St Philips Close

About the service

St Phillips Close is a residential care home and is registered to provide accommodation and personal care. The building is purpose built and provides facilities and living accommodation for up to 8 people who live with a learning disability and/or a physical disability. There are two separate buildings which accommodate 4 people in each.

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

Right Support:

People’s risk were assessed in a person centred way, however, these were not reviewed on a regular basis. Care planning did not routinely involve the person and their relatives as appropriate. People who may become anxious or distressed had positive behaviours support plans, however, these had not been reviewed for some time. People were generally encouraged to make choices and decisions in accordance with their level of understanding.

People had their own bedroom and shared facilities. Staff took action to ensure people’s care and support was in a safe, clean and well-maintained environment. However, staff told us concerns raised with the landlord and senior managers were not being addressed in a timely way.

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.

Right Care:

Staff had completed necessary training to meet people’s needs. However, they did not always recognise risk of harm to people and did not always escalate concerns as required. During the inspection staff raised a whistle blowing concern, the provider began a process of investigation.

Right Culture:

The culture of the service supported people and staff in an inclusive way; enabling people to live their day to day lives as they chose to. Staff told us that the culture of the service had greatly improved as a new team had been formed. However, quality assurance systems to assess and monitor the service were not always being routinely used. This meant the provider did not have enough oversight of the service to ensure it was being managed safely and quality maintained. Therefore, we could not always be assured people always receive high quality care.

There were missed opportunities for staff to involve people in day to day activities such as cooking, cleaning, laundry. There were long periods of time when people were not spoken to, particularly people who did not seek staff attention. One person spent all day in bed due to not having appropriate equipment in place to enable them to access the rest of the house.

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 31 March 2020).

Why we inspected

We received concerns in relation to governance and risk management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well led only.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Philip’s Close on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection. We have made recommendations about safe recruitment, medicines storage and ‘as needed’ medicines.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St Phillips Close is a residential care home and is registered to provide accommodation

and personal care. The building is purpose built and provides facilities and living accommodation for up to eight people who live with a learning disability and/or a physical disability. There are two separate buildings which accommodate four people in each.

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.

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

People told us they liked living at St Phillips Close. They told us staff were kind and caring.

People were protected from the risk of harm. There were enough suitably trained staff to meet people’s needs. Robust recruitment procedures were followed. Risks to people’s safety and welfare were identified and managed. People’s medicines were managed safely. We spoke to the senior to ensure all creams were labelled.

People’s needs were assessed, and support plans included information about their needs and preferences. Staff knew people well and knew how they liked their care to be delivered. Staff treated people well, they were kind and compassionate. People’s privacy and dignity were respected, and people were supported to be as independent as possible.

The home was clean and well maintained. The design and décor of the building took account of people’s needs.

The provider worked well with other agencies to make sure people experienced safe and effective care. The management team were open and clearly committed to the continuous improvement of the service. People were listened to and no complaints had been raised at the service.

The provider had systems in place to monitor the quality and safety of the service. We saw these were effective in making improvements to the service. For example, best interest and mental capacity assessments were in the process of being updated for people in the home with support from family and advocates.

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.

The service applied the principles and values apply 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.

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 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We carried out the inspection of St Philips Close on 30 May 2017. At the time of our inspection, there were seven people using the service. This was an unannounced inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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 were protected from the risk of potential abuse because staff knew how to recognise the signs and what action to take to safeguard them. The risks to people were managed in a way that promoted their independence. However, we observed a staff practice that put people at minimal risk. People were cared for by sufficient numbers of staff who were recruited safely. People received their medicines as prescribed by staff who were appropriately trained.

People's care needs were met by skilled staff who were supported in their role to provide effective care and support. 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 had applied the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards in their care practices. People were referred for a Deprivation of Liberty safeguard appropriately. People were encouraged to make as many choices about their care as possible. People had access to a choice of meals and were encouraged to eat and drink sufficient amounts. People had their nutritional needs met. People were assisted by staff to access relevant healthcare services when needed.

People were cared for by staff who were kind and sympathetic to their needs. Staff had extensive knowledge of people and their background and preferences. People's right to privacy and dignity was respected by staff. People were encouraged to maintain relationships that were important to them.

People were encouraged to be involved in their care assessments and had access to an advocate to represent them. The service provided was person-centred to meet people's specific needs. Staff were able to recognise when people were unhappy and this was explored and resolved where possible. The provider had systems in place to record and monitor complaints. People were asked what activities they would like to be involved in and staff supported them to achieve these goals.

People were supported to have a say in how the home was run. The home was run by a registered manager who was supported in their role by the operations manager. Staff felt supported in their role by the registered manager. The provider had effective systems in place to assess and monitor the quality of the service provided to people. We observed there was a happy and person-centred culture in the home.

Below is a summary of what we found. The summary is based on observing care, speaking with people who used the service and their relatives, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

There were effective systems in place to reduce the risk and spread of infection. We were shown around the home by a member of staff and found people's bedrooms and communal areas were cleaned to a high standard. The home was well maintained. We received information which told us the premises and equipment were serviced within recommended timescales.

Care records contained good information about how people's needs should be met and identified how care and support should be delivered. Daily communication records showed that people received appropriate care to meet their identified needs.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were recognised, respected and promoted.

Is the service effective?

The provider supported staff to deliver care to an appropriate standard. Training records showed that appropriate training was being delivered. Training records showed that appropriate training was being delivered. Staff we spoke with told us everyone worked well together and they felt well supported.

Is the service caring?

We spoke with one person who used the service and they told us they liked living at the home and were well looked after. They told us the staff were nice and they liked to go shopping with them.

Staff told us people received very good care and support. We observed staff assisting people who used the service. People received good care and support. It was clear from our observations that staff knew the people they were supporting very well.

Is the service responsive?

People received care and support they agreed to. We spoke with one person who used the service and they told us they could make decisions about their care and support. People's preferences were clearly recorded in their care records and staff told us these were always respected.

Care records had specific guidance on how to involve people in making decisions. Each person had a decision making profile which identified 'what is the best way to present choices to the person', 'what ways you can help the person understand' and 'when is the best time for the person to make decisions'. People also had a decision making agreement that identified how the person must be involved, who can help with decisions and who makes the final decision.

People had health action plans and, in the main, these showed people received appropriate healthcare. One person's health action plan had not been updated. We asked to see information about dental care but this was not available. They had received some recent healthcare treatment but there was no reference to this in their health action plan. This could result in people's healthcare needs being overlooked.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at a number of records and audits which confirmed regular checks were carried out and the provider had assessed and monitored the quality of service provision.

The registered manager had been appointed to another position within the organisation so was no longer based at the home but was still involved in the service. The provider had appointed a new manager who commenced on the day of the inspection.

Staff told us the home was well managed. One member of staff said, 'It's a really good staff team and we are well supported.' Another member of staff said, 'We get good support but in the last few months it hasn't been as consistent. We wobbled a bit because we didn't have a manager but now the new one has started we will be back on track.'

We saw records that demonstrated key people, including relatives and other significant people were consulted about the care needs and wishes of people living at the service. This information was then used to devise a plan of care which empowered and was fulfilling for each person.

We saw how staff supported people, at their own pace, to make sure they knew how best to meet a person's need. We saw examples of good practice, including people being treated with respect and dignity.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage the administration of medicines safely.

Staff spoke enthusiastically about their work. There were enough staff on duty to meet people's needs. Staff were receiving training on a regular basis and this was monitored by the manager.

There were quality monitoring systems in place, which included relatives giving feedback about the care and treatment provided. This gave a good overview of the quality of the service and provided feedback which could be acted upon by the provider. This also meant that the quality of the service was being kept under review.