Cygnet House

Cygnet House is a residential care home providing accommodation and personal care for adults with learning disabilities, autistic spectrum disorder, and mental health needs. The service is registered to accommodate up to two people and there were two people living at the service at the time of the inspection.

Cygnet House comprises one house divided into two self-contained flats with a shared kitchen facility. There is also a secure garden space which people can access.

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

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.

Risks identified were safely managed; however, for some people these were not always accurate, updated, or in place. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. Medicines were managed safely, but some documentation needed improvement. The provider had recruitment checks in place to ensure staff were suitable to work in the service. Staffing levels had improved and people were going out more; the provider understood the need to continually review staffing levels due to the often unpredictable and complex needs of people living in the service.

People were supported by staff who had completed the relevant training to give them the skills and knowledge they needed to meet their needs. People were supported to have sufficient amounts to eat and drink and were protected against the risk of poor nutrition. However, improvements are needed to ensure any fluctuations in weight are promptly addressed. 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. However, assessment documentation needed to be revised to ensure the principles of the Mental Capacity Act 2005 were being followed, and we have made a recommendation about this.

People’s care records were not always accurate or updated. It was not always evident that people had been consulted about their support plans and involved in creating them, often people had not signed to show their involvement. People were supported to express their wishes and preferences regarding their care and staff provided personalised care. People and relatives were confident to raise concerns and complaints, and these were listened to, resolved and used to drive improvements in the service.

Staff treated people in a kind and caring way. People and relatives valued the service and the support the staff provided. Staff treated people with respect and helped them to maintain their independence and dignity.

There were governance systems in place, however, they had not identified all of the issues we found and therefore need to be strengthened in some areas. The manager and operations manager were committed to making improvements in the service. The provider will need to ensure the manager has sufficient support to enable the service to meet Regulations and improve their rating to Good.

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 Requires Improvement (published 27 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 Cygnet House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to care records 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 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 will request an improvement 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.

Cygnet House 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. On the day of our inspection two people were living in Cygnet House.

At the time of the inspection the registered manager had not worked at the service since September 2018. There was no manager in place and no one had been asked to act up while a new manager was being appointed. 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.

This care service supports people living with a learning disability and should be 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. Meaning, people with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. However, it was not always evident that the provider understood these principals, there was not always enough staff on duty to promote independence and choice.

We had not planned to inspect this location on this occasion. This inspection was prompted after we discovered breaches in another service owned by the same provider, which is in close proximity to Cygnet House, and a third service also owned by them. All three services are managed and staffed by the same team. Having identified breaches of regulation in relation to staffing and quality assurance in Swanrise we decided to inspect the other two services.

Although both people who lived in the service had 1-1 care staff support, we found that there were not sufficient staff on duty to keep people safe. The 1-1 care staff worked long hours and there were no staff members available to stand in for the 1-1 care staff to have a break or to step in to offer assistance if it was needed in emergency situations. On the second day of the inspection, a decision had been taken to permanently add a floating staff member to the rota, however this person was to move between the three services within the same grounds and was not effective.

We saw that people did not always receive care that was personalised to their needs. People’s daily activities were sometimes restricted because of staff not being available to support them. Staff had not always been given update training to ensure their knowledge and skills were refreshed and kept up to date. Training and supervisions had fallen behind.

Risks in people’s environment were assessed and steps have been put in place to safeguard people from harm without restricting their independence unnecessary. Risks to individual people had been identified and action had been taken to protect people from harm. However, because staffing levels were not sufficient, people were not always protected from risk.

The service had not been well led; failings in place prior the registered manager leaving had not been identified by either the provider or the previous general manager, who had also recently left. However, we acknowledge that these have now been identified and the provider was taking action to make improvements. An acting manager had not been put in place while a new manager was being recruited, which meant that those shortfalls were not being properly addressed in a timely manner.

People’s needs were assessed and they received care in line with current legislation. The service was in the process of changing the care plans to a new format, they detailed and gave staff sufficient information to allow to get to know people and to meet their needs.

The staff had been safely recruited. People where protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and how to report any incidents they witness or suspected.

Medicines were managed in a way that ensured that people received them safely and at the right time. Staff understood their roles and responsibilities.

People were asked for their consent by staff before supporting them in line with legislation and guidance. We saw examples of positive interaction between the staff and people supported by the service. People could express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity. The service listened to people’s experiences, concerns and complaints, which they took steps to investigate.

There was a registered manager 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.

There were not always staff available who were able to support one person to access the community and provide them with support as often as had been agreed between the person and the service.

The registered manager had not always notified CQC of incidents which they are obliged to inform.

There were systems in place which monitored the service, however the organisation around these was such that the relevant information was not always available when required. Audits included medicines, premises and care records.

The home was safe and people were protected from the risk of abuse by staff who understood how to deal with any concerns. Staff were aware of risks to people and mitigated these, with the guidance being recorded in people’s care plans. People who were living with a learning difficulty were supported safely to manage behaviours which some may find challenging.

People were supported to take their medicines as prescribed.

There were enough suitably recruited staff to ensure that people were safe. Staff received training in areas relevant to their roles as well as a comprehensive induction and regular supervisions with a senior member of staff.

Staff supported people to follow their dietary requirements as well as eat and drink enough. People had a choice of what they wanted to eat and drink, and when.

People were supported to access healthcare. Where needed, staff supported them to understand information and make decisions. Staff were aware of people’s mental capacity and the importance of making decisions in people’s best interests when needed.

Staff were aware of each person’s preferences and specific support needs and how to meet them. They knew people well and treated them with kindness, whilst respecting their privacy and promoting their independence. Staff built positive relationships with the people they worked with.

They also worked well as a team and felt supported at work.