Archived: Summerfield House

Summerfield House is a residential care home providing personal care for up to five people with a learning disability or autistic spectrum disorder. At the time of inspection four people were living in the home and one person had temporarily moved back to their family home.

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

People were not protected from abuse. Incident records detailed physical, verbal and emotional abuse which had not been responded to. There had been no action taken following the incidents to prevent reoccurrences and ensure people were protected from the risk of abuse.

There was a widespread lack of recognition from the staff and provider about the inappropriate and abusive practices being undertaken. The culture of the service was such whereby incidents of abuse, resulting in harm, were deemed as normal.

The registered manager and provider had failed to ensure that monitoring and governance systems and processes were established and operating effectively to ensure compliance with the regulations. The provider failed to ensure there was effective and consistent managerial and operational leadership in place. The home presented with a closed culture meaning poor culture that led to harm, including abuse.

There had been no safeguarding alerts made to the local authority safeguarding team for numerous allegations of abuse. There had been no consideration of notifications needing to be made to the CQC in line with legal requirements.

Care plans and risk assessments weren’t always updated to consider how to support people. People were not supported to be involved or make decisions about their care. We were not assured of good infection prevention control practice in relation to COVID-19.

There were widespread concerns that people were not treated with dignity and respect. Staff practice, language and records were demining and derogatory to people. There was little understanding from staff in regard to poor practices and the impact on people’s wellbeing.

Care was not personalised to meet people’s needs, preferences, interests and give them choice and control. People were not involved in developing their care plan and their individual needs and circumstances were not considered. The registered manager and provider had not taken appropriate steps to comply with the Accessible Information Standard to ensure people’s communication needs were met.

There were widespread and significant shortfalls in the care, support and outcomes that people experience. The registered manager and provider showed a lack of understanding of how to apply the Mental Capacity Act 2005. The home did not work with professionals to ensure effective outcomes for people.

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.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care did not maximise people’s choice, control and independence. Care was not person centred. The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives. This meant people did not receive person centred care, the provider and staff did not do all that was reasonably practicable to make sure peoples care and treatment was appropriate, met their needs and they had choice. We took action to address this. Full information about CQC’s regulatory response to the serious concerns found during this inspection is added to the report after any representations and appeals have been concluded.

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 04 September 2019).

Why we inspected

The inspection was prompted due to concerns received about abuse. A decision was made for us to inspect and examine those risks.

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 improvements. Please see all sections of this full report.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, person centre care and governance at this inspection.

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 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.

Summerfield House is a residential care home providing personal care for up to five people who have a Learning Disability or Autistic Spectrum Disorder. At the time of the inspection, the service was supporting five people.

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. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were kept safe as staff knew how to identify and report any concerns of abuse. Risks to people’s safety were managed well. Staff had been recruited safely and there were enough staff to meet people’s needs. Medicines were given in a safe way.

People were supported by staff who had received appropriate training. People’s needs had been assessed and their dietary needs were met. 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. The design and décor of the premises met people’s needs. People had access to healthcare services where required.

People were supported by staff who knew them well. People had access to activities that met their individual interests. There was a complaints procedure in place and people knew how they could share complaints.

People felt the service was well led. The registered manager had a visible presence around the service and staff morale was high. There were systems in place to monitor the quality of the service and people were given opportunity to provide feedback.

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 30 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Summerfield House provides personal care for up to five young people with learning disabilities. At the time of our inspection the service was supporting five people who lived at the home.

There had been no registered manager working at the service since December 2015 however a new manager was in the process of applying to become the registered manager. This person was not present during our inspection but we spoke with them on the telephone. 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 of the Health and Social Care Act 2008 and associated

People told us and indicated that they felt safe. We saw they were happy to approach staff for support and reassurance. Staff were aware of the need to keep people safe from harm and they knew how to report allegations or suspicions of poor practice. The manager had assessed any risks associated with people’s conditions and staff knew what to do to reduce these risks.

People were supported to take their medicines appropriately. Staff could access medication which was suitably stored and knew how to dispense it safely. There were regular checks to make sure this was done properly.

People were supported by staff who had the appropriate skills and knowledge they needed to meet their care needs.

People were supported by staff who knew their preferences and what they liked to do. Staff supported people to choose food and drinks they liked and ensure they received the appropriate nutrition to stay well.

People were supported to have their mental and physical healthcare needs met. The manager sought and took advice from relevant health professionals when needed.

People said staff were caring and we saw that people enjoyed the company of the staff who supported them. People were involved in deciding how they wanted their care to be delivered and their choices and wishes were respected. Staff respected and promoted people’s privacy.

Staff supported people in a range of activities to promote their independence and involvement in the local community.

People had access to a complaints system and the manager responded appropriately to concerns.

There was effective leadership from the manager and senior members of staff to ensure that staff in all roles were well motivated and enthusiastic. The provider understood their responsibilities to the commission but their actions to ensure they acted in a timely manner were not always robust.

Systems in place to monitor the quality of the service had improved and when necessary action plans were established to implement and monitor improvements to the service.

All the people we spoke to told us that the workers caring for them had a good manner, respected their dignity and spoke to them as adults. One person who used the service told us, "The staff are really good. I like it here".

People who used the service were involved in planning their care. They were supported to make choices about the care they received. Where decisions were made on a person's behalf they were done so with their agreement and in their best interest.

Staff felt supported to meet the care and welfare needs of the people who used the service. One member of staff told us, 'I like working here, the manager doesn't cut corners'.

The provider was able to protect people against the risk of unsafe care and treatment by regularly assessing and monitoring the quality of the service provided and introducing changes when required.

We noted that the registered manager no longer worked at the location and that they had formally applied for their registration to be cancelled.