Archived: The Beaches

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.

The service provider, Mr Campbell, 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.

Staff were unaware of the safeguarding processes to follow if they needed to report any concerns outside of the organisation, a safeguarding policy was not available for staff to refer to.

Safety checks had not identified the risks of fire doors being propped open. Individual personal emergency evacuation plans (PEEPS) lacked enough information to inform staff how people should be supported in the event of a fire.

The processes for auditing medicine and making improvements when errors were made were not robust. The medication administration record (MAR) sheets showed all required medicines were in stock and people had received their medicines as prescribed. Staff stored medicines securely in a lockable cabinet.

Accidents and incidents were recorded but the provider lacked good oversight of incident management. Risk assessments had not been updated 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.

People were not protected from robust recruitment procedures, the provider could not demonstrate how they ensured the staff they employed were suitable for their roles.

There was no system in place for staff training to be monitored, we were unable to assess the training staff had received and when they had received it. Induction processes did not adequately prepare new staff to complete their roles. It was not possible to see if all staff had received regular supervisions. We asked the provider to send us information after the inspection relating to training and supervision but did not receive any.

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.

Care plans lacked enough person specific detail which meant people may be at risk of receiving inappropriate support. People’s behavioural guidelines lacked enough information to guide staff to manage incidents well.

Information recorded about people did not always demonstrate staff were respectful or compassionate about the person’s individual needs.

The provider lacked oversight and improvement was not driven. Some feedback was obtained with the view of improving the service, but action was not taken or recorded to demonstrate the improvements that had been made. The provider had not kept accurate or complete records to support staff to deliver safe care and treatment to people.

There were suitable numbers of staff on shift to meet people's needs. Staff demonstrated a good understanding of how to support people well.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

People's healthcare needs were managed well and people were supported to access outside health professionals when they needed this.

Staff demonstrated caring attitudes towards people and showed concern for people’s welfare. People were treated with dignity and respect and staff interacted with people in an interested and compassionate way.

People were supported to attend activities and day trips outside of the service and were offered various activities within the service.

People had access to an easy read complaints policy in their care files. A relative told us they knew how to complain and were confident the provider would act on any concerns raised.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.