The S.T.A.R. Foundation

We found the following examples of good practice.

The provider had a process in place to enable relatives to visit their family members in a safe way and in line with Government guidance. The service booked visitors in at a time that suited people. Visits were spaced out, to help with maintaining social distancing. People also were supported to keep in touch with their relatives by social media, video and telephone calls.

Professional visitors were required to show a negative lateral flow test and evidence of COVID-19 vaccination. Visitors had their temperature taken in the entrance area to ensure they did not show symptoms of illness.

Infection prevention and control measures were in place and staff understood how to prevent the spread of infection. Staff had completed training in hand hygiene and donning and doffing personal protective equipment. Staff wore personal protective equipment in line with current guidance.

People using the service and staff took part in the home’s testing programme. This enabled the provider to take swift action to prevent the spread of infection if anyone tested positive for COVID-19.

The home was clean and high touch areas, such as door handles and hand rails were cleaned regularly.

The S.T.A.R. Foundation, locally known as Astrum House is a specialist residential and nursing home providing support for up to 60 people. At the time of our inspection there were 32 people using the service. The service provides support for people with a learning disability, autistic people, mental health and people with a physical disability. Some people using the service were living with dementia.

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

We found the provider had taken reasonable steps to improve the service. There had been some changes in the management team, and they were beginning to establish and lead the service. The current manager had not yet registered with CQC but had started the application process. Systems in place to monitor the service had improved but had not always identified areas of concern and therefore required further embedding into practice.

Risks associated with people’s care and support had been identified. However, risk assessments and care planning documentation were sometimes conflicting and did not always contain the most up to date information.

The service was predominantly clean, and people were protected from the risk and spread of infections. However, some areas of the home required some maintenance work to enable them to be cleaned more effectively.

Sufficient staff were available to meet people’s need in a timely way. People received their medicines as prescribed.

People were safeguarded from the risk of abuse. Staff confirmed they received training in this subject and could explain what action they would take if they suspected abuse taking place.

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.

People were supported to maintain a healthy and balanced diet which included their choices and preferences.

We observed staff interacting with people who used the service and found they were kind, caring and considerate. Staff respected people’s privacy and dignity. However, while staff were caring they did not always support people to maintain their independence.

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.

This service was predominantly able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The provider had identified the model of care and setting at The S.T.A.R. Foundation was not always suitable for people with a learning disability. This was due to the size and layout of the building. The provider was aware of this and was considering how they could improve the lives of people with learning disabilities. However, people were still able to access community facilities and had links with the local community and shops.

Right care:

• Care was predominantly person-centred and promoted people’s dignity, privacy and human rights. People were supported with social stimulation. However, people’s involvement in daily living skills was not always encouraged to enable independence.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using the service were leading confident, inclusive and empowered lives. People were not always supported to develop new skills to enable them to live enhanced lives.

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 9 November 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 9 November 2020. 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

This was a planned inspection based on the previous rating.

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The S.T.A.R. Foundation, known locally at Astrum House is a specialist residential and nursing home providing support for up to 60 people. At the time of our inspection there were 53 people using the service. The service provides support for people with a learning disability, people with autistic spectrum disorder, mental health and people with a physical disability. Some people using the service were living with dementia. The home is separated into three units known as block A, B and C. Each block is then further separated in to five units of four people, these areas are known as pods.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. A small number of people living at the service had a learning disability and/or autism and did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them. The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support did not always focus on them having as many opportunities as possible for them to gain new skills and become more independent.

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

We identified a closed culture, people did not have their human rights upheld, protected characteristics were not recognised or respected and equality was not promoted.

The provide had systems in place to monitor the quality of service. However, these were not effective or robust and did not always identify areas of improvement. Some relatives we spoke with felt communication was poor. There was no evidence that feedback from people who used the service and their relatives had been gathered or acted on.

Risks associated with people’s care were identified but were not managed in a way that kept people safe.

Staff were not always deployed effectively to ensure people’s needs were met. Staff had not consistently received specific specialist training to meet people’s needs. One to one support was not always provided in line with people’s identified needs. Staff did not receive competency checks on their performance and abilities to ensure they carried out their roles and responsibilities safely.

The provider had a recruitment process in place which showed staff were recruited safely. However, monitoring of poor performance needed improving.

The provider had systems in place to safeguard people from the risks associated with abuse. Staff had received training in this area and were knowledgeable about how to safeguard people. However, following our inspection, we referred five safeguarding concerns to the Local Authority.

We identified shortfalls in the way people’s medicines were managed.

People were not always protected by the risk and spread of infection.

Staff were kind in their response to people, however their approach was not always person-centred and at times was task orientated. Staff did not always respect people’s privacy and dignity.

There was a lack of working together with external agencies to deliver effective care and treatment and support people’s access to healthcare services. This meant their needs were not being met and had a negative impact on people’s well-being and mental health.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

There was lack of evidence to show that people were involved in decisions about their care, support and treatment.

Most people we spoke with told us the food was nice. However, from observations it was not clear that people had choices, as meals came to the units pre plated. We identified weight loss, therefore it was not always clear that people’s nutritional needs were met.

The environment was not appropriate and did not meet best practice in supporting people living with dementia.

Through our observations and from talking with people we found there was a lack of social stimulation and access to activities. People had limited access to the community and outside space.

During observations we found that specialist units did not use accessible information to enable people to communicate effectively.

Complaints were recorded in line with the provider’s policy, however, there was no evidence to show what actions had been taken to minimise issues reoccurring.

End of life care plans were in place, but they did not always identify people’s preferences and choices.

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 14 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, lack of social stimulation, not meeting the requirements of the Mental Capacity Act (MCA) and governance. Initially, we completed a site visit to look at the Safe, Effective and Well led key questions. Following the concerns, we identified, we completed a second site visit to include the key questions of Caring and Responsive.

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.

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 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.

We wrote to the provider and asked them to take action to mitigate immediate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The S.T.A.R. Foundation 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, privacy and dignity, consent to care and treatment, person centred care, staffing, safeguarding and leadership and oversight 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 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.

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.

The S.T.A.R Foundation, known locally as Astrum House, is a nursing and care home providing nursing and personal care to people with physical disabilities and long term mental health conditions. It comprises three wings divided into discrete four person units. At the time of the inspection there were 59 people living in the home.

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

People reported feeling very safe and cared for in the home. Staff were knowledgeable about safeguarding people and when to raise concerns. Records showed staff had acted as required when concerns had arisen. People received their medicines safely and recruitment practices were safe. The home was clean and staff understood their infection control responsibilities.

People told us that staff were responsive to their needs. We received positive feedback about the staff and the experience of living in the home. One person said: “Life gets better every day here at Astrum.”

People we spoke with told us that staff were kind and caring and that they were treated with dignity and respect. We observed staff upheld people’s dignity when interacting with them, and relatives confirmed they felt staff were kind and caring.

Care was person centred and people were supported to access health and social care professionals when they needed to. We received very positive feedback about the activities available in the home, and when we observed activities taking place it was clear people were enjoying themselves.

The home was managed by a registered manager who people told us was accessible and approachable. One visiting relative said: “You can get them [the management team] whenever you need them, they are always around.”

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 Requires Improvement (published 27th November 2018)

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.

The S.T.A.R Foundation 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.

The home is located close to the town centre of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to many amenities and public transport links. The home accommodates up to 60 people with support needs including dementia, physical disabilities and mental health conditions. At the time of the inspection 60 people were using the service. The home comprises three discrete units, each consisting of separate “pods” of four en suite bedrooms with a kitchen/diner and living area, as well as central communal facilities, including a large lounge area, a therapy pool and a sensory room. The home is known locally as Astrum House.

The service had registered manager. 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.

We found that staff went about their day to day duties treating people with respect and dignity. We observed a genuine warmth when staff spoke with people and staff told us that treating people respectfully was the most important part of their job.

The home environment was designed to meet the needs of the people living there, with a range of facilities including a hydrotherapy pool. The home had an activities coordinator who devised a varied activities programme, including activities both within the home and within the local community.

Medicines were stored and handled safely. Where people were at risk of harm, or presented a risk to others, there were appropriate risk assessments in place to ensure staff kept people safe.

Recruitment procedures were sufficiently robust to ensure people’s safety.

We looked at the arrangements for complying with the Mental Capacity Act, and found that although on the whole this was adhered to, improvements were required in the way consent was obtained and recorded.

Mealtimes were observed to be comfortable and pleasant experiences for people. People told us the food available was always good.

The management team were accessible and were familiar to people using the service. The provider had a system in place for auditing the quality of the service, although we identified improvements could be made to this. There were arrangements for obtaining and acting on feedback from people using the service and their friends and relatives.

The S.T.A.R Foundation is a 60 bed service providing residential and nursing care to people with a range of support needs including physical disability, mental health support needs, learning disability and dementia. It is known locally as Astrum House.

The home is located close to the town centre of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to many ameneties and public transport links. The home comprises three discrete units, each consisting of separate “pods” of four en suite bedrooms with a kitchen/diner and living area. In addition there are central communal facilities, including a large lounge area, a therapy pool where people could access hydrotherapy treatments, and a sensory room”

The service had a registered manager 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 and associated Regulations about how the service is run.

We found that people received care which was tailored to their individual needs, and upheld their dignity and privacy. There were plentiful activities both within the home and within the wider community. People using the service praised the activities available to them.

Staff were well trained in relation to keeping people safe from the risks of harm or abuse, and spoke with knowledge about this. Medicines were stored and handled safely.

Recruitment procedures and audit procedures were sufficiently robust to ensure people’s safety.

There were up to date and thorough risk assessments relating to issues where people were at risk of harm, or presented a risk to others, and we saw evidence that staff were adhering to them.

We found that improvements were required in the way consent was obtained and recorded.

Mealtimes were observed to be comfortable and pleasant experiences for people, and people told us they enjoyed their food.

Staff told us they received a good standard of training which enabled them to better carry out their roles.

The management team were accessible and were familiar to people using the service. The provider had a thorough system in place for monitoring the quality of service people received.

The provider was failing to comply with legislation in relation to the requirement to display their CQC rating on their website, as well as in the requirement to notify CQC about certain key incidents within the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our last inspection on 9 April 2014 we found safeguarding policies and procedures had not always been followed when issues of concern had been highlighted. This included alleged abuse not being reported to the appropriate external services.

At this visit we found the provider had addressed the shortfalls we identified at our last inspection. Safeguarding policy and procedure had been followed and all staff had attended further training in this subject. This had helped to make sure staff reported concerns promptly and appropriate agencies were alerted in a timely manner.

People we spoke with told us they felt safe living at the home. Their experiences were also captured through information received from the provider and the council, checking records and speaking with staff.

Since our last visit the care planning system had been improved and care records now reflected people's needs, and any risks associated with their care, in more detail. The care records we checked contained more in depth guidance about actions staff may need to take to minimise risks and manage incidents.

Is the service effective?

At our last inspection we found that periodical reviews of people's care package involving social workers had not been documented in one of the files we looked at. Therefore it was not possible to assess when their last review had taken place and if any changes were needed. At this visit we saw the electronic care planning system had been fully implemented and visits were now routinely recorded.

At our last visit we also found that although staff had in the main received adequate professional development and an annual appraisal of their work, regular support sessions had not taken place. At this visit records and staff comments indicated these sessions were now being provided consistently.

Is the service well-led?

At the time of our last inspection there was no registered manager at the service. Since then a new manager has been appointed and successfully registered with C.Q.C.

At our last visit there was a quality assurance system in place, but it had not been constantly managed and maintained. At this visit we found the manager, clinical lead nurse and the compliance team were working together to monitor all aspects of the system.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. We also saw the service had a dignity champion on each unit to promote best practice in this topic. People using the service said staff respected their privacy and dignity. One person told us how staff listened to what they wanted and acted on their preferences.

People told us they felt safe living at the home. However, we found safeguarding policies and procedures had not always been followed when issues of concern had been highlighted. This included alleged abuse not being reported to the appropriate external services.

We found most staff had received training in relation to safeguarding vulnerable people from abuse, but appropriate action had not always been taken. We saw the provider had arranged for further training on this subject to take place with additional guidance on how to raise concerns outside the home.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. However, these were not consistently followed. For example identified concerns had not always been appropriately reported and action taken. We also found care records had not always been completed comprehensively so lacked the information staff may need to minimise risks and manage incidents.

There were systems in place to make sure people received their medications safely and we saw staff had completed training in this subject.

We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to safeguarding people and risk management.

Is the service effective?

We saw people had access to advocates if they could not speak for themselves or needed additional support.

People who used the service and a visitor we spoke with said they were involved in writing plans of care, but the plans we saw were not always in a format people could easily understand.

Evaluations of care had taken place monthly. A nurse told us how they sat with people to discuss their plans of care and amended them as needed. However periodical reviews of people's care package involving social workers had not been documented in one of the files we looked at. Therefore it was not possible to assess when their last review had taken place and if any changes were needed.

Staff had received appropriate professional development. The staff we spoke with felt they had access to a varied training programme that helped them meet the needs of the people they supported. We saw staff had received an annual appraisal of their work which included a training and development plan. However, staff support sessions had not been carried out on a regular basis.

Is the service caring?

People were supported by kind, caring and patient staff. We saw staff interacting with people positively and encouraging them to be as independent as they were able. People's comments indicated they received the care and support they needed and they were happy with how staff supported them.

People's preferences, interests and individual needs were recorded in the care plans we checked.

The provider had used meetings and surveys to gain people's views. When we asked people if there was anything they would like to improve the majority could not think of anything. Other people outlined minor things they felt would make their unit better, such as a snooker table.

Is the service responsive?

People told us they were encouraged to be involved in social activities, attend day centres and carry out day to day living skills, such as cooking, making their bed and doing their laundry.

People told us they knew how to make a complaint if they needed to. When we looked at complaint records we saw action taken had been recorded.

Is the service well-led?

At the time of our inspection there was no registered manager at the service. The provider told us a new manager had been appointed and they would be starting in May 2014. Due to inconsistencies identified at the home, management responsibilities for overseeing it had been reorganised for the interim to make sure the service operated effectively.

There was a quality assurance system in place, but not all areas have been consistently managed and maintained. The provider had taken action to address this by allocating certain aspects of the system to specific staff. We saw they were also working through an action plan developed with Rotherham council to address shortfalls found at the service.

We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to having an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others

People received a well-balanced diet and were involved in choosing what they ate. The people we spoke with said they were happy with the meals provided. Staff promoted healthy eating and checked people were eating and drinking properly.

We saw there were effective systems in place to reduce the risk and spread of infection.

There were systems in place to make sure people received their medications safely and we saw staff had completed training in this subject.

Background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people.

There were enough qualified, skilled and experienced staff to meet people's needs. We observed staff were able to meet people's needs in a timely and unhurried way. One person told us, 'The staff are always there to help.'

We saw records were accurate and fit for purpose. They were kept securely and could be located promptly when needed.