Archived: Saxon House

Saxon House is a domiciliary care service that supports people with their personal care needs in their own homes or flats both in the community and in an extra care housing unit where the service was based. Extra care housing is purpose built or adapted single household accommodation in a shared site or building. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care provided by the service. Not everyone being supported by Saxon House received the regulated activity of personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. On the day of our inspection 35 people were being supported with their personal care in the extra care housing unit and 21 people in the wider community.

In May 2018 Hales Group Limited registered Saxon House to provide the regulated activity of personal care. The previous organisation continued to manage the extra care housing accommodation and are responsible for the upkeep of people’s flats and the communal areas. This meant Hales Group Limited only provided personal care to the people living in the extra care complex, within their contracted hours and are not responsible for who moved into the flats or providing care or supervision outside people’s contracted care times. The previous organisation had provided activities and other services, without charge, that were outside their remit as a registered domiciliary care agency. This has led to misunderstandings and expectations from the service that are outside their remit. Hales Group Limited are not obliged, under their registration with the Care Quality Commission (CQC), to offer or arrange activities within the housing complex or out in the local community.

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

People’s care plans were person centred and gave staff the information they needed to be able to meet people’s needs. However, people told us they did not know which staff member was going to work with them and sometimes staff they had not met before arrived to support them with their personal care needs. Nor did people have consistency in the staff that attended to them. One person told us in the previous nine days they had received care from nine different staff members.

The registered manager was supported by the organisation and staff told us they were open and supportive. There were quality assurance systems in place to monitor the quality of service the organisation offered people. However, the governance systems in place had not yet ensured people received their visits when they needed them and from consistent staff.

People who used the service were protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and knew how to report any incidents they witnessed or suspected. People were protected by staff that had been safely recruited.

Risks were assessed, and steps have been put in place to safeguard people from abuse. Risks to individual people had been identified and action had been taken to protect people from harm.

Staffing levels were rotated at sufficient levels. However, staff absences, short notice sickness for example, meant people’s care visits were sometimes late and on occasion missed without notice. People were supported with their medicines in a way that ensured that people received them safely.

People received care from staff that had the knowledge and skills they needed to carry out their roles. People were asked for their consent by staff before supporting them. People were supported to eat and drink enough to maintain a balanced diet. People were also supported to maintain good health and access healthcare services.

We saw examples of positive and caring interaction between the staff and people using the service. People told us they were able to express their views, staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

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 11 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks. Prior to the end of the inspection it was confirmed to us that the concerns were not all substantiated, and the provider had investigated those area of concerns raised with us.

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.

Saxon House is situated near Norwich in Norfolk. The service provides support to people who live in their accommodation, with their own tenancy agreements.

This was the first inspection to the service since a change in registration in May 2018 when Hales Group registered the service independently of its local branch to provide the regulated activity of personal care. During November 2018, we received safeguarding concerns and other information of concern about the service. We therefore brought this scheduled inspection forward, so that we could check that people were receiving safe care. Prior to the end of the inspection it was confirmed to us that the safeguarding concerns were not substantiated and the provider had already investigated the other area of concern raised with us.

The service is required as part of its registration to have a manager registered with the CQC. 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 registered manager in post however they had submitted an application to CQC to cancel their registration. A service manager was in post who had already submitted an application to register. At the time of this inspection their application was being progressed.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Not all care plans were up to date and sufficiently detailed to reflect individual’s care and support needs. Some care plans were not up to date, however, others were detailed and provided staff with specific guidance on the support people required. Improvements were required to ensure risk assessments reflected people’s actual needs.

There were sufficient staff to meet people's needs. Staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse, harm and all forms of discrimination. Staff told us they would report any concerns to their managers who they were confident would take any action necessary to ensure people's safety.

There were systems in place for managing medicines and staff had completed training in relation to safe medicine administration. People were protected from the risk of infection by staff that complied with their infection prevention policy.

People were happy with the support they received to eat and drink, and were supported to maintain good health and had access to healthcare when required.

Most people were supported and cared for by staff who were kind and caring, however people had mixed views the caring nature of staff. Staff supported people to be as independent as possible. People were enabled to make decisions about their care and were involved in how their care was planned and delivered.