Background to this inspection
Updated
15 October 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by four inspectors on two separate days. A third planned day was cancelled due to an outbreak of Covid-19 at the service. The remainder of the inspection was completed remotely.
Service and service type
St Erme Campus 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.
The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection there was no registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We met with six people who used the service. We spoke with fifteen members of staff and the deputy operations manager.
We reviewed a range of records. This included people’s care records, incident reports, daily logs and medication records. We looked at two staff files in relation to recruitment and staff supervision.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with four professionals who regularly visit the service. We spoke with seven relatives. We requested contact details for staff so we could speak to them privately but they declined to share their details with us.
Updated
15 October 2022
About the service
St Erme Campus is a care home providing personal care for up to twenty people with autism. At the time of the inspection 13 people were living at the service.
Accommodation is on a campus style development and is based in three separate houses known as The Lodge, The House and St Michaels. There is also a small office building on the campus. Campuses' are group homes clustered together on the same site. They may share staff and some facilities. The service is part of Spectrum (Devon and Cornwall Autistic Community Trust) which has several services in Cornwall providing care and support for autistic people and/or people with a learning disability.
People’s experience of using this service and what we found
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 not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
The model of care and setting did not maximise people’s choice, control and independence.
People did not have fulfilling and meaningful everyday lives. There were limited opportunities to leave the service and a lack of variation in available activities.
The environment and facilities did not promote independence and autonomy.
Right care:
There were not enough suitably skilled staff to meet people’s needs and keep them safe.
Where people had identified goals and aspirations, they had not been supported to achieve these.
Right culture:
We identified a poor culture where there were low expectations for people and an acceptance of situations and quality of life which would not be acceptable for most people. People were not supported to live full and meaningful lives or develop their own routines.
At our last inspection we identified staffing shortages, the use of agency staff was introduced and this impacted positively on staffing numbers. However, staffing levels remain a concern and St Erme Campus is frequently working to ‘contingency’ levels which are set by the provider as the lowest number of staff required to keep people safe. The risk of running the service at, or near to, ‘safe’ levels was highlighted when three agency staff, all working 14-hour shifts, (70 hrs each per week) tested positive for Covid-19. This left the service understaffed with limited further staffing resources to draw from. Contrary to legal requirements for people to self-isolate following positive tests Spectrum allowed staff who had tested positive for Covid-19 staff to continue working at the service in a ‘bubble’ arrangement with people using the service who had also tested positive.
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. Deprivation of Liberty (DoLS) conditions were not met. Despite frequent reminders from the Cornwall Council DoLS team the manager had not supplied DoLS reports to them in line with conditions for three people.
The provider had failed to ensure monitoring, governance and business continuity systems were established and operating effectively to ensure compliance with the regulations. There was a lack of supportive leadership in place. There were indicators of a closed culture developing.
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 and there were breaches of the regulations (published 17 August 2021). We imposed conditions on the registration for the service which required the provider to send us monthly reports.
At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated inadequate. This means the service has been rated inadequate or requires improvement for four consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last 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 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 Erme Campus 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 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, dignity and respect, safe care and treatment, safeguarding, staffing levels and deployment, and governance.
We took legal steps to remove the service from the providers registration. The service has now closed.