Archived: Samuel Close (1,2,3)

Updated 12 February 2021

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 two inspectors, a Head of Inspection and an Expert by Experience, who made phone calls to relatives following the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Samuel Close (1,2,3) 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 had two managers 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. A third staff member was also applying to register as a registered manager. One of the registered managers was the lead manager and also acted as a service manager.

This inspection was unannounced.

What we did before the inspection

We checked the information we had about the service including notifications they had sent us. A notification is information about incidents or events that providers are required to inform us about. We asked the local authority commissioning and safeguarding teams for any information they had about 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

People were not always able to express their views about the care they received, so we observed the care provided in the communal areas. We also tracked people's care to better understand their experiences and to see that it matched with their care records. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked around the service to check the environment.

We spoke with both the registered managers and the team leader who was applying to become registered manager at the time of the inspection. We reviewed a range of records on site. This included medicines records, care plans and risk assessments. We sought consent to contact relatives and an Expert by Experience spoke with five relatives of people living at the service by phone. We spoke by phone with six members of staff including day and night staff.

After the inspection

We requested information to be sent to us for review including audits, staff training records and equipment checks. We contacted a heath professional who has regular contact with the service to understand their views about the service.

Updated 12 February 2021

About the service

Samuel Close (1,2,3) is a residential service of three adjoined houses accommodating up to 16 adults in total, who require personal care. Each house, or unit has separate adapted facilities. People living there have a range of needs including learning disabilities, physical disabilities and/or autism. At the time of the inspection 13 people were using the service.

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

We found considerable improvements had been made at the service since the last inspection and the issues we had found then had been acted on. However, the oversight and support from the provider needed some improvement to ensure they remained aware of changes and that improvements continued. In a small number of areas work was still in progress partly due to the effect of the pandemic and because positive changes to the culture of the service needed more time to become a consistent routine for all staff.

We have made a recommendation that the provider seek guidance around the setting of safe staffing levels.

Families told us they felt their loved ones were safe. Staff understood their roles in safeguarding people from harm. Risks to people had been assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns.

There were safe recruitment practices that followed legal requirements. Medicines were safely administered and managed. The service had policies and procedures to respond effectively to Covid-19. Staff mostly followed appropriate infection control practices to prevent or minimise the spread of infection.

Staff received training and support to meet people's needs. People's nutritional needs were assessed and met. Staff liaised with health professionals to meet people's health needs. Work had been done to improve the décor of the building.

Relatives said staff treated people with care and kindness. Training had been provided to staff on how to improve the way they communicated with people. Staff treated people with dignity, respected their privacy and encouraged their independence. Assistive technology had been considered to enhance people's independence in their daily living skills. People were now more involved in aspects of their daily care.

People had personalised plans for their care. These were up to date and reflected their needs. They were involved in a range of personalised activities that met their needs. People's needs in respect of their protected characteristics, such as their ethnicity or disability were assessed and supported.

There were systems to monitor the quality and safety of the service. Staff worked in partnership with relatives, health and social care professionals and voluntary organisations.

Staff asked for people's consent before they provided care or support. 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 guidance CQC follows 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 some of the underpinning principles of Right support, right care, right culture.

Right support:

The setting of the service as a large residential home was in the process of being addressed, through the decision by the provider to register each unit separately with its own registered manager. This process had been started at the time of the inspection.

Work had been undertaken to improve the model of care to increase people’s choice, control and independence. Further work was planned in this area.

Right care:

Overall care was person-centred and promoted people’s dignity, privacy and human rights. People were being encouraged to be as involved in their care and independent as possible. Work had been done to improve staff communication and interaction with people.

There were limitations to the building which had a clinical design and was not best suited to increasing people’s independence. This was under consideration in liaison with the local authority and health professionals.

Right culture:

Considerable improvements were evidenced to the ethos, values, attitudes and behaviours of staff. It was observed that the culture was more open and inclusive. This was in the process of being embedded at the service.

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 December 2019) and there were multiple 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.

However, we have found evidence that the provider needs to make some further improvement. Please see the Safe and Well-led sections of this full report. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 and 20 November 2019. Breaches of legal requirements were found and we took enforcement action serving two warning notices. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Samuel Close (1,2,3) on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.