Sapphire House

Sapphire House accommodates up to five people who have a learning disability or who are autistic, in one adapted building. At the time of our inspection there were three people living in the home.

Sapphire House had three ground floor bedrooms with en-suite facilities. In addition to this there were two self-contained annexes with a bathroom, bedroom, lounge and kitchenette. One annex was on the ground floor and one was on the first floor. There was a large communal lounge and conservatory with direct access to the garden areas.

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

Risks were identified and recorded so staff knew how to respond to these, in order to keep people safe. There were enough staff to meet people’s needs and they were recruited safely. People received the medicines they required. The service was clean and tidy and staff were seen following good infection control practices.

Care plans were personalised and gave staff the information they needed to support people. The staff had worked with the local community learning disability team to develop positive behaviour support plans which ensured there was a person-centred approach to supporting people. Health care professionals’ input was accessed when required. Health care professionals spoken to said, the staff were good at keeping them up to date and sharing information for the benefit of the people living at the service.

The management team looked for ways to improve the service, including learning from incidents and events to know people better. They enhanced people’s lives by identifying their aspirations and encouraging and supporting them to achieve them.

Since the last inspection the management team had changed. As a result the governance arrangements in place to help monitor the service were in the process of being embedded.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported 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.

Based on our review of Safe and Well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• People were supported to access local shops, activities and amenities if they wanted to. Staff were observed to enable people to make day to day choices, including around food choices and things they wanted to do.

Right care:

• Staff understood people’s specific care needs and preferences and supported people in a person-centred way. People’s privacy and dignity was respected. Staff enabled people to make choices about how they wished to be supported in any given activity. People had been supported to personalise their own rooms.

Right culture:

• The management team and staff showed commitment and respect to people whom they supported. They spoke with passion and knowledge about their role, central to which was to empower those whom they supported to live their best life possible.

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 Inadequate (published 15 April 2021) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sapphire House accommodates up to five people who have a learning disability or autistic spectrum disorder, in one adapted building. At the time of our inspection there were five people living in the home.

Sapphire House offers three ground floor bedrooms with en-suite facilities. In addition to this there are two self contained annexes with a bathroom, bedroom, lounge and kitchenette. One annex is on the ground floor and one on the first floor. There is a large communal lounge and conservatory with direct access to the garden areas.

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

Risks in relation to people's care was not always sufficiently detailed to ensure people were cared for in a safe way. There was not always up to date guidance in place for staff about how to manage or reduce risk. Risk assessments in place required review to ensure they were accurate.

The service had not had a COVID-19 outbreak, however, we found failings in the service's infection prevention systems which increased the risk of the transmission of COVID-19, and placed people who were clinically vulnerable at increased risk. Staffing levels had not always been sufficient to ensure people and staff were kept safe. People received their medication as prescribed, although guidance for emergency medicines needed to be clearer.

There had been a lack of strong leadership, consistency and oversight at the service. Regulatory responsibilities had not been met. There was a new registered manager and deputy manager in post. Initial feedback from staff about the new management team was positive. The new management team understood the challenges facing the service and there was significant work to do to raise safety standards and to provide good care. We observed staff supporting some people in a positive manner during our inspection visit. However, significant work was needed to change the existing culture, ethos, attitude and practice at Sapphire House.

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 not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The provider had not ensured that people were supported safely. Staff told us that their colleagues had not always treated people with dignity. Previous leadership had not ensured that there was an open and inclusive culture at the service.

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 Requires Improvement (published 9 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns from two whistle-blowers in relation to the care people were receiving, including poor infection control procedures, staffing levels, poor staff culture and governance. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

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 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 Sapphire House 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 have identified breaches in relation to safe care and treatment, staffing, governance and reporting procedures.

We issued the provider with a Warning Notice, notifying them that they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a timescale by which they were required to become compliant.

We will return to Sapphire House to check that improvements have been made. If the provider fails to achieve compliance within the given timescale, we may take further action.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 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.

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.

This was the first comprehensive inspection of this service.

At this inspection we found the provider to be in breach of four of the regulations.

Risks around fire safety were not appropriately managed. One person did not have a personal emergency evacuation plan and fire drills were not carried out. This meant the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

A further breach of the regulations was found, this was because there were gaps in staff training and staff did not attend training in infection control and food hygiene. Therefore, the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider was also in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because there was a lack of governance processes in place which monitored the quality of the service being delivered. Some checks were being carried out but these did not provide a thorough oversight of the service.

We found the provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because safeguarding and other important events were not always reported appropriately. Whilst the local safeguarding team had been informed, we were not notified of some events.

Staff understood what constituted abuse and had attended training in safeguarding. Staff also attended courses relating to people’s individual care needs such as challenging behaviour and autism.

Individual risks to people’s health and wellbeing had been identified and appropriate plans were in place to minimise known risks.

There were consistently enough staff to support people safely and there were safe practices around the recruitment of staff.

New staff completed an induction and shadowed experienced members of staff. Staff were further supported in their role through regular supervisions.

Full assessments of people’s care needs took place before they started living in the home.

Mealtimes in the home were relaxed and flexible to suit people’s needs. People were able to choose their own food and were supported to maintain a healthy diet.

Staff worked alongside healthcare professionals to provide collaborative care to meet people’s needs. Prompt referrals were made to healthcare professionals where there were concerns about a person’s health or wellbeing.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that the service was working within the principles of the MCA. People were involved in day to day decisions about their care and treatment and staff knew the importance and guidance around making a decision in a person’s best interest. Where people were deprived of their liberty, records relating to this had been completed in line with the Mental Capacity Act 2005.

Staff treated people in a kind and caring way and knew people’s care needs well. Staff were responsive to people’s needs and effectively communicated with people. People were supported to maintain relationships with their family and friends and were also supported to access their local community.

People’s care records were detailed and person-centred. Care records were updated and reviewed regularly.

There was a complaints procedure in place and people knew how they would raise a complaint.

People were asked for their feedback about the service they received.

Staff enjoyed their work and felt supported by the management team.

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.