Archived: S.S Care Limited Also known as Victoria House

S.S Care Limited, hereafter referred to as Victoria House, is a residential care home that provides personal care and support for up to six people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were four people living at the home and two people being supported in the community as extensive refurbishments were carried out to the basement flats.

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

People told us they were happy and felt safe living at Victoria House. We found the service was not operating in accordance with the regulation and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

The provider did not have sufficient oversight of the service to ensure people received the care and support they needed that promoted their wellbeing and protected them from harm. Systems and processes to monitor the service were not effective and did not drive improvement. These included concerns with records, risk management, medicines, a lack of person-centred care, infection control and the environment.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Although the manager and staff demonstrated a strong commitment to the people living in the service and spoke passionately about providing good quality care. They did not always understand how their actions impacted on people’s privacy, dignity and/or human rights.

Whilst we did not find people were being disadvantaged, people were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible.

Staff told us they felt supported and appreciated by the manager. We found the service did not have an effective system in place for recording what training staff had received. This meant that neither the provider or manager could be assured that staff had the necessary skills to carry out their roles.

People told us they could make decisions about what they ate and drank and when and support plans contained clear information about what each person could do for themselves.

Staff who knew people well were familiar with people's different communication methods and how they made their wishes and needs known.

People were encouraged and supported to lead full and active lifestyles, follow their interests, and take part in social activities

People were encouraged to share their views through regular reviews and relatives felt comfortable raising complaints and were confident these would be acted on.

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 good (published 24 May 2017). Since this rating was awarded S.S Care Limited had been purchased by another healthcare provider. Whilst there had been no change to the legal entity there had been a complete change in the senior management of the service. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the need for consent, dignity and respect, person-centred care, recruitment, training, notifications, and governance. We have also made recommendations in relation to the environment.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

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 and continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.

This inspection took place on 21, 22 and 23 March 2017 and was unannounced.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding (DoLS). People were encouraged to make choices and were involved in the care and support they received. However, some people did not have the mental capacity to make complex decisions about their health and welfare. Where this was the case, people’s records did not always contain an assessment of their capacity. Where decisions had been made in a person’s best interests these were not always being fully documented. This meant we were unable to tell, if decisions were specific, made in consultation with appropriate people such as relatives or being reviewed. We raised this with the registered manager who assured us they would take immediate action to address this. We did not find that people had been disadvantaged or that decisions taken were not in people's best interests.

People told us they were happy and they felt safe living at Victoria House. One person said, “I do feel safe, I like living here.” Another said, “The staff are nice to me and [directors names] are my friends.”

People who used the service told us they knew what keeping safe meant for them and were regularly reminded about what might place them at risk, such as 'stranger danger' or ' mate crime' and how to avoid this. People were protected by staff who knew how to recognise the signs of possible abuse or avoidable harm. Staff had received training in safeguarding vulnerable adults and whistleblowing. Staff demonstrated a good understanding of how to keep people safe and how and who they would report any concerns to.

Recruitment procedures were robust and records demonstrated the provider had carried out checks to help ensure that staff employed, were suitable to work with people who use care and support services. There was a strong emphasis on training and continuing professional development throughout the organisation. Newly appointed staff undertook a comprehensive induction, shadowed experienced staff, and did not work alone until the registered manager was confident they had the right skills to carry out their role.

People were supported by kind and caring staff who spoke positively and with compassion about the people, they supported. It was clear people had developed good relationships with the staff that supported them. People who were able, told us they had the opportunity to express their views and were actively involved in making decisions about their care and support. People said they made choices every day about what they wanted to do and how they spent their time.

People received their prescribed medicines on time and in a safe way. Medicine stock levels were monitored monthly and the home had appropriate arrangements in place to dispose of unused medicines. People were supported to maintain good health and had regular access to health and social care professionals, such as GPs, dietician, speech and language therapist and care managers.

People were kept safe because risks associated with their support needs; lifestyle choices and environment had been identified and action taken to minimise and reduce the risk of any harm to the individual or others. Where risks had been identified, management plans were developed to help ensure staff knew how to support people safely.

People and relatives were aware of how to make a complaint, and felt able to raise concerns if something was not right. People, staff, relatives, and health care professionals told us the home was well- led, and described the management team as open, honest and supportive. There was an effective quality assurance system in place to drive continuous improvement within the home.

The registered provider had notified the Care Quality Commission of significant events, which had occurred in line with their legal responsibilities.

Records were well maintained and stored securely.