Archived: Serenity House

Updated 20 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Serenity House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with two people who used the service. We spoke with five members of staff including the provider who is the registered manager, deputy manager, operations manager, a support worker and the house-keeping staff member and who also was one of the director’s. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

The provider sent evidence to demonstrate the urgent action taken to reduce environmental and fire safety risks to keep people safe.

We spoke with a staff member, two people who used the service and four relatives. We looked at training data and quality assurance records. We continued to seek clarification from the provider to validate evidence found. We sought further information and feedback from the local authority.

Updated 20 January 2022

About the service

Serenity House is a residential care home providing personal care to six people at the time of the inspection. The service can support up to 15 people. The service is registered to support older people, however people with a learning disability and autism were in residence. The service is not registered to support people with these needs.

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

The systems in place to assess, monitor and manage risks to people’s health, safety and welfare was fragmented and unsafe. Sufficient action was not taken in relation to fire safety risks and risks relating to the ongoing building renovations.

There were significant health and safety risks in relation to the premises and unsafe storage of machinery and equipment. Infection prevention and control procedures did not protect people and staff from the risk of contagious diseases.

People were at risk of harm because risk assessments were not always place for specific risks to people. System to monitor and review risks and support plans was not effective. People were not always involved in the process to assess, develop and review risks and their support plans.

Staffing levels were not always consistent. This meant people did not receive a person-centred approach which included the one to one support they needed. Systems and processes to protect people from the abuse and improper treatment was not robust.

People received their medicines as prescribed. However not all medicines were stored safely. The provider took action following our inspection visit to ensure medicines that needed to be refrigerated were stored securely.

People were mostly supported to have maximum choice and control of their lives and staff mostly supported them in the least restrictive way possible and in their best interests. Although policies were in place the systems were not robust to 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. This was because the provider was not aware of the principles and lacked insight as to the model of care and environment to promote the lives of people with a learning disability. The service was only registered to support older people, despite supporting people with a learning disability and autism in residence. Staff required further training to support people with a learning disability and autism. Support plans were personalised but did not always involve people to ensure their wishes and aspirations were identified to enable staff to promote them to lead confident and inclusive lives.

The provider did not have oversight and systems and processes to assess, monitor and improve the quality of service remained ineffective. Quality assurance systems had not identified widespread issues and risks. This placed people at serious risk of harm.

The provider had not fulfilled their legal responsibilities. Breaches of regulations were found at our inspections of March 2021, November 2019, March 2021 and October 2017. This demonstrated the lack of lessons learned and limited action had been taken to improve the service as further breaches of regulations were found at this inspection.

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 requires improvement (published April 2021). We issued a requirement notice in relation to regulation 12 (Safe care and treatment) and a Warning Notice and the provider was required to meet the requirements of regulation 17 (Good governance) by 31 July 2021. The service rating has deteriorated to inadequate. Breaches of legal requirements were found, and the service was placed in special measures. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the environmental and fire safety risks, health and safety risks and leadership of the service. We decided to inspect and examine those risks and to check whether the Warning Notice was met. This report only covers our findings in relation to the key questions of Safe and Well-Led which contained the Warning Notice. 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 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 requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Serenity House on our website at www.cqc.org.uk.

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, infection prevention and control, safeguarding service users from abuse and improper treatment, premises and equipment and governance and quality monitoring. The provider had failed to keep their registration up to date and had failed to submit notifications to the CQC, which they are required to do so by law.

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

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.