Archived: The Beaches

Updated 5 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of

our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 12 July 2017 and was unannounced. The inspection was conducted by one inspector. Before our inspection we reviewed information we held about the service, including previous inspection reports. The provider had not had the opportunity to complete a Provider Information Return (PIR) as they had not received this document before the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We collected this information throughout the inspection.

During the inspection we spoke with two people, one healthcare professional, two staff, and the deputy manager. Before the inspection we received feedback from one healthcare professional. Some people were not able to express their views clearly due to their limited communication. We observed interactions between staff and people.

We looked at a variety of documents including four people's support plans, daily records of care and support, three staff recruitment files, medicine administration records, and quality assurance information. We asked the provider to send us some information after the inspection which we did not receive.

Updated 5 September 2017

This inspection took place on the 12 July 2017 and was unannounced. The Beaches provides accommodation and support for up to four people who may have a learning disability or autistic spectrum disorder. Some people display behaviour which may challenge others. At the time of the inspection four people were living at the service. People had access to a communal lounge/dining area, kitchen, shared bathrooms, and laundry room. There was a large garden which people could access when they wished although one person’s mobility meant they could not access this alone. One person had access to an additional room upstairs where they watched television or listened to music which they called The Den.

The service provider also works as the manager. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider was not present throughout the inspection; the service had a newly appointed deputy manager who was present throughout the inspection.

The service was last inspected in December 2016 where eight breaches of our regulations were identified. The well led domain was rated as inadequate and an overall rating of requires improvement was given at that inspection. The breaches of regulation related to notification of incidents, person centred care, obtaining consent, management of medicines, risk assessment, safeguarding, staff employed, staff training, and leadership and management.

The provider was required to submit an action plan to The Commission following the inspection in December 2016 to outline how they proposed to improve the service and meet the breaches. The provider failed to submit their action plan by the required date and was asked three times by the Commission before this was received. The provider told us that they had made improvements to all areas on the service which had been identified as a concern. At this inspection we found that little action had been taken to address the concerns raised previously. The provider continued to be in breach of the regulations identified at the previous inspection.

Recordings of accidents and incidents were not consistent, the provider lacked oversight of incident management. Risk assessments had not been implemented when people had been identified as being at risk. The provider had not done everything reasonably practical to reduce the risk of harm to people. The provider's processes for recording and responding to safeguarding incidents were not robust.

The processes for auditing medicine and making improvements when errors were made were not robust. Recommendations made by a healthcare professional about the management of medicines had not been fully responded to. This meant people were at risk of receiving medicines in an unsafe way.

Staff had not been effectively trained, supported or monitored to ensure they were able to support people well with their individual needs. Induction processes did not adequately prepare new staff to complete their roles.

Risk to people’s health and wellbeing had not been assessed or monitored well.

The provider did not have a good understanding of the process they should follow to comply with the Mental Capacity Act. The provider was not working within the principles of the Act. Certain restrictions had been placed on people in regards to simple everyday decisions, and capacity had not been assessed or a best interest process followed.

People did not benefit from care plans which reflected their preferences and individual needs. New staff relied on other staff to guide their practice. Staff did not have any guidance to refer to when supporting people’s behaviour.

The provider lacked oversight and improvement was not driven. The provider had not kept accurate or complete records to support staff to deliver safe care and treatment to people. The provider lacked understanding regarding the importance of maintaining accurate, complete and contemporaneous records in respect of the service delivery which impacted on the care and support people received. The provider had not conducted any internal quality assurance or audits of the service.

There were suitable numbers of staff on shift to meet people's needs, staff responded to people in a kind and caring way. When people required reassurances staff were patient in their approach. People were treated with dignity and respect and staff interacted with people in an interested and compassionate way.

Appropriate safety checks were made in relation to the environment to keep people safe.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices. People were supported to attend activities and day trips outside of the service and were offered various activities within the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.