlighted at the inspection. The provider had systems and processes in place for checking people received safe quality care. However, these were not always effective. People were encouraged to put forward suggestions and ideas to help improve the service.

Sutherland Court provides personal care to seven adults with complex physical needs and learning disabilities. The home is comprised of two large adjoining bungalows known by staff as house one and house three. The home is located in a residential area of Lightcliffe Halifax close to shops, cafes, and leisure facilities. At the time of the inspection there were seven men living at the home.

The last inspection was in January 2014 and at that time the provider was compliant with all standards and regulations inspected.

The home 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.

People told us they felt the service was safe. Staff understood how to recognise and report any concerns about people’s safety and welfare. Before new staff started work the required checks were done to reduce the risk of people being supported by staff unsuitable to work with vulnerable adults. Staff were trained and supported to understand people’s needs and provide them with safe and appropriate care and support.

People received their prescribed medicines safely. However, the home did not have the correct storage facilities for certain types of medicines. As these medicines were not currently prescribed or in stock for people who used the service there was no risk to people. We recommended the provider reviewed the storage arrangements for medicines to ensure they complied with current guidance and legislation.

There were enough staff to provide people with the support they needed and to make sure people were supported to take part in leisure activities in the local community. The home had their own transport which made it easier for people to go out regularly.

The home was clean, odour free and well maintained. Some parts of the home were in need of redecoration. Risks to people’s safety and welfare were identified and action was taken to reduce or manage the risks. There were procedures in place to make sure staff knew what to do in the event of an emergency to keep people safe.

People were supported to have a healthy and varied diet which took account of their likes, dislikes and cultural needs. People’s weight was checked regularly and action was taken in response to any unplanned weight loss or gain.

Staff obtained people’s consent before providing support, care and treatment. When people were unable to give informed consent decisions were made in their best interests. Best interest decisions were clearly recorded and showed appropriate consultation had taken place.

People were supported to access the full range of NHS services to meet their health care needs. There were procedures in place to make sure hospital staff were provided with information about people’s support needs as well as their health care needs in the event of them admitted to hospital.

People told us the staff were kind and compassionate and this was confirmed by our observations during the visit. Staff knew about people’s individual likes, dislikes and abilities. They supported people to exercise choice, make decisions and be as independent as possible.

People’s support plans were person centred and included detailed information about their individual needs, preferences and abilities. People living in the home and their relatives were involved in planning and reviewing how care and support was delivered.

There was a complaints procedure in place and people’s relatives told us they were confident they would be listened to if they had any concerns. There had not been any complaints about the service in the last twelve months.

The registered manager provided strong leadership and was enthusiastic about the service and their role. The staff team were equally enthusiastic and showed a strong commitment to supporting people to live active lives and achieve their full potential.

The provider had systems in place to monitor and assess the safety and quality of the services provided and there was evidence of a commitment to continuously improving the service. However, it wasn’t always clear from the records what was being done to follow up on identified shortfalls in the service.

People living in the home, their relatives and others involved in their care had the opportunity to give feedback on their experiences of the services provided.

Our observations of the service showed that care staff spoke with and interacted with people who used the service in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people understood what was going to happen.

The people who used the service appeared happy and comfortable with the surroundings. They appeared to be relaxed with the staff in their interactions with them. We noted that people who used the service had access to a wide range of activities, which were personalised to their individual needs.

Relatives we spoke with after our visit were very satisfied with the care. They told us 'I can't say enough about their care' another said 'it's always very clean and the staff are very good.'

People living at Sutherland Court had complex needs which meant they were unable to talk to us. We used different methods, such as observing clients and staff interacting, to help us understand their experiences. During our visit we spoke with the Registered Manager, the Deputy Manager, two members of staff and two relatives.

The relatives we spoke with told us the staff at Sutherland Court regularly updated them about their relatives' health and they felt the care was good. They said they were involved in care decisions and signed consent forms relating to care and treatment needs. One of the relatives told us 'The staff are very good, they really are' another relative said 'He's really settled there, staff are good to them all and look after them. They take them out quite a bit, including holidays.' They told us they felt their relatives lived in a safe environment.

We spoke with two care workers who told us St Anne's was a good company to work for and they felt confident the service provided was good. Care workers received appropriate training for their role and told us they felt well-supported by their managers.