Archived: Saxon Court

Saxon Court is a residential care home providing accommodation and personal care to up to 49 people. The service provides support to people with a learning disability and/or autistic people. At the time of our inspection there were 10 people using the service. One of whom did not have a learning disability.

The provider told us that currently a maximum of 20 people would be able to live at the home. This was because refurbishment of other rooms was required.

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

The provider had worked hard to address the areas for improvement following the last inspection. Although significant improvements had been made, further time was needed to fully embed these changes into day to day practice as the service continues to grow and develop.

Improvements had been made to the quality assurance system. Areas for improvement and development were identified and actions taken. These were continuing to be reviewed and developed to include all the relevant information. Changes had been made to record keeping, but further improvements were required to ensure that records fully reflected people’s needs and contained all the information staff may need.

Risks to people were generally well managed as staff knew people well and understood their needs. However, risk assessments were not always in place.

Although the home was clean and tidy improvements were needed to ensure all high touch points were regularly cleaned.

People were protected from the risks of abuse and discrimination. However, there was a keypad on one door in the communal area. Although the door was closed, and there was no evidence to suggest that this was to restrict people’s movements, it did mean people did not have free access throughout the home.

People were supported by staff who were kind and caring. Staff knew people really well and understood how to support them with individualised care. There was a system in place to ensure people’s medicines were managed safely. There were enough staff, who had been safely recruited to support people.

The provider and staff team were committed to improving and developing the service.

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 key questions Safe and Well-led. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence;

The home was much larger than most domestic style properties. However, it was similar in design to other homes in the area. There were identifying signs visible outside the home which showed it was a care home and who support was provided for. At the time of the inspection most of the people who lived at Saxon Court had lived together there for many years. The provider told us that due to the layout of the home they were able to divide the home into separate units when more people moved in.

Improvements were needed to promote and develop some people’s independence and to support them to be involved in making their own choices and decisions about the running of the home.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Care provided was person-centred. Staff knew people well and understood what was important to each person. Staff supported people in line with their individual preferences and abilities. They respected each person and took account of their rights as individuals. One relative told us, “[Name] has lived there for many years, she is really happy.”

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives;

The provider and staff were committed to supporting people to live a happy, contented and as least restrictive lives as possible. People were supported and encouraged to maintain their skills and independence. Due to their age and general frailty some people chose to live a more sedentary life. People were given choices about how they lived their lives and what they done each day. However, further work was needed to ensure people’s independence was fully promoted and opportunities for development

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 rated Inadequate (published 18 November 2021). There were four breaches of regulation. We imposed a condition on the provider’s registration and the service was placed in special measures.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, further time is needed to allow these improvements to be fully implemented and embedded into everyday practice. The service is now rated Requires Improvement.

This service has been in Special Measures since 18 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to follow up on the concerns identified at the previous 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. The provider will continue to send us information as part of their condition of registration. We will work alongside the provider and local authority to monitor progress.

Saxon Court is a residential care home providing personal care to 18 people with learning disabilities or autistic spectrum disorder. The service can support up to 49 people.

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

The systems and processes followed by the provider failed to identify that safe care and treatment was not provided. We identified eight incidents that had not been reported to the local authority under their safeguarding guidance nor had CQC been notified. There was no oversight of safeguarding incidents by the provider.

We observed long periods of time where no staff were available to help support people, some of whom required one to one support to ensure that people mobilised safely and prevent falls. Staff had multiple tasks to complete including covering for the cook who did not work at weekends and who was on leave at the time of the inspection and cleaning, to support a part time agency cleaner. Several people at the service needed the support of more than one staff member for personal care, transfers and safely moving around the service. Meeting these needs resulted in no staff being available to provide meaningful interactions for people.

Risks to people were not safely managed. Some people were at risk of choking but not all safety guidelines had been followed. Care plans were not always clear in reflecting people’s needs and were not easily accessible to staff, this had resulted in a choking incident. Several people were at risk of falls and we saw that many falls had been recorded in daily notes but no effective audit had taken place to examine causes and to minimise recurrence. There were not enough staff to meet people’s needs. Medicines were not stored or consistently administered safely. There was no oversight on medicine numbers.

The environment where people lived contained hazards and safe moving and handling practices were not consistently followed. The provider was not meeting government guidelines regarding Covid-19 in relation to the heightened cleaning regime care homes needed to follow during the pandemic. There were not enough staff to ensure the service was clean and hygienic and cleaning records were inconsistent. Parts of the service including the kitchen, had not been cleaned for several days. Individual Covid-19 risk assessments had not been completed for people or staff.

Staff were hard working but were not supported by the provider who was also the registered manager. Staff told us they rarely saw the provider at the service and did not have daily access to support and guidance from them. There was no oversight of auditing processes by the provider and care plans did not reflect the actual levels of care and support provided to people. Staff supervision meetings were inconsistent.

We requested several documents and updates from the provider during and immediately after our inspection relating to staffing, oversight of the service and people’s safety. Not all of these documents were received, and many were sent after deadlines.

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 provider was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

• The model of care and setting did not maximise people’s choice, control and

Independence. There were locked doors throughout the service separating parts of the service. We discussed this with staff, some locked doors were in place to protect people’s safety to prevent people from accessing the stairs without staff support where there was a risk to the person. For locked doors on the ground floor, staff told us if there were enough staff to support people safely, the locked doors would not be required. One person did not have a mental capacity assessments or best interest decisions around being behind a locked door. We saw that one person who was at risk of falls who wanted to walk around the service was frequently brought back to an armchair to sit down. Staff told us and we observed that staff did not have enough time to walk with the person. Guidance states that services should be designed so that the environment does not feel institutional, we saw many signs around the home identifying the service as a care home. This included people’s personal information such as a poster on the wall which indicated what people’s fluid requirements were and which care forms needed to be completed for each person.

Right care:

• Care was not person-centred and promotes people’s dignity, privacy and human

Rights. People were not engaged in meaningful occupation and told us there was nothing to do. One person said, “I'm bored. Are you bored? Isn't it boring here, there's nothing to do.” People’s care plans clearly detailed people’s hobbies and interests. During our inspection, we did not see any of these interests or hobbies being supported. We observed staff did not have time to spend with people to sit and talk to them. People were left on their own for long periods of the day. People’s daily notes did not show any activities taking place. Staff told us that due to the lack of staff, people were not able to choose how they spent their day or to go out if they wanted to. One staff member told us how two people would love to go out to lunch today but couldn’t because there was no one to take them, the staff member commented, “People in prison get more opportunities than the people here.”

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives. Staff told us that they had raised multiple concerns around staffing levels with the provider and felt their concerns were ignored. Care staff were kind and caring but felt that they were failing people by not being able to provide safe care or opportunities for people. Staff told us the immense pressure that they felt under in trying to provide support for people at the service. Staff told us that the lack of activity and engagement impacted on people’s moods. We saw that people spent long periods of the day without meaningful interactions, staff said hello as they walked past but were not able to spend any time with people.

Rating at last inspection (and update)

The last rating for this service, following a comprehensive inspection was good (published 7 June 2019). A focussed inspection to look at safe and well-led (published 7 March 2020) identified improvements were needed in well-led because auditing systems, policies and procedures were not always robust enough to ensure that there was sufficient oversight of the management of people’s finances. However, the overall rating for the service remained good.

At this inspection we found breaches of regulation and the service has been rated inadequate.

Due to the level of concerns identified at the inspection, we notified the Local Authority who took action to provide support for staffing and review people’s needs.

Why we inspected

We received concerns in relation to the lack of staffing at Saxon Court. 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 good 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 Covid-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe 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.

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

Enforcement

We are mindful of the impact of the Covid19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid19 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 people’s safety staffing, medicines, quality assurance and notification of other incidents 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 will request an action plan for 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the s

Saxon Court is a residential care home providing personal and nursing care to 16 people at the time of the inspection. The service can support up to 49 people. Saxon Court provides care and support to adults living with learning disabilities, limited verbal communication abilities and behaviour that challenges. The building was divided internally into four separate wings; High Beeches, Meadowview, Ashcroft and Cherry Trees.

Services for people with learning disabilities and or autism are supported

When we inspect we look to see whether the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. As this was a focussed inspection, we did not cover all aspects of the home that would demonstrate full compliance with Registering the Right Support. We looked at the full aspects of Registering the Right Support at our last comprehensive inspection. Details of where this report can be seen are detailed below.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 49 people. Sixteen people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

Quality assurance systems and audits were not always effective enough to ensure that people’s finances and the appointeeship process was managed sufficiently. Risks to people’s finances were recorded but were not always detailed enough to cover the full risks associated with managing people’s money.

People told us they felt safe at the service. Systems and processes were in place to ensure people were safe from potential abuse, including their finances. People’s medicines were managed and administered safely. There were enough staff to support people to remain safe, while people were protected from the risk of infection. Accidents and incidents were recorded and acted upon.

People, relatives and staff were complimentary about the service manager and deputy manager. People felt managers promoted an openness and transparency in the home and sought their views and involvement. The service manager was open to making improvements and driving quality of care at the home.

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.

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 7 June 2019)

Why we inspected

We received concerns in relation to the management and oversight of people’s finances. 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 remained as Good. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saxon Court 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.

Saxon Court is a care home that was registered for up to 49 people. Saxon Court provides care and support to adults living with learning disabilities, limited verbal communication abilities and behaviour that challenges. The building was divided internally into three separate wings namely; Meadowview which housed six people, Ashcroft housed seven people and Cherry Trees housed three people. At the time we visited there were 15 people in total living at the home, one person was in hospital.

People's experience of using this service:

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured people who live at the home can live as full a life as possible and achieve the best possible outcomes that include control, choice, inclusion and independence.

People told us they received a good service and felt safe. Accidents and incidents were recorded, and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines.

People received planned and co-ordinated person-centred care which was appropriate and inclusive for them.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure, and carried out relevant vetting checks when they employed staff. Staff were suitably

trained and received regular supervisions and appraisals.

People were supported with good nutrition and could access appropriate healthcare services. People's wellbeing was monitored and promoted.

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 were involved in planning and reviewing their care and support.

People's needs were assessed before they started using the service. Staff treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible.

The care manager and staff team promoted the values of promoting choice and control and independence and inclusion. People were supported to achieve their own goals and be safe.

Systems were in place to monitor the quality and safety of the service. The registered manager and staff were keen to drive improvement that would impact positively on people's lives.

Rating at last inspection:

At the last inspection the service was rated Good (published 7 December 2016 ).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

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

We carried out an unannounced comprehensive inspection of this service on 25 October 2016. A breach of legal requirements was found in relation to consent and the Mental Capacity Act (2005). After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Saxon Court on our website at www.cqc.org.uk.

There was a newly registered manager employed at the home. 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. The provider had also recruited a general manager for the service who had started some weeks before our inspection.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. The processes of the Mental Capacity Act 2005 had been followed when applying for DoLS. Appropriate applications for DoLS had been made for people who lived in the home.

Peoples' health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were incorporated into peoples' care plans and acted upon.

People had sufficient food and drink to maintain good health. Staff were aware of people’s specific dietary needs and where required adaptations were made to ensure people received adequate nutrition.

Staff were trained with the right skills and knowledge to provide people with the care and assistance they needed.

Saxon Court provides care and support to adults with learning disabilities, limited verbal communication abilities and challenging behaviour. The service provides residential care for mostly older adults with learning disabilities and complex needs. Saxon Court is divided internally into three separate wings namely; Meadowview which had seven people, Ashcroft had four people and Lynwood four people. At the time we visited there were 20 people in total living at the home.

There was a new manager at the home. The new manager is also the provider and they had submitted their application as the registered manager with CQC after the previous manager left. 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.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. However, the processes of the Mental Capacity Act 2005 had not been followed when applying for DoLS. Not everyone had appropriate DoLS in place, hence, appropriate DoLS applications had not been made when we visited.

People were protected against the risk of abuse. We observed that people felt safe in the home. Staff recognised the signs of abuse or neglect and what to look out for. The new manager, care manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place. This was to identify and reduce risks that may be involved when meeting people’s needs such as inability to verbally communicate, which could lead to behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Effective recruitment processes were in place and followed by the manager. Staff had the opportunity to discuss their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The new manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The new manager understood the requirements of their registration with the Commission.

During this inspection, we found a breach of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with three people at the home, four care staff, the manager and the provider. We also spoke with the Area Manager who attended for part of the inspection. One person told us "I like it here". Another person said "I am happy". A member of staff commented "There have been a lot of changes and things have improved".

We found that people were supported to give consent to care and treatment. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Care and welfare was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that a new care plan system was in place which was kept up to date. Monitoring had been improved to make sure that people received care as outlined in their care plan.

There were systems in place to make sure that people were cared for in a clean, hygienic environment. The provider was aware of improvements that were needed to the environment and had a plan in place to do this.

We found that people were not protected by robust recruitment procedures as the provider had not always obtained sufficient information about staff before they were employed

We spoke with three people that used the service. They all told us that they thought that the care that they received was good and that they felt safe living at Saxon Court. One person told us 'It's good, I feel safe'. Another person told us 'It's not too bad, I get up myself when I want to'.

We spoke with three staff that worked at the service. They all felt that people that used the service received a good standard of care.

We spoke with a professional that was visiting the service. They told us that people always appeared to be well cared for whenever they had visited.

We found that people's likes, dislikes and preferences were recorded. We found that there were also details about their usual daily routines. We found that people's care needs were assessed but we were not always able to evidence that these were being met.

We found that staff received regular supervision and an annual appraisal and that there was adequate training in place. We saw that the provider carried out an annual survey that gave people that used the service, their relatives and other people involved in their care with the opportunity to provide feedback about the service.