Community Integrated Care (CIC) - 4 Seafarers Walk

Community Integrated Care (CIC) - 4 Seafarers Walk is a residential care home who can provide personal care for up to 5 people with a learning disability and or Autism. At the time of the inspection there were 4 people living in the service.

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

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines. Some improvements were needed to ensure staff were making accurate records when medicines were audited, and this was actioned immediately by the service manager.

People told us they enjoyed living at 4 Seafarers Walk and they felt supported by staff who knew them well.

Staff had received training in safeguarding and understood their responsibilities. People were protected from abuse and there was an open culture, where staff supported people to express any concerns. Risks to people were assessed, and staff knew how to support people to minimise risks to their health and wellbeing.

Recruitment processes were safe to ensure only suitable staff were employed. There were enough staff to meet people’s needs and this was regularly reviewed.

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 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 able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The outcomes for people using the service promoted choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to be involved in decisions about their own lives and gain new skills.

Right Support: The providers strategy to ensure people were supported to live their best life possible, was evident in the opportunities and support provided to people.

Right Care: Staff clearly knew people well and the consistency and strength of the staff team had been improved by the service manager. This meant people received person-centred support from staff who knew them well and respected their privacy and dignity.

Right Culture: The ethos and values of the service manager had been embedded in the staff team. This meant the values, attitudes and behaviours of care staff supported people to be confident and empowered in living in the community.

The provider had systems and processes to monitor quality within the home. The registered manager and service manager understood their regulatory responsibilities and shared information with stakeholders in a timely way.

There was a complaints procedure and people were supported to express their views.

The service manager and staff were proactively working with external professionals to ensure people received effective and safe care.

There was a clearly defined management structure and regular oversight and input from the provider’s management team. The staff team were positive about their roles and felt supported by the service manager.

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 4 August 2021) and there were 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 17 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 risk management, management of medicines and 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 and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last full comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Integrated Care (CIC) - 4 Seafarers Walk 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.

Community Integrated Care (CIC) - 4 Seafarers Walk is a residential care home providing accommodation and personal care to three people at the time of the inspection. The service supports people living with a learning disability and autism in one adapted building and can support up to 5 people.

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

The system and processes in place to prevent the risk of abuse of service users were not always operated effectively. Staff had not taken all reasonable steps to make sure people were not treated in a degrading manner. Staff did not always report incidents in a timely way or ensure unexplained injuries were investigated. Procedures in place to safeguard people from financial abuse had not been consistently followed.

Risks to people had not been consistently reviewed or managed safely. This included risks to people from the premises, environment and equipment. We found no evidence that people had been harmed but people could be at risk of harm if actions to mitigate risks were not followed.

The management of people’s medicines was not always safe. The provider has acted on these concerns following the inspection.

We were not assured the provider was doing everything possible to ensure the home was clean and infection prevention and control risks were acted on. We have made a recommendation about this. We were assured the provider was otherwise following current guidance to prevent people catching and/or spreading infection.

There were enough staff on duty to meet people’s needs. Due to staff vacancies there was a high use of agency staff, but the same and familiar agency staff were used as much as possible.

The systems and processes in place to monitor and assess the quality and safety of the service had not been effective in driving improvement. The systems had not identified the safety and quality of the service was compromised in a timely way. As a result, there has been a significant decline in the quality of the service identified by the provider and the CQC rating has deteriorated from good to requires improvement.

The provider has acted, and the service is now being managed through an ‘enhanced support framework.’ This means there will be enhanced involvement from the provider’s support services. There will be weekly internal senior management meetings to review and update the continuous improvement action plan.

The culture in the service had not been positive or open and the service had not been consistently well-led. We have made a recommendation about staff engagement to support the development of a more positive culture.

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 safe and well-led key questions the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People received care and support which aimed to give them maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The culture and practices in the service were being improved to ensure people always experienced safe care that met the values and standards of this guidance.

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 28 May 2019).

Why we inspected

We received concerns in relation to safeguarding, risk management, staffing, service management and culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

The provider has taken action to mitigate the risks and is closely monitoring the progress of their action plan for improvement at the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Integrated Care (CIC) – 4 Seafarers Walk 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 have identified breaches in relation to risk management, management of medication 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

At the time of the inspection there were three people living at the service. Best practice guidelines recommend supporting people living with a learning disability in settings that accommodate less than six people. The service model at 4 Seafarers Walk was aligned to the principles set out in Registering the Right Support. Outcomes for people using the service, reflected the principles and values of Registering the Right Support including; choice, promotion of independence and inclusion. People's support was focused on them having as many opportunities as possible, to have new experiences and to maintain their skills and independence.

People’s experience of using this service:

People living at 4 Seafarers walk had limited ability to have verbal conversations with us. However, when asked if they liked living at the home, people responded with a smile or said, “Yes.”

The staff demonstrated that they knew people well.

Quality assurance processes were robust and risks to people and the environment were managed safely. The service was clean and infection control audits ensured that cleaning tasks were completed and any issues were identified and acted upon quickly.

Staff recognised people’s individual needs and supported them to make choices in line with legislation.

Care plans were detailed and person centred. People were involved in deciding how they wished to be supported and in reviewing their care plans when needed. Information was available in a format they could understand.

Staff were kind, patient and responsive to people's needs. People were treated with dignity and staff respected their privacy.

Staff were well trained and received regular supervision to help develop their skills and support them in their role.

Rating at last inspection: The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 21 August 2018.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

4 Seafarers’ Walk 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.

4 Seafarers Walk accommodates up to four people in one adapted building. At the time of our inspection there were three people living at the home. 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.

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.

People were supported by staff who knew and understood the risks to their health and wellbeing. However, recorded risk assessments were not always in place to ensure guidance was available for staff should this need to be relied upon. Action was taken during the inspection process to address this.

Staff had not always followed guidance in place to prevent people from experiencing a deterioration in their health. This guidance had been put in place following a safeguarding incident and failure to follow this guidance could result in significant harm to people. No one had come to any harm because of the omissions that we found and the registered manager took immediate action to implement a more robust monitoring procedure to prevent a reoccurrence.

People medicines were managed safely. However, records for medicines that were unwanted or unused were not kept to check these medicines for disposal were handled properly. A returns book was introduced following our inspection.

The home appeared clean and free from malodour, however the arrangements in place for the assessment, prevention and control of the spread of infections did not meet current guidance. The registered manager has addressed this following our inspection.

The Duty of Candour is a Regulation which aims to ensure providers are open and transparent with people and those acting lawfully on their behalf in relation to the care and treatment provided to people and when things go wrong. Robust systems and processes were not in place to ensure the provider identified whether incidents met the threshold for the Duty of Candour. We have made a recommendation about seeking advice and guidance on the Duty of Candour regulation.

At our last inspection in June 2017 People's finances were not always managed safely and systems to manage people's finances were not always correctly followed. At this inspection, we found that improvements have been made to the management of people’s finances and these were managed safely. A system was in place to investigate and learn from incidents and accidents and make improvements to the service.

Staff understood their responsibilities to protect people from abuse and how to report and act on any concerns. Staff were recruited safely and the relevant checks were made to protect people from the employment of unsuitable staff. There were sufficient staff to keep people safe and meet people’s needs.

People’s needs were assessed and guidance and training was available to staff to support them to meet people’s needs effectively. Staff completed an induction into their role and ongoing refresher training. Some staff training was outstanding and being progressed at the time of our inspection.

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’s dietary needs were known and met by staff. People were supported to receive healthcare as required which included annual health checks.

The premises were suitable for people’s needs and people had been involved in the decoration and personalisation of their rooms.

Staff were kind and caring in their approach. Staff knew people well and could tell us about their personal histories, interests, likes and dislikes. Staff understood how to provide care that was respectful and dignified and promoted people’s rights to confidentiality and equality.

People’s care plans were person centred and reflected their needs and choices. People’s communication needs were known and met by staff and flagged for other professionals in their hospital passport. A range of activities were carried out with people to meet their individual activity needs and interests.

A procedure was in place to manage complaints. This was available to people in an accessible format. Any complaints would be overseen by the provider to monitor progress and outcome.

Staff spoke positively about the culture and leadership in the home. The provider promoted their values with staff and staff were supported to understand their roles and responsibilities through team meetings, supervision and provider led events.

A system was in place to monitor the quality and safety of the service people received and actions were identified and monitored for completion to drive continuous improvements. However, this is the second consecutive inspection where the service has been rated Requires Improvement.

4 Seafarers Walk is situated in a quiet residential area to the south east of Hayling Island. The home is a bungalow which was purpose built to provide accommodation and care to five people with learning and physical disabilities. At the time of this inspection there were four people living in the service. There were eight permanent support workers, which included two senior support workers, three agency support workers and one registered manager who was the service lead.

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.

At our last inspection in May 2015 we made a recommendation for the provider to refer to the Mental Capacity Act 2005 and its codes of practice. This was because mental capacity assessments had not been reviewed in line with legislation. At this inspection we found the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were followed.

Financial checking systems in place were not always safely followed and audits in place did not always prevent people’s money from being at risk of loss or being taken without permission. We have made a recommendation to the provider to ensure staff review and follow their policy on managing peoples monies.

Staff knew what they should do to keep people safe from harm and safeguarding concerns and incidents were reported and investigated. Risk assessments were completed for each person which identified risks to themselves and others. There were enough staff to meet peoples needs and keep them safe. Safe recruitment, medicines and fire practices were followed.

Staff were skilled and experienced to support people at the service, felt well supported and attended regular supervision, appraisal and training sessions. People were supported to eat and drink in line with their support plans and health needs. People regularly accessed external health and social care services.

Staff were kind and caring and respected people's dignity and privacy whilst providing personal care. People received an individualised and personalised service and staff knew them well. People’s preferences were taken into consideration and people were supported to be as independent as possible and consent to their care. Positive compliments had been received into the service thanking the staff for the support they provided to people

Support plans were in place, sufficiently detailed and reviewed regularly. Complaints had not been received into the service. People took part in meaningful activities.

Staff felt the manager was approachable and communicative and encouraged them to develop their skills. Audits to analyse the quality and safety of the service were in place and mostly effective.

During our inspection we spoke with the manager, two staff members, one relative and two people who use the service.

We saw that the home was clean and well maintained. People were able to personalise their rooms with their own possessions and each room was clearly identified for the individual using photographs and personal items in the doorway. People could access their rooms whenever they chose and could close the door for privacy.

There was a clear plan for each person regarding activities they participated in for the week though this was flexible and offered choice to people. We observed one person listening to their favourite music in their room. During our visit two people went for an outing to the local town supported by two staff members. People were able to participate in activities in the communal areas of the home including watching television, listening to and making music and dancing.

We saw that the home had clear care plans in place to provide personalised care for people. These identified goals for people to achieve and maintain their independence. We saw people being actively encouraged to maintain their independence in all activities. We saw that people had their care discussed and agreed with them or their representative.

The provider had a system of quality monitoring in place and we saw evidence to show that it highlighted deficiencies in the service and action plans were put in place to address these. Relatives told us that they were consulted on their views and felt listened to by the staff and management. For example one relative was very happy with the service and another felt they had to continually monitor things or they didn't happen.

We saw that records were accurate and stored securely, however, they were not all kept up to date.