Archived: Seeleys Respite Centre

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.

We previously inspected the service on 29 April 2014. The service was meeting the requirements of the regulations at that time.

Seeleys Respite Centre (Seeleys) is registered to provide accommodation for younger and older adults who are living with a learning disability. The service provides residential respite care. It can accommodate a maximum of 12 people at any one time. At the time of our inspection four people were staying at the service. People use the service as and when needed, this can be from one night upwards. People who use the service are awarded an allocation of nights per year. We heard some positive feedback about how people book their stays. One relative told us “The bookings system is managed really well, very flexible.”

The service did not have 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.

Risk assessments were completed for each person using the service; however potential environmental risks were not always identified or assessed. For instance, we found a number of potential risks in communal areas which could have led to people coming to harm.

People were not always protected from risk of fire as a fire door was unable to close. Staff did not appear to be aware of where to find information on how to support people to leave the building escape in the event of a fire.

The service did not ensure that consent was gained from people in line with the Mental Capacity Act 2005. It had sought consent from third parties without satisfying themselves that the third party had legal authority to act on the person’s behalf.

The provider had not ensured that the Commission was notified of specific events it was required to do so.

Medicine was generally managed and stored safely. However, there was a lack of information for staff about ‘as required’ (PRN) medicine. We have made a recommendation about this in the report. Some staff that had not been assessed as competent to administer medicine had access to the keys for the medicine cabinets. We have made a recommendation about this in the report.

There was a clear recruitment policy which was followed to ensure the service employed suitable staff. However, the policy did allow the service to start new employees without all the required checks if a risk assessment was undertaken. We have made a recommendation about when the service starts new staff without all the required pre-employment checks.

Staff demonstrated compassion and a caring attitude towards people using the service and were knowledgeable about their likes and dislikes.

People were supported with care that was personalised to them; care plans detailed how people would like to be supported.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We saw staffing rotas were maintained at the service. These ensured there were enough skilled and experienced staff to meet people's needs 24 hours a day. A senior member of staff or designated shift leader was identified on each shift. This helped ensure all required tasks were carried out to meet people's needs and maintain the smooth running of the service. Gaps on the rota were covered by agency staff. Staff we spoke with told us the agency provided a consistent group of staff to cover the service. This promoted continuity of people's care.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us no applications had needed to be submitted to deprive anyone of their liberty. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This ensured there were proper safeguards in place.

Is the service effective?

Equipment had been provided at the service to meet people's needs. For example, hoists and adapted baths. Equipment was serviced to make sure it was safe to use. Staff had been trained in moving and handling techniques to make sure they carried out manoeuvres safely.

Is the service caring?

We found there was good regard for people's privacy and dignity at the service. We spent some time observing practice. We saw staff welcomed people to the service, offered them drinks and showed them to their room. We heard staff were respectful when speaking with people and took an interest in what they had done since they last saw them. The staff we met were knowledgeable about people's individual situations, such as their family circumstances and things which were important to them. This helped ensure people received care in a sensitive way.

Is the service responsive?

When we visited the service on 6 February 2014, we had concerns about how risks to people's health and welfare were identified and assessed. We set a compliance action for the provider to improve practice. The provider sent us an action plan which outlined the changes they would make to become compliant. We used this visit as an opportunity to check that sufficient improvements had been made.

We looked at four people's care plans. These provided a comprehensive account of the support people required. We found risk assessments had been written for a range of activities and situations. For example, moving and handling, use of bed rails and managing challenging behaviour. Detailed guidance had been written where significant risks were identified. This helped reduce or control the potential for people to experience harm. We were satisfied the provider had made sufficient progress to ensure the outstanding compliance action was met.

Is the service well-led?

We read the service's new quality assurance policy. This included provision for carrying out six monthly quality audits of the service and annual satisfaction questionnaires. This would ensure there was an effective system to regularly assess and monitor the quality of service that people received. We also noted there had been a recent visit to the service by one of the board members. Their report showed they had been made aware of the findings of our last inspection and had checked that improvements had been made.

The provider had carried out their own assessment of the area where there was non-compliance at our last inspection, and made appropriate changes. A new system had been introduced since then to audit a sample of files each month. This would help to ensure files were consistently up to date and reflected people's needs.

The provider sent us an action plan which outlined the changes they would make to become compliant.

We returned to the service on 6 February 2014 to check whether improvements had been made. This was after the date the provider told us all actions to improve the service would be completed.

We checked seven people's records. These showed the provider had not completed all the actions they said they would. For example, there was only one moving and handling assessment in place out of the seven files we read. We found only a small percentage (9%) of the total number of people who used the service (76 people) had been assessed for the risks associated with moving and handling. This meant there was a risk people were not supported safely.

We were shown evidence of updated risk assessments on the service's computer system for other areas of risk for the people whose care we tracked. For example, risks associated with choking, food allergies and absconding. These had not been accessible to the whole staff team and were not included in people's care plan files. This meant the service had not ensured appropriate measures were in place to reduce or remove risks to people who used the service.

We observed people were greeted warmly by staff when they arrived at the service. Staff took an interest in what they had been doing and provided them with drinks. Staff we spoke with had a good understanding of people's needs. We observed people were free to move around the building or spend time in their room. We saw staff helped one person use the internet to look at a website about their favourite pop star.

Care plans had been written to outline the support people required. Families (primary carers) had contributed to the information to ensure people had continuity of care between their home and the service.

We found the service had not always written risk assessments to protect people's safety and welfare. In some cases, there was reliance upon using risk assessments completed by another provider. These had not been kept up to date and may not have reflected changes to people's needs over time. This placed people at risk of harm.

We found the service was suitably staffed to meet people's needs. We saw additional staff had been called in to work after someone was admitted as an emergency. This ensured everyone's needs could be met during the shift. There had been some occasions when agency staff did not have the level of skill and expertise to ensure the service operated effectively. Changes had been made since then to improve staffing arrangements at the service.

The provider had set up an effective system to regularly assess and monitor the quality of service that people received. This ensured they would be alerted to any issues affecting the care and welfare of people using the service. The provider intended to send surveys out to people and their representatives in future, to gain feedback about the quality of care.