The Care Quality Commission (CQC) has undertaken inspections at four services run by Spectrum (Devon and Cornwall Autistic Community Trust) and has rated all of them as inadequate.
Silverdale is a residential care home in Redruth providing personal care for up to four people with learning disabilities. At the time of our inspection the service was supporting one person. The service was previously rated requires improvement overall, is now rated as inadequate overall and has now been placed in special measures.
CQC carried out an unannounced focused inspection of Silverdale to follow up on action we told the provider to take at a previous inspection in June 2021. Following the inspection, the overall rating dropped from requires improvement to inadequate, and the rating for safe, also dropped from requires improvement to inadequate, while the rating for well-led remained inadequate. The ratings for effective, caring and responsive dropped from good to requires improvement.
Trelawney House is a residential care home which can provide personal care for to six people with a learning disability and autistic people. Five people were living in the service at the time of the inspection.
CQC inspected the service to check whether improvements had been made following an earlier inspection in September 2021. At that time, CQC rated the service inadequate overall. It was also rated as inadequate for being safe, effective and well-led and requires improvement for being caring and responsive.
Following the latest inspection, Trelawney House remains rated inadequate overall as do how safe and well-led the service is. How responsive they are to people’s needs remains requires improvement. However, its rating for being caring has improved to good, and its rating for being effective has improved to requires improvement.
Carrick is a residential care home providing personal care for up to five people with learning disabilities or autistic people. The service is run by Spectrum (Devon and Cornwall Autistic Community Trust).
CQC carried out an unannounced inspection after receiving information of concern about a significant increase in the number of incidents occurring in the service. A decision was made to inspect and examine those risks and the performance of the service.
Following the inspection, the overall rating for the service remains inadequate. The ratings for safe and well-led also remain inadequate. However, responsive improved and moved from inadequate to requires improvement.
Heightlea, is a residential care home providing personal care for up to five people with learning disabilities or autistic people.
CQC carried out an unannounced inspection to follow up on concerns identified at the previous inspection in November 2021 where inspectors were concerned regarding safety risks in the service. At this inspection June inspection, there were still concerns that the measures to keep people safe were not always adequate.
Following the inspection, the overall rating for the service dropped from requires improvement to inadequate. The rating for safe remains inadequate. The rating for well-led dropped from requires improvement to inadequate. Caring moved from good to requires improvement and effective and responsive remained required improvement.
Debbie Ivanova, CQC’s deputy chief inspector for people with a learning disability and autistic people, said:
“We expect health and social care providers to guarantee people with a learning disability the safety, choices, dignity, and independence that most people take for granted. When we inspected Silverdale, Trelawney House ,Carrick and Heightlea we found the people who called these services home, were being failed by leaders.
“All four services were short staffed and were relying on agency to fill most of the hours on the rotas. At times these staff were working 84-98 hour weeks and also completing sleep in shifts as well. The mixture of these long working weeks and the dependency of the people living in the services left everyone at a high risk of being impacted negatively by a closed culture. The interim managers overseeing the services were aware of this risk and noted that further recruitment was needed. But, Spectrum overall had not assessed the risk or taken action to mitigate it.
“During our inspection, we did see some improvements at Trelawney House. However, in the other services there were still a number of breaches outstanding and we have told Spectrum to make a number of improvements with immediate effect. We are using the CQCs enforcement powers to keep people safe but cannot comment on these processes until they are complete. In the meantime, we are working closely with the local authority and other partners to ensure people’s safety whilst these improvements are made and fully embedded.”
Inspectors found over all four services:
Despite an improvement at Carrick, staffing arrangements remained challenging. The services had significant numbers of staff vacancies and had been unable to recruit additional staff. This meant all four services were dependent on agency staff to achieve minimum staffing levels. These agency staff continued to be allowed to work excessive hours each week and had regularly worked over 84 hours per week with limited opportunities for rest. These working practices exposed people and the staff to ongoing risk of harm.
Three of the four of the services did not have a registered manager in post and there was limited leadership from the provider. This, in combination with the small number of agency staff regularly working excessive hours, meant there was a risk of a closed culture developing. This had not been identified and no plans in place to manage this risk.
Thematically there has been concerns that individuals could have been exposed to the risk of financial abuse. At Carrick, information gathered during this inspection indicated that there was a financial relationship that may not have been in the best interest of one person living there. As a result, this information was shared with the local authority as a safeguarding alert. At Silverdale and Trelawney, the right systems were in place to ensure monies held in the service were appropriately managed. At the time of the inspection Spectrum were acting as appointee for a number of people and had responsibility for managing all aspects of these people’s finances. These responsibilities were subsequently taken on by Cornwall Council. This meant people’s finances were overseen by an independent body which further protected people from any risk of financial abuse.
The culture in the services remains a concern. There has been a lack of effective oversight by the provider and limited management support. However, Spectrum has recognised that additional senior managers were required to support its services