Archived: Seeleys Respite Centre

Updated 22 April 2017

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 took place on the 14 and 23 November 2016 and was unannounced; this meant that the staff and provider did not know we were visiting. The first day of the inspection was carried out by an inspector and an inspection manager. On the second day the same inspector was joined by another inspector.

We did not ask the provider to complete a Provider Information Return (PIR). The PIR is a form that the provider submits to the Commission which gives us key information about the service, what it does well and what improvements they plan to make. We reviewed notifications and any other information we had received since the last inspection. A notification is information about important events which the service is required to send us by law.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the two people living at Seeleys Respite Centre who were receiving care and support; the registered manager, the safeguarding and quality co-ordinator and the interim managing director. We spoke with five care staff. We reviewed seven recruitment files and nine people’s care plans, including records relating to their medicine. We looked at records relating to health and safety within the service and cross referenced practice against the provider’s own policies and procedures.

Following the inspection we received information from two relatives and we contacted social care and healthcare professionals with knowledge of the service. This included people who commission care on behalf of the local authority and health or social care professionals responsible for people who lived in Seeleys Respite Centre.

Updated 22 April 2017

Seeleys Respite Centre provides short term accommodation to adults with profound learning disability, some of whom will have a physical disability. The service is registered to provide support to 12 people. At the time of out inspection seven people were being supported.

This comprehensive inspection took place on 14 and 23 November 2016. It was conducted to follow up on previous enforcement action taken.

We previously inspected the service on 12 and 13 April 2016. We found breaches of the Health and Social Care Act 2008. We found people who used the service were not protected against the risk of unsafe premises and environmental hazards. We took enforcement action to ensure people’s safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be compliant by was 30 May 2016. The provider sent us an action plan detailing how they intended to improve. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Seeleys Respite Centre’ on our website at www.cqc.org.uk.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

At this inspection we found the service had not responded to our previous concerns. We found continued breaches of the Health and Social Care Act 2008. People were still placed at risk due to unsafe premises. The service had not assessed hazards within the home for instance, we found a number of items were easily accessible to people which could have posed as a strangulation risk. We found a light fitting in the main dining area had exposed electrical wires which could have caused harm to people.

Risk posed by the environment had not been assessed and reduced. In all twelve bedrooms we found loose electrical cables. These were from televisions, radios and sensory equipment. The cables presented a risk to people as they could be used for self-harm, or could have caused an accident. Staff were not clear on the support people required in the event of a fire. Risk to people had not been assessed and reviewed to ensure support was available to reduce the likelihood of harm.

The environment had not been kept clean and was not well maintained. We found open waste bins in communal areas. This meant people had access to waste.

People were not protected from abuse. Some people had come to harm as a result of physical assault by other people who used the service. We found incidents of physical abuse had not been reported to the local authority or to CQC. We found the service had not investigated these incidents to prevent people being harmed in the future.

People were not supported to exercise their human rights. The service failed to act within the core principles of the Mental Capacity Act 2005. Where people had been assessed an incapable of consenting to care and treatment, the service did not ensure it followed a best interest process to ensure the person’s rights were upheld.

People were not always treated with dignity and respect. We found curtains did not sufficiently cover windows. This meant people could be viewed from the outside. We observed people who were not receiving support from the service had free access to the home. We observed one person walking into office areas, bedrooms and communal lounges. This person had not been invited into the home by anyone staying at the service.

The service did not ensure people received their medicines as prescribed. We found that some people did not have an up to date consent letter from their GP, verifying the medicines they were currently prescribed. Therefore, we could not be assured that the service was administering the correct medicines to people. We have made a recommendation about the pre-admission process in the report.

The service did not have robust recruitment process, which meant it did not ensure staff employed had the right skills and attributes to work with people. We received concerns from staff about staffing levels. Some staff felt they were placed at risk of harm due to staffing numbers being too low. We spoke with the registered manager about this. They felt staffing was adequate. Staff were shared with the adjoining day centre. We have made a recommendation about staffing in the report.

We found people were not actively involved in decisions about their care. We found staff did not have the skills to expand their communication style to suit a person’s individual need. The service did have an ‘inclusion’ notice board. This included information about other services the provider offered. We found easy read versions of information were not made available to people. We have made a recommendation about this in the report

The service was not well led. The service failed to notify CQC of certain events when it was legally required to do so. There is a requirement for services to be open and transparent when things go wrong. We call this duty of candour (DOC). There are clear responsibilities on registered services. We checked if the requirements of this had been met. We found at least six incidents which met the DOC threshold. We did not find any records confirming that the required actions had been undertaken. We spoke with the registered manager about this and they could not provide us with reassurance this regulation had been met.

Due to the level of concerns about the service we received throughout our inspection and the lack of action following our previous inspection. We had considered urgent action under our powers in Section 30 of the Health and Social Care Act 2008. We asked the provider to detail how they intended to ensure people’s safety. Due to the prompt response from the provider and the local authority to our findings to reduce the immediate risk to people we decided not to pursue this course of action.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the Care Quality Commission (Registration) Regulation 2009. You can see some of the action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service 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 will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.