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Archived: Cliffemount Community Care

Overall: Inadequate read more about inspection ratings

411 Hale Road, Hale Barns, Altrincham, Cheshire, WA15 8XU

Provided and run by:
Cliffemount Community Care Limited

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Background to this inspection

Updated 25 October 2019

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.

The inspection was prompted in part by the receipt of information of concern from a whistle blower who had worked at the service. This information indicated potential concerns about the provider’s financial management and oversight of the service. The inspection examined these areas, with details contained within this report.

This inspection took place on 5 and 6 June 2018 and was completed by one inspector. The first day was unannounced.

We did not ask the provider had completed a Provider Information Return (PIR) prior to our inspection. The PIR provides some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including notifications made to the Care Quality Commission (CQC). A notification is information about important events which the service is required to send us by law.

We had contacted the local authority commissioning and safeguarding teams regarding the whistle blowing concerns we had received. They also raised concerns with the CQC around the staff knowledge and the support provided for one person who had epilepsy.

Some of the people living at the service had limited communication skills. We made observations throughout our inspection of interactions between the people living at Cliffemount and the care staff.

During the inspection, we spoke with one person who used the service, two people's relatives, five members of care staff, one visiting social work professional, the new home manager and the new Chief Operating Officer (COO).

We looked at records relating to the management of the service such as the staffing rota, policies, incident and accident records, three staff recruitment files and training records, two care plans, and quality assurance systems.

Overall inspection

Inadequate

Updated 25 October 2019

This inspection took place on 5 and 6 June 2018 with the first day being unannounced.

Cliffemount Community Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Cliffemount accommodates up to five people with a learning disability or autism. At the time of our inspection there were four people living at the service. The service was last inspected in August 2017 when it was rated as 'requires improvement'; however, there were no breaches of the of Health and Social Care Act 2008 at that time.

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.

There was a new manager in post at the home who was in the process of registering with the CQC. A registered manager is a person who has registered with the CQC 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 new manager was supported by a new Chief Operating Officer (COO) whose role was financial management and oversight of the service.

The inspection was prompted in part by the receipt of information of concern from a whistle blower who had worked at the service. This information indicated potential concerns about the provider’s financial management and oversight of the service.

The overall rating for this service, following this latest inspection, 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 timeframe.

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 may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

During this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the lack of clear guidelines and for the use of physical intervention, staff training for the use of physical intervention, the lack of pre-employment checks with the Disclosure and Barring Service (DBS), the governance and oversight of the service and the fitness of the provider, Cliffemount Community Care Limited, and its director to fulfil their statutory responsibilities.

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.

We found serious concerns about the financial management of Cliffemount Community Care by the provider, (Cliffemount Community Care Limited) and its director. Bills for utilities had not been paid resulting in bailiffs’ letters stating that they would seize goods at the property if payment was not made. Council tax had not been paid over a period of five years and a court order had been made to set a payment plan. We saw a letter stating the providers public liability insurance was to be cancelled in August 2017 due to non-payment of premiums. The COO arranged for new public liability insurance to be bought after our inspection, meaning the service did not have suitable insurance in place for a period of nine months. We had also been contacted by an external investigator prior to this inspection. This matter was still on-going and we were awaiting the outcome from this.

Information had been removed from the staff personnel files. We were told this was by the previous manager. Staff DBS checks had been completed for all staff in April 2018. The COO said the previous manager had not processed the DBS checks for new staff. However, our investigations showed Cliffemount Community Care Limited had not processed any DBS checks for a period of three years, which preceded the previous manager’s employment with the service. This meant staff had been employed at the service without the required pre-employment checks being made to check they were suitable to work with vulnerable people.

Care plans and risk assessments were in place and had been regularly reviewed. These provided guidelines for staff to follow when supporting the people living at the service. Behaviour support plans were in place, where required, which detailed potential triggers for any behaviours and details of the distraction techniques to be used to reduce people’s anxieties. However, one behavioural support plan did not provide any details of the physical intervention techniques staff were to use. New staff had not received physical intervention training and so were not trained to use any of the physical intervention techniques that they may need to use.

Staff completed an induction when they started working at the home. A range of e-learning training was completed.

The provider did not have the governance systems in place to have clear oversight of the service regarding the lack of DBS checks, financial management and the destruction documents relating to staff information.

The pre-admission assessment and transition for one person moving to the home had gone well and they had settled at the home. However, for another person the information provided to the service was not the complete picture of the person’s complex needs, meaning the full information about their needs had not been established prior to their move. The service was told by the person’s family and the information from a previous provider, that the person’s epilepsy was well controlled, which was not the case. Epilepsy care plans were written following the person having a seizure. Staff described how they supported people during a seizure and when rescue medication should be administered.

Details of any incidents and accidents were recorded, including what happened before, during and after the incident. These were reviewed by the new manager and action taken to reduce the risk of further incidents where possible.

Medicines were administered as prescribed. People’s health and nutritional needs were being met.

The previous manager had completed supervisions and appraisals. The new manager planned to complete these every three months. Staff feedback about the changes in the management of the home were mixed. Some staff were very positive and said the new manager and COO were approachable and would listen to their ideas. However, other staff were unsettled by the changes and the reasons why they had occurred.

Clear details about how people communicated was included in the care files, including the use of individual signs and iPads where appropriate. We observed kind and respectful interaction between people living at the service and the members of staff.

The service was working within the principles of the Mental Capacity Act (2005). People’s capacity to consent to their care and support was assessed. Where people lacked capacity, decisions were made in their best interests.

People were supported to maintain their cultural beliefs and needs.

People were encouraged to complete tasks they could do for themselves. People engaged in a range of activities within the local community.

A range of audits were in place for health and safety and medicines. A monthly overview of the service was written for the COO. There had been a gap since April 2018 in these being completed due to the changes in manager and staff at the home. These were due to restart in June 2018.