Archived: Altum Spring

At our inspection in May 2015, we found that the service was not meeting all the regulations we reviewed. We found four breaches in the Health and Social Care Act Regulations 2008 relating to staff training around physical intervention, managing risks, recruitment of staff and lack of training in Mental Capacity Act (MCA) 2005. In addition, we found two breaches in the Care Quality Commission (Registration) Regulations 2009 (Part 4). We saw that the home was using two names for the service, one of which was not identified on the home’s statement of purpose. The statement of purpose is a legal document that sets out the home’s aims and objectives. Services, which are registered with the Care Quality Commission, are required to notify us about certain events and incidents that occur. From the records, we checked we found that the registered manager had not always notified us about incidents that had happened at the home.

We returned to the service in November 2015 and found that the service had made improvements and the regulations were met. Following that inspection we were made aware, following contact with the Police, that we had not received all the notifications from the service when contact had been made by the home with them mainly relating to young people who were missing from home. Once made aware the provider made the notifications.

Altum Spring is registered to provide accommodation for up to four young people between the ages of 16 to 25 years old who require support with personal care. There were four young people living at the home during our inspection.

There was no registered manager was in post. This was because the provider and the manager had an application in progress to register with the Office for Standards in Education, Children’s Services and Skills (Ofsted). This was because there had a change of manager and because the home was in the process of registering with OFSTED. 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 this inspection, we found that the home had breached the regulations in relation to the maintenance of the premises, the management of medicines, staff training and the lack of an effective quality assurance system.

We saw that the premises were not well maintained both inside and outside the home. We saw that plans were in place to upgrade the home and this work started during our inspection.

We saw that systems in place to ensure that medicines were safely administered needed to be improved so that medicines could be properly accounted for.

Because there had been a high turnover of staff this meant that all members of the staff team had not received the basic training they needed to support young people effectively and safely.

There were no formal quality assurance systems in place to gain feedback from young people, parents, relatives and health and social care professionals for their views and opinions about the service.

You can see what action we have required the provider to take at the back of the main report.

Whilst we recognise that sufficient staffing was provided by the use of permanent and agency staff, young people were not benefitting from a stable and experienced staff group and this could impact on the quality of care that they received.

A young person we spoke with told us that they felt safe at the home. They said, “I feel safe with the staff they reassure you.” Another young person commented, “I feel like I belong here.” A staff member told us, “I feel safe and comfortable here. We have a good time.”

Young people were encouraged to be involved in household tasks to increase their daily living skills that would help towards their transition into independent living. We saw that were a young person had lived at the home for a long time they had achieved their goal of living independently and were due to move into an adult supported living service in the near future.

Staff had access to psychological support to help them understand young people’s behaviours and help them to develop coping strategies to help reduce and manage their presenting behaviours. This service was in the process of being extended to provide one to one sessions with young people.

The atmosphere at the home was calm and relaxed. We saw there were frequent and friendly interactions between people who used the service and the staff supporting them. A young person said, “All the staff are really nice. They are definitely 100% kind and caring. They understand me and are not judgemental. They encourage us to gain our independence through trust.”

We saw that young people’s records were disorganised, which made it difficult to find up to date relevant information. However, we saw that a new computerised care planning and risk assessment tool was in place and staff were being trained to use it.

Young people spoke positively about the service. A young person said, “I have had lots of experience of other services such as hospitals and CAMHS but this is definitely the best one I have been to and I have had more help here than anywhere else” and “I am more confident and have more self-belief since I have been here. I have grown up a lot.”

We saw that opportunities were provided to support young people to receive education and look at options for further training and employment.

Young people were involved in a range of different activities both inside and outside the home depending on their individual needs and personal wishes. Young people also had contact with their families and friends as appropriate.

The manager was clear about the need to ensure the service was run in a way that supported young people’s individual needs and promoted each person’s right to lead their own life as safely as possible. A staff member told us that the manager and the deputy were approachable.

We saw that young people and staff were able to speak openly and freely with the manager in order to express their views and opinions.

We received positive feedback from a social worker, an independent reviewing officer and the visiting neighbourhood Police team about the service and the manager.

We informed the provider of our intention to carry out an inspection visit; this was to ensure that key staff members were available so that we could discussion what action they had taken to rectify the breaches. We found that the service had taken action to address all the breaches found. However, we found at this inspection visit that a number of the staff team had left. This was in part due to the changes in the way the service was managed. The service had recruited new staff and had arranged training for them, which was in progress.

This service is registered to provide accommodation for young people who require support with personal care between the ages of 16 – 25 years old. At the time of our visit three young people aged 17 years of age were using the service. We did not speak with young people during our inspection visit but did briefly observe good relationships between staff and young people.

We were aware at the time of our visit that the service was in the process of making an application to register with Office for Standards in Education, Children’s Services and Skills (Ofsted). Ofsted confirmed that this was the case and we saw evidence that commissioners of the service had been informed that the application was to be made.

A new manager had been appointed since our last visit and had been working at the home for seven weeks. The manager had submitted an application to register with us. 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.

Staff had received training in the use of physical intervention techniques. Staff we spoke with were able to tell us clearly what these techniques were or explain how they were to be used to help ensure the safety of young people who used the service.

Young people’s risk assessments were seen to be up to date; however staff we spoke with felt that further improvements could be made to recording systems. Plans were in place to improve the service’s administrative systems by introducing a computerised records system.

We saw that improvements had been made to the recruitment system. Staff files showed that the recruitment procedures covered the areas required by law.

The statement of purpose had been reviewed and amended and CQC were now receiving detailed notifications from the service. Systems were in place to regularly assess and monitor the service provided and young people were involved in plans to make improvements at the home.

We saw that the service was in the process of requesting accreditation with the Royal College of Psychiatrists for assessment to become part of the Community of Communities scheme. This will help to establish a therapeutic community approach to the purpose of the service going forward.