S E L F Limited - 14 Park View

About the service

S E L F Limited - 14 Park View is a care home and provides accommodation and support for up to nine people living with a learning disability. There were nine people living at the service when we visited.

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

Right Support

Since the last inspection, practices and the culture within the service had significantly improved. The provider had employed a new registered manager who supported people to live free from unwarranted restrictions. People, including those unable to make decisions for themselves, now had as much freedom, choice and control over their lives as possible. Staff effectively managed risks to minimise restrictions.

The provider and registered manager had improved staffing levels and ensured enough staff were on duty. Where people had support, they told us this was flexible, available when they needed it and to the level they needed. People were supported safely with medicines and infection prevention and control practices reflected good practice. Staff managed the safety of the living environment and equipment well through checks and action to minimise risk. Work had been completed to repair the heating system.

The registered manager had worked with staff to improve the quality of record-keeping. Staff now kept clear and detailed care records, which were accurate, complete, legible and up-to-date. Every person’s record contained a clear one-page profile with essential information about dos and don’ts to ensure that new or temporary staff could see quickly how best to support them. People were involved in discussions about their support and given information in a way they understood.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received additional training around how to recognise and report abuse. The provider had significantly improved how they looked after people’s money and all spending could be easily accounted for. Wherever possible people looked after their own money. People now had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations. People, those important to them and staff reviewed plans together regularly. Staff now ensured decisions about any routines in the service were based on people’s choices.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff enabled people to access specialist health and social care support in the community. People who lacked capacity to make certain decisions for themselves or had fluctuating capacity now had decisions made by staff on their behalf in line with the law. People benefitted from reasonable adjustments to their care to meet their needs, and their human rights were respected. This was because staff put their learning into practice.

People received support to eat and drink enough to maintain a balanced diet. People were involved in choosing their food, shopping, and planning their meals. Staff now supported people to be involved in preparing and cooking their own meals in their preferred way. Mealtimes were flexible to meet people’s needs and to avoid them rushing meals.

Right culture

Since the last inspection CQC has cancelled the previous manager’s registration via enforcement powers. This was due to them creating a closed, controlling and restrictive culture in the service, which had failed to promote people’s human rights. Subsequently the provider critically reviewed the service and put effective measures in place to radically change the ethos in the service. The service was now open to new ways of working and practices were introduced to promote independence and inclusivity.

People received good quality care, support and treatment because trained staff could meet their needs and wishes. The new registered manager ensured staff placed people’s wishes, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people's care. There were formal listening events for family and friends to share their views and discuss issues with staff and comments were actioned by the provider.

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 14 January 2022). We identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and good governance.

Following the inspection, we took enforcement action to cancel the manager’s registration and they are now no longer able to work as a registered manager of a care service. We issued the provider a warning notice in relation to the breach around good governance.

We also served requirement notices and the provider was required to provide actions plans detailing how these breaches would be addressed.

Why we inspected

We undertook this focused inspection to check whether sufficient action had been taken in response to the Warning Notice and requirement notices we served following our last inspection.

The provider completed an action plan after the inspection to show what they would do and by when to improve dignity and respect, safe care and treatment, safeguarding service users from abuse and improper care and staffing levels. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. 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.

S E L F Limited - 14 Park View is a care home and provides accommodation and support for up to nine people living with a learning disability. There were nine people living at the service when we visited.

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

Risks to people were not always safely managed, monitored or assessed. The service did not have effective systems to protect people from the risk of financial abuse. Covid-19 protocols were not always followed, and the service did not have effective systems to prevent and control the spread of infections.

We found restrictions had been placed on people including holding people’s cash cards, allocated time slots for smoking and vaping and fixed timings for mealtimes and administration of medicines. The provider took immediate action to support people’s fundamental human rights in line with legislation when we brought this to their attention.

Quality assurance systems were not effective, lacked detail and did not include all aspects of the service. The issues we found during the inspection had not been identified. The provider had not maintained an oversight of the service, which facilitated a poor culture and allowed poor and unlawful practices to be established and embedded.

The service did not ensure enough staff were deployed to meet people’s needs. Staffing rotas did not always reflect the number of staff on duty and the provider’s expected staffing levels were not achieved.

During our inspection people did not have access to heating and hot water. Following the inspection, the provider confirmed the heating system had been replaced. Maintenance records were incomplete; therefore we were unable to establish how long this problem had been going on.

People’s confidential records were not always accurate and complete and were not held securely.

A training programme was in place. Staff received supervisions and appraisals. However, the majority of staff told us that they were not free to discuss issues at their supervisions as it resulted in a negative impact on them or the rest of the staff team.

Medicines were managed safely. People were referred to health professionals when required.

People gave mixed feedback about the service. Some people told us they were happy whilst others expressed their dissatisfaction about the restrictions placed upon them.

Relatives and social professionals we spoke with were positive about the service and told us people were happy and settled.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 the key questions of safe, effective and well-led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Restrictive, controlling practices had been adopted within the service. Peoples’ choices had been removed in certain aspects of their lives.

Right care: People did not receive person-centred care and support and the service did not promote people’s dignity, and human rights.

Right culture: Attitudes and behaviours of the management team did not ensure people using services lead confident, inclusive and empowered lives.

Care staff were compassionate about ensuring people lived full lives. They recognised the issues at the service and repeatedly raised concerns with the management team.

The provider is conducting a full investigation into the failings and has put actions in place to address restrictions immediately.

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 good (published 20 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people using the service, staffing levels and management of the service. A decision was made for us to inspect and examine those risks.

An initial inspection took place on 2 September 2021 to establish that people were safe. We inspected and found there was a concern with staffing levels and the management of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

This report only covers our findings in relation to the key questions safe, effective and well-led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.

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.

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 COVID-19 and other infection outbreaks effectively

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection, the provider has taken action to mitigate the risks. The provider was receptive to our feedback and has implemented new systems and procedures in response.

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 will continue to monitor the service.

We have identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We have arranged to meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The care service had 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’s experience of using this service: People told us they were happy at the service. One person said, “I like it here and the staff are great.” The service had made improvements and had effective systems in place to ensure medicines were managed safely. People told us they felt safe. Staff were knowledgeable about safeguarding and were confident any concerns would be dealt with appropriately. A robust recruitment process was in place. Health and safety checks were regularly conducted to make sure people lived in a safe environment.

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

People received personalised care. We observed many positive interactions between people and staff. Staff clearly knew people well and were knowledgeable about people’s life histories, preferences and care and support needs.

Staffing levels were sufficient to meet people’s needs. The registered manager regularly reviewed staffing levels to ensure enough staff were available to support people in the community.

People were involved in developing care plans and setting goals. Staff supported people in daily decision making.

The service ensured people had access to health professionals when required and supported with any ongoing care and support needs.

Incidents and accidents and safeguarding matters were recorded and reviewed.

Staff morale was high. Staff were supported well by the management team. Training was designed around the needs of the people living at the service.

Information throughout the service was available in an appropriate format for people to understand the care and support they received.

People were supported to take part in activities and interests they enjoyed. The service also supported people to develop life skills, literacy and numeracy.

People, relatives, healthcare professionals and staff had opportunities to give feedback.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Requires improvement with breaches in regulation 12 and regulation 17 (the last report was published on 22 May 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good.

We previously inspected SELF Limited - 14 Park View (‘14 Park View’) in September and October 2015, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

14 Park View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 14 Park View provides care and support for up to nine people who have a learning disability. Nursing care is not provided. There were nine people using the service at the time of our inspection. The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the CQC individually we found that there were areas that were common to all three services. For example, training programme and delivery, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services.

The service had a registered manager in place. 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.

The management of a recent safeguarding concern was not robust in terms of establishing clear outcomes, nor was the investigation process sufficiently accountable.

Risk assessments did not always set out clearly enough how to protect people who may be at risk of absconding, or at risk of harm from others.

Medicines administration practices were not always in line with good practice and opportunities had been missed to improve these practices.

Auditing processes had not identified some of the areas identified on inspection and the provider needed to review how they managed the auditing of the service in the longer term, both in terms of the efficiency of individual audits and who these responsibilities may in time be delegated to.

Staff did not always ensure confidential information was appropriately locked away, or that keys to the medicines storage units were securely stored.

The majority of risk assessments were sufficiently detailed with clear strategies in place for staff to help protect people in a way that also did not unnecessarily restrict them.

People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.

There were sufficient numbers of staff on duty to meet people’s needs and staff were aware of their safeguarding responsibilities.

All areas of the building were clean and processes were in place to reduce the risks of acquired infections. The registered manager agreed their response to a flood in a bathroom could have had more regard to people’s individual hygiene. The premises were generally well maintained, with external servicing of equipment in place.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. These checks were refreshed after three years after external advice.

The ordering, storage, administration and disposal of medicines was generally safe, although we identified areas of poor practice with regard to creams and the administration of ‘when required’ medicines.

People had accessed external healthcare professionals such as GPs, psychiatrists, nurses and occupational therapists to get the support they needed. Staff liaised well with these professionals.

Staff received a range of mandatory training and training specific to people’s needs.

People were encouraged to have healthy diets and were protected from the risk of malnutrition, with staff adhering to external advice from dietitians.

The premises were appropriate for people’s needs and there were ample communal areas and bathing facilities.

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

Relatives and external professionals confirmed staff had formed good relationships with people, in part thanks to a continuity of care and a keyworker system.

People were encouraged to access their local community, which reduced the risk of social isolation.

The atmosphere at the home was communal and relaxed. Person-centred care plans were in place and regular house meetings took place. Care plans were reviewed regularly with people’s involvement.

The service had good links with a local farm, stables and college, and people pursued a range of activities and hobbies meaningful to them.

People who used the service, relatives and professionals we spoke with gave positive feedback about the hands-on approach of the registered manager and the personal interest they took in ensuring people’s day to day goals were met. The registered manager and staff had maintained a caring, person-centred culture within which people were supported to develop their independence.

We found the service was in breach of regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance).

You can see what action we told the provider to take at the back of the full version of the report.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The service was safe. Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe.

The provider had systems in place to ensure people received their medication from trained staff and in a timely manner. Where people had been prescribed 'as and when required' medication, the provider had developed protocols for staff to refer to so that it was administered appropriately.

People did not raise any concerns with us about the staff. People's comments included: 'Staff 100%'; 'Staff give you respect'; and, 'Staff are really nice to me.' We observed during our inspection that staff appeared to have the time to give people the attention they wanted and needed.

Is the service effective?

The service was effective. Information gathered during the initial assessment was used to develop detailed support plans. These were focussed on self-development tasks and activities to promote independence, such as having a bath and making the bed. The tasks were personalised to the needs of each individual.

Is the service caring?

The service was caring. The staff were very supportive towards the people they cared for and were kind and caring. We saw that staff supported people sensitively and offered re-assurance when required. We saw that people responded positively towards staff and appeared calm and relaxed around them. People told us they were happy with the support they received from staff. They commented: 'Top notch'; 'I really like living here'; 'Staff give you respect'; and, 'The manager always says goodbye before she goes home.'

Is the service responsive?

The service was responsive. People had access to a range of specialists and health professionals to ensure they received appropriate care. For example, this included their GP, psychiatrist, Community Mental Health Nurse, social worker and other health professionals.

People we spoke with told us they were happy with the service. They told us that they knew who to talk to if they had any concerns or worries. People commented, 'I have no concerns for anything'; 'The staff help me'; and, 'The staff sit down and talk to you if you are upset.'

Is the service well-led?

The service was well-led. People had opportunities to give their views about the service. The provider held regular 'service user' meetings, which were usually well attended. We saw from meeting minutes that people's views were listened to and actions from the meeting had been recorded. People also had regular key worker meetings with staff. This gave people the opportunity to have one to one time with staff to talk about their care and the things they would like to do.

The provider had a system of monthly quality audits in place. These included health and safety checks, checks of staff files, medication and care records. We saw that the audits had been successful in identifying changes required to people's care plans.

The provider had systems to log and investigate incidents, accidents and restraint. We viewed the accident records and found these were monitored by the manager. Information from a range of sources including incidents and accidents was analysed and used to improve the care people received.

We saw people looking to the staff for reassurance when we spoke with them, and the staff provided this support without it being intrusive or inappropriate. People said they felt safe and knew who they would go to if they were worried. We observed staff assisting in a professional and pleasant way and the atmosphere in the service was quiet and calm and the staff were focusing on the people they were supporting.

Staff were recruited and selected using a robust process which made sure they were fit to work with vulnerable people and had the skills and knowledge to deliver the service. People living in 14 Park View told us "The staff are lovely, especially the manager who is great".

There were systems in place to make sure the proprietor could assess the quality of the service they provide and make improvements if necessary. These included obtaining peoples views and audits, and were appropriate to the service they deliver.

We met with the people living there and although not all could tell us their views or experiences owing to their speech and language impairments, others gave us very clear information. Some spent time with us and we observed positive interactions between the staff and the people who were using the service. They were very happy with the support they received.

The people living in the service were being supported by staff on a one to one basis for some of the time and they were responding very positively to the staff who were with them when we were there. Two of the people living in the service gave us permission to see their bedrooms and they told us that they were happy with the way they had been decorated and had been personalised to their taste.

During our visit we saw the people using the service looking repeatedly to the staff for reassurance when we spoke with them, and the staff provided this support without it being intrusive or inappropriate. We observed staff assisting the people living in the service with their usual daily activities; including helping with domestic tasks watching television or going out to the farm. Staff responded to their needs in a professional and pleasant way and the atmosphere in the service was quiet and calm and the staff were focusing on the people they were supporting.