Archived: The Beach

About the service

The Beach is a is a residential care home that provides personal care and support for up to 14 autistic people, people with a learning disability or both. At the time of the inspection there were 11 people living at the service.

The service is a two-storey block of flats with a communal area, located overlooking Porth beach in Newquay. The service is part of Spectrum (Devon and Cornwall Autistic Community Trust) which has several services in Cornwall providing care and support for autistic people and/or people with a learning disability.

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

This was a targeted inspection that considered staffing levels and the impact on people’s experiences. Based on our inspection of staffing we found the following.

Right Support:

Due to low staffing numbers people were not supported to have the maximum possible choice, control and to be independent. People did not consistently have control over their own lives.

Right Care:

The service did not have enough appropriately skilled staff to meet people’s needs and provide person-centred care in line with people’s preferences.

Right Culture:

Staff did not always know and understood people’s needs. There was a high level of agency staff which meant people did not always receive consistent care from staff who knew them well.

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 9 August 2022). Following the inspection, we issued a warning notice requiring the provider to become compliant with the regulations by 19 July 2022.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to staffing.

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

We will request an action 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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Beach is a is a residential care home that provides personal care and support for up to 14 autistic people, people with a learning disability or both. At the time of the inspection there were 11 people living at the service.

The service is a two- storey block of flats with a communal area, located overlooking Porth beach in Newquay. The service is part of Spectrum (Devon and Cornwall Autistic Community Trust) which has several services in Cornwall providing care and support for autistic people and/or people with a learning disability.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate consistently how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Staff were committed to supporting people in line with their preferences. However, this was difficult to achieve because staffing levels were below those identified as necessary to meet people's assessed needs and wishes. Staff supported people to receive their medicines safely and as prescribed and people were enabled to access health and social care support in the community.

Right care:

The language used by staff to describe a person within their care notes and, on occasion, when speaking with us, was disrespectful. This meant people's care was not person-centred and did not promote their dignity. People’s access to activities was limited, both in and out of the service due to staffing levels. Risks associated with people’s care were assessed and included in their support plans. Care records guided staff on the action they were to take to mitigate risks to people and themselves.

Right culture:

The deputy manager and regional manager and staff were clear about their aim of providing person-centred care. They had a good knowledge of the service and understood the needs of people they supported. However, the ability to deliver person-centred care was often hindered due to staffing levels. Appropriate actions had not been taken by the provider to make improvements within the service since our last inspection. The provider worked with the safeguarding team and multidisciplinary teams to support safe care provision.

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 7 July 2021). The service remains rated requires improvement.

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 the provider remained in breach of regulations.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, further concerns and risks were identified so a decision was made to carry out a comprehensive inspection to include the key questions effective, caring and responsive.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in regulation in staffing, dignity and respect and governance. 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

We will request an action 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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Beach is a care home providing personal care for people with learning disabilities and autistic people. At the time of the inspection 11 people were living at the service. The service can support up to 15 people.

The service is a two- storey block of flats with a communal area, located on Porth beach in Newquay. The service is part of Spectrum (Devon and Cornwall Autistic Community Trust) which has several services in Cornwall providing care and support for autistic people and/or people with a learning disability.

We expect health and social care providers to guarantee autistic people and people with a learning disability with 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.

This service was not able to demonstrate consistently how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Staff worked to support people in line with their preferences. This was sometimes difficult to achieve when staffing levels dipped below those identified as necessary to meet people’s needs.

Right care:

People received care and support that was person-centred. Records of people's care were individualised and detailed their needs and preferences. Staff were aware of people's support needs.

Right culture:

Staff working at the Beach knew people well. They were used to supporting people to go out and have a full life. During lockdown and periods of COVID-19 pandemic outbreak in the service, they had been pro-active in supporting people to maintain their interests in-house.

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

This focused inspection did not look at all aspects of the service.

There were insufficient numbers of permanent staff to cover all shifts. The service was at times staffed below the level identified as necessary to meet people’s needs for part of the day. The reduction in commissioned staffing levels affected a small number of people at the service. Due to these staffing levels for these particular people, their support was being considered in the Local Authority Safeguarding arena.

Staff were recruited safely. The manager was actively recruiting more staff.

On arrival we were informed that the service was in ‘outbreak’ due to the COVID-19 pandemic. The registered manager had alerted everyone that lived or worked at the service, plus relatives and relevant authorities. Staff were aware of the procedures to follow and staff were wearing correct PPE.

People were supported to be as independent as possible and have control over their lives. Staff encouraged and supported people to make decisions and choices about how they spent their time.

Staff understood their role in protecting people from harm or possible abuse. Accidents and incidents had been investigated to identify areas of learning and prevent similar incidents from being repeated.

People and their relatives were involved in decisions about people’s care and were kept informed of any changes to the running of the service. Relatives and staff told us the registered manager and staff were approachable and listened when any concerns or ideas were raised.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beach on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to staffing. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an updated action plan for 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Beach is a care home that provides support and personal care for up to 15 people with learning disabilities. At the time of our inspection the service was supporting 12 people.

The service is a two-story block of 10 flats located on Porth beach in Newquay.

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

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 the underpinning principles of Right support, right care, right culture.

This focused inspection did not look at all aspects of the service. People lived in their own flats or with one flat mate and were supported to be as independent as possible and have control over their lives. People’s dignity was respected, and staff encouraged and supported people to make decisions and choices about how they spent their time.

Prior to our inspection we received information of concern that staff were not using surgical face masks while supporting people during the Covid-19 pandemic. We found that staff were using surgical face masks in people’s flats and while providing support and people understood why this was necessary. However, staff were not wearing masks in the service’s office and in communal areas of the service when people were not present. This was contrary to guidance published by Public Health England and a breach of the regulations.

We raised this failing with the registered manager during the inspection and staff subsequently wore masks in all areas of the service.

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service. Covid-19 testing had been regularly completed and there were plans in place to enable people to be cared for in isolation should this become necessary.

Staff understood their role in protecting people from harm or possible abuse. Accidents and incidents had been investigated to identify areas of learning and prevent similar incidents from being repeated. Medicines were managed safely.

Staffing levels were sufficient to meet people needs and people told us, "I think there are plenty of staff." Restrictions to staff movements between services had been introduced in response to the pandemic. This change had, impacted positively on both staff morale and the consistency of support people received.

The registered manager provided effective leadership to the service and performance audits were underway designed to drive improvements in the services’ performance. WiFi internet access was now available throughout the service and the digital care planning system now enable staff to complete care records in all flats.

People and their relatives were complementary of the service and the staff team. Staff told us they felt well supported by the registered manager and records showed supervision meetings had been held regularly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last overall rating for this service was Good. (Report published 31 August 2018)

Why we inspected

We undertook this focused inspection in response to information of concern that we had received. This information indicated that staff were not following current government infection control guidance.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this report.

Follow up

We will request an action plan for 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met the outstanding legal requirement from the last inspection and is now rated as Good.

The Beach provides care and accommodation for up to fifteen people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection 11 people were living at the service. The Beach is a modern property based on the outskirts of Newquay and overlooks a beach.

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 care service has been 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although the service is able to accommodate fifteen people the accommodation is situated in three adjacent properties and is set up as self-contained flats. Two people shared a flat and others had their own accommodation. Everyone had keys to their own front door. This meant people had access to their own private spaces and could choose who they spent their time with or whether they wished to spend time on their own. One of the three buildings had a shared living and dining area where people could spend time socialising together if they wished.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The previous registered manager left in August 2016. 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. The manager had applied for registration. Staff, people and relatives were all positive about the management of the service. Comments included; “It’s a much happier place all round”, “[Manager’s name] is a good man he is” and “People are happy, staff are happy and so there are less incidents.”

People were comfortable and at ease with staff and within their environment. Staff were supportive and caring in their approach. They spent time chatting to people and checking on their well-being.

Activities provided were varied and met people’s individual preferences and interests. People were able to go on spontaneous trips out as well as taking part in planned activities.

There was a stable and experienced staff team in place. Staff told us they were well supported and worked together as a team. Some staff had not had formal supervision for some time. We have made a recommendation about this in the report. Roles and responsibilities were clearly defined and understood by all. Systems for communicating changes in people’s needs were effective.

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.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being on a computerised system. This could be accessed by the senior management team as necessary. Records did not always contain enough information to provide a picture of how people had spent their time and what had worked well. Incident forms were not consistently completed which meant opportunities to learn from events could be lost. The internet connectivity was poor and staff were not always able to reliably access the system.

The Beach provides care and accommodation for up to fifteen people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection 11 people were living at the service. The accommodation is situated in three adjacent properties and consists of eight self-contained flats. Some people shared a flat and others had their own accommodation. One of the three buildings had a shared living and dining area where people could spend time if they wished. The Beach is a modern property based on the outskirts of Newquay and overlooks a beach.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The previous registered manager left in August 2016. 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. The manager told us they were in the process of applying for the position. However, they were not intending to stay in the role for very long and a new manager was due to start at the service in August. Following the inspection we were informed the manager had withdrawn their application due to the short length of time they would have been in post.

Relationships between some members of the staff team and the manager were strained. This had left staff saying they felt undervalued and insecure. Arrangements for the management of the service were changing and we will continue to monitor the situation.

People did not always feel safe when receiving care and support. The systems in place to help ensure people received consistent support were not well established. Arrangements for support sometimes changed with very little notice leading to people becoming anxious and distressed. We have made a recommendation about this in the report.

There were sufficient numbers of qualified staff to meet people’s identified needs. Recruitment practices helped ensure staff working at the service were fit and appropriate to work in the care sector. Staff told us the induction processes and training provided were thorough and gave them the knowledge required to carry out their roles.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. 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.

The Beach was situated on the sea front and people, staff and relatives were unanimously positive about the location and access to local amenities. Some internal and external work was being carried out to improve the appearance of the building. At our previous inspection we identified a problem with the bathroom flooring in one person’s flat. At this inspection we found no action had been taken to address the problem. Following the inspection we were sent evidence to show this work had now been completed.

People’s support plans included clear and detailed information about their health and social care needs. There was clear guidance for staff on the actions to take to minimise any identified risks. Information about people’s backgrounds and social histories gave staff an insight into the events which had helped shaped people’s characters.

Staff had developed positive relationships with people; they knew them well and had a good understanding of their needs. We observed staff support people according to their needs at any one time. There were examples of friendly conversation and light teasing as well as times when staff gently reassured people when they had expressed a concern or worry.

People had access to a range of activities. Staff supported people to access the local community regularly. Staff had a good knowledge of people’s interests and hobbies and were able to describe any goals people had and what they were doing to support them.

We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The Beach provides care and accommodation for up to fifteen people who have autistic spectrum disorders. At the time of the inspection ten people were living at the service. The accommodation is provided within three adjacent properties and consists of eight flats. Two of the flats were shared by two people and the rest were single occupancy. One of the three buildings has a shared living and dining area where people could spend time if they wished. The Beach is a modern property based on the outskirts of Newquay and overlooks the beach.

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 was a relaxed and friendly atmosphere and we saw staff and people laughing and chatting together. Staff told us they liked and respected the people they supported and enjoyed their work. Relatives told us; “He’s very happy there, always well looked after” and; “She is generally supported by people she likes and trusts.”

Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the manager. Recruitment practices helped ensure staff working at the service were fit and appropriate to work in the care sector.

There were sufficient numbers of qualified staff to keep people safe. Staff demonstrated a shared approach to supporting people which emphasised helping people to develop and maintain independent living skills. A relative told us; “[Name] has progressed very well with Spectrum.”

People, where appropriate, were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

People’s support plans included clear and detailed information about their health and social care needs. Information about people’s needs were regularly discussed and updated so that staff had accurate information when providing care. We saw that, when necessary, support patterns were amended to reflect sudden changes in people’s needs. For example, one person required additional support during the night for a short period following an event which had led to an increase in their anxieties. A waking night care worker had been put into place until the person had become more settled.

People had access to a range of activities. Staff supported people to access the local community regularly and told us they saw this as valuable. One said; “It’s helping people to live their lives the way they want to.”

The registered manager had a good understanding of the day to day running of the service. There were clear lines of responsibility and accountability within the service which were understood by all. Quality assurance systems were in place to help ensure the safety and effectiveness of the service.

Four people who used the service were present during the visit. We spoke with three people who told us they were 'happy to live here' and 'this was the best decision, coming here to live'. People told us they had no concerns regarding their care and that they liked the staff.

We observed how staff interacted with people and saw there was relaxed atmosphere in the home. We saw people who used the service approached staff without hesitation. We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

We found all people who used the service had a care plan and found the information was up to date and had been reviewed regularly.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

We spoke with the manager, Spectrums' divisional manager and seven members of staff. Staff told us that since the previous inspection they had received more support from Spectrum senior management team, changes to the delivery of care had been made and additional support for staff had been introduced. These changes were viewed positively by the staff team. We also spoke to two care professionals who do not work for Spectrum. They told us that since the previous inspection the home 'seems more organised, staff happier and the care provided to people remains good.'

The provider had reviewed the facilities that the home provided to people who used the service, staff and visitors. An action plan had been developed to ensure that the quality of care and support would be to an appropriate standard.

We observed staff interacted with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We examined two people's care records. We found that one person did not have a care plan in place and another care plan did not reflect the person's current care needs. Therefore staff had limited guidance or direction in how to support or provide care for the people living at The Beach.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

Staff told us, confirmed by records that they had not had regular one to one meetings with their line manager for sometime. In addition some training for staff was out of date. This meant that staff work practices had not been monitored sufficiently to ensure they could carry out their roles competently.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. However procedures had not been followed which left people who used the service, visitors and staff at risk of harm.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were satisfactory. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.

The provider was reviewing recording systems to ensure that all information was kept accurately.