Little Oyster Residential Home

About the service

Little Oyster Residential Home is a residential care home providing accommodation and personal care for up to 64 people. The service supports people with learning disabilities, autism, physical disabilities and mental health conditions. The main building is arranged across 2 floors with lift access and the service has an annex, bungalows and flats on the same site. Only 1 of the flats was occupied. At the time of our inspection there were 15 people using the service.

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

Right Support:

The service had systems and processes in place to safely administer and record medicines use. There was a robust auditing process in place that helped to identify areas for improvement and minimise impact on people’s care and safety. However, there was no process in place to record why PRN (as and when required) medicines were being used or if these had been effective and national guidance wasn’t always being followed when disposing of certain medicines. We made a recommendation about this.

Staff supported people to take part in activities of their choice. People were supported to pursue interests in their local area. People's rooms were personalised and they were supported to move to another part of the service if they wanted to and if it was appropriate. Staff supported people in a clean and well-equipped environment. The service had an ongoing programme of redecoration in progress.

Right Care:

People were protected from poor care and abuse. The provider had policies in place and staff had been trained. Safeguarding concerns were reported to the appropriate authorities and the manager worked with the local safeguarding teams to ensure any issues were fully investigated.

Risk assessments had improved since our last inspection and these gave staff enough information to provide safe care. Care plans were detailed and people's preferences and choices were documented. There were enough staff deployed to provide support for people. Staff knew people well and understood how to provide safe care. People told us, “A lot of things changed here since January 2023. This is the first week with no agency [staff] which is better” and “I am happy with my care.”

Right Culture:

Since the last inspection a new manager had joined Little Oyster Residential Home. The manager had continued working with the wider management team to embed the quality monitoring and audit processes. The new care system gave the management team better oversight of the care and support provided, handover records were utilised in this system to give staff clear information about people’s care and support. These quality monitoring processes were embedded and were continuously reviewed to ensure they gave a good oversight of the service.

The management team met with staff daily to share information and ensure staff had the most up to date information. Other meetings were held regularly, including a clinical risk meeting. Staff told us the management were supportive and approachable.

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 and update

The last rating for this service was requires improvement (published 7 August 2023) and there were breaches of regulation. This was a focused inspection of safe and well-led. Effective, caring and responsive were also rated requires improvement at a previous inspection (published 24 March 2023) and there were 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. However, there were some areas for improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 2 inspections.

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.

Recommendations

We have made a recommendation about the management of some medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Little Oyster Residential Home is a residential care home providing accommodation and personal care for up to 64 people. The service supports people with learning disabilities, autism, physical disabilities and mental health conditions. The main building is arranged across 2 floors with lift access and the service has an annex, bungalows and flats on the same site. At the time of our inspection there were 45 people using the service.

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

Right Support:

Medicines were not managed safely. People were supported with their medicines, but systems in place were not robust enough and on occasions the service had run out of a person’s medicines. There were gaps and errors in record keeping.

Staff supported people to take part in activities of their choice. People were supported to pursue interests in their local area. People’s rooms were personalised and they were supported to move to another part of the service if they wanted to and if it was appropriate. Staff supported people in a clean and well-equipped environment. The service had an ongoing programme of redecoration in progress.

Right Care:

People were not always protected from poor care and abuse. The local authority was in the process of investigating a lot of safeguarding concerns. The provider had policies in place and staff had been trained. Safeguarding concerns were reported to the appropriate authorities and the manager worked with the local safeguarding teams to ensure any issues were fully investigated.

Risk assessments had improved since our last inspection and most gave staff enough information to provide safe care. However, some risk assessments were less detailed and put people at potential risk of harm. Care plans were mainly detailed and people’s preferences and choices were documented. There were enough staff deployed to provide support for people. Staff knew people well and understood how to provide safe care.

Right Culture:

Since the last inspection a new manager had joined Little Oyster Residential Home. The manager had implemented new quality monitoring and audit processes and a new care system that gave the management team better oversight of the care and support provided. These quality monitoring processes were still being embedded.

The manager met with staff daily to share information and ensure staff had the most up to date information. The mechanisms for sharing this information widely amongst the staff team were not robust. Other meetings were held regularly, including a clinical risk meeting. These meetings had not always been effective in ensuring staff had up to date information to provide safe care. Although systems had been introduced they had not been fully embedded into the culture of the service. Staff told us the manager was supportive and approachable.

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 and update

The last rating for this service was inadequate (published 23 March 2023) and there were 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 some improvements had been made and the provider was no longer in breach of some regulations. However, they remained in breach of others.

This service has been in Special Measures since 23 March 2023. 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 received concerns in relation to people’s safety, risk assessments and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, managing medicines safely, safeguarding people from harm, good governance and record keeping.

CQC’s regulatory response to the more serious concerns found at the last comprehensive inspection can be found in our last report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Little Oyster Residential Home is a residential care home providing personal care to 54 people at the time of the inspection. The service can support up to 64 people. The main building is divided into two floors and an annex, and there are separate bungalows and apartments where people live more independently. The service accommodates people who have learning disabilities, mental health conditions and physical disabilities.

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

Right Support

Staff did not provide effective support to identify people's aspirations and goals and assist people to plan how these would be met. Staff did not always focus on people's strengths and promote what they could do. There was not a consistent approach to supporting people to learn new skills or maintain their skills for as long as possible, where this was appropriate. Records showed basic preadmission assessments had been carried out to identify people’s needs. These assessments had not always been used to develop people’s care plans.

The service had systems and processes in place to safely administer and record medicines use, however these were not always followed. Medicines were not managed safely. Medicines were not always administered in line with the prescription. Some people had not received their medicines as prescribed.

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 service provided people with care and support in a clean and well-equipped environment. The service was undergoing a programme of redecoration and repair.

Right Care

People's care was not always person centred and did not always meet their assessed needs. Care plans and risk assessments contained conflicting information. People's preferences had not always been recorded which meant people did not always receive care as they would like.

Although most people received improved experiences in relation to their dignity, respect and human rights, the provider had not treated people with dignity and respect.

Staff had training on how to recognise and report abuse and they knew how to apply it. Although staff we spoke with understood how to protect people from poor care and abuse, abuse had not always been identified and reported to make sure people were safe from harm. Registered persons had failed to follow safeguarding policies and procedures. The service had enough staff to meet people's needs and keep them safe. Most staff had the necessary training to meet people's assessed needs.

Right Culture

Since the last inspection, people, their relatives and staff had been encouraged and supported to provide feedback about the service. Most people and staff felt listened to. Some staff did not always feel the same. Complaints made to the service had mostly been responded to in line with the providers policy.

The provider's quality monitoring processes were not robust and had not always identified concerns and improvements in the service identified during the inspection. There was no senior manager or provider oversight of the quality monitoring processes. This meant that the quality of service provided had declined since the last 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 3 August 2022). There were 6 breaches of regulations. We served the provider conditions on their registration and a requirement action. 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 the provider remained in breach of regulations. This service has not been rated good for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Enforcement

We have identified breaches in relation to risk management, medicines management, safeguarding people from abuse, assessing and designing care needs to ensure people receive person centred care, mental capacity and good governance. 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 of 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.

About the service

Little Oyster Residential Home accommodates up to 64 people across three buildings. The main building is divided into two floors and an annex (which had been renamed Sea Breeze and Sea View), and there are separate bungalows and apartments where people live more independently. The service accommodates people who have learning disabilities, mental health conditions and physical disabilities. The service was providing personal care to 42 people at the time of the inspection.

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

Most people told us the service had made improvements since July 2021. They told us this had led to improved experiences for them. Some people had not had the same improved experiences and improvements had not been embedded in every area of the service.

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

Staff did not provide effective support to identify people's aspirations and goals and assist people to plan how these would be met. Staff did not always focus on people's strengths and promoted what they could do. There was not a consistent approach to supporting people to learn new skills or maintain their skills for as long as possible, where this was appropriate.

The service had systems and processes in place to safely administer and record medicines use, however these were not always followed. Medicines were not always administered in line with the prescription. Some medicines with additional administration or safety requirements had not been properly identified and addressed in people’s care plans or risk assessments.

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 supported this practice.

The service provided people with care and support in a clean and well equipped environment. The service was undergoing a programme of redecoration and repair. However, some safety aspects had not been identified and mitigated prior to the inspection. The risk to people from hot, uncovered radiators and risks arising from people’s diagnosed health needs had not been addressed.

Right Care

People’s care was not always person centred and did not always meet their assessed needs. Care plans and risk assessments contained conflicting information. People’s preferences had not always been recorded which meant people did not always receive care as they would like. Some people experienced delays in receiving care when they needed it because call bells were not always answered in a timely manner and people living in the apartments outside of the main building experienced delays because staff assigned to work with them were also assigned to work in the main part of the service.

Although most people received improved experiences in relation to their dignity, respect and human rights, some people did not feel treated with dignity and respect.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe. However, Staff had not always had the necessary training to meet people’s assessed needs.

Right Culture

Since the last inspection, people, their relatives and staff had been encouraged and supported to provide feedback about the service. Most people felt listened to. Three people did not always feel the same, one person had been asking to move bedrooms and had not been listened to. Complaints made to the service had not been responded to in line with the providers policy.

The provider’s quality monitoring processes had not always identified concerns and improvements in the service. The management team were still in the process of embedding changes, providing mentoring, support and coaching to staff to understand the importance of recording.

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 06 October 2021). The provider was found to be in breach of Regulation 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider was no longer in breach of some regulations. Improvements meant that breaches of regulations 13, 14, and 15 had been met. However, the provider remained in breach of regulations 9, 10, 11, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures since 06 October 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

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified continued breaches in relation to: risk management, medicines management, staff training, ensuring consent to care and treatment in line with law and guidance, ensuring people received person centred care and support, treating people with dignity and respect, management of complaints and ensuring systems and processes are operated effectively to assess, monitor and improve the quality and safety of the service 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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Little Oyster Residential Home accommodates up to 64 people across three buildings. The main building is divided into two floors and annex, and there are separate bungalows and flats where people live more independently. The service accommodates people who have learning disabilities, mental health conditions and physical disabilities. The service was providing personal care to 52 people at the time of the inspection.

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

People were not always safe at the Little Oyster Residential Home. Comments included, “This place is needing sorting out, they are putting on a façade because you are here. I feel unsafe here because of the staffing levels”; I want to move. Between you and me I feel very unsafe – I can’t sleep or settle”; “[A person] has started banging on my window late at night, I have reported it to staff, it scares the life out of me” and “I feel safe but there is not enough staff, they don’t have cover for sickness which means they run short.”

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Timely action had not been taken to address issues identified within audits. People were at risk because the provider had not acted to ensure they had sufficient oversight of the service. Records were an area of concern across the service; records were not complete and accurate and had not always been stored correctly. The provider had failed to sustain the improvements and the service had declined in quality.

The provider had not developed an open and honest culture where staff were empowered to raise any safeguarding concerns. People were not protected from harm and abuse.

Risks associated with diabetes, epilepsy, catheter care and constipation had not been robustly assessed and action had not been taken to reduce risks to keep people safe. Some risk assessments were generic and did not relate to the people they were about. People were not protected from the risks in the event of a fire. Fire risks had not always been well managed.

There was a poor system in place in relation to accidents and incidents. Accident and incident records evidenced that timely and appropriate action had not always been taken to address incidents.

We were not assured there were enough staff to meet people’s needs. We observed call bells were not always answered quickly. We also observed that call bells were muted or switched off without staff attending to people to find out what they wanted or needed. Staff were not always recruited safely.

Medicines were not managed safely. Policies and processes for managing medicines were not always followed. Thickening agents prescribed for people who had swallowing difficulties were not always measured accurately when added to liquid medicines. Records were not always made when people’s medicines patches were removed or where on the body they were applied. Large amounts of unwanted medicines, clinical waste and other containers had not been appropriately disposed of.

The cleanliness of the building had declined, people were at risk from the spread of infection. Government COVID-19 guidance had not always been followed in relation to testing people and staff.

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. People’s care plans contained conflicting and confusing information about their mental capacity. It was not always clear when a person lacked capacity and when a best interests decision had been made, who had been involved in the decision making process.

Training records evidenced that some staff had not completed their training to give them the skills and knowledge of safely working with people. A large selection of staff employed were not listed on the training records, which indicated that they had not received any training

People told us that the meals were of poor quality and lacked vegetables and were not balanced. Some people told us they did not always get choices of meals and some said they didn’t know what meal choices were on offer until the food was brought to them. Food and drink did not always meet people’s assessed needs.

People had not always had access to medical appointments for their health needs to be met. People’s health records evidenced that several people had not seen their dentist since 2019.

Maintenance tasks had not always taken place in a timely manner, which could put people at risk of harm. We observed there were areas of the service that were not clean; carpets were stained and dirty in places, bathroom, toilets and ensuite floors were dirty and stained in places and there was an unpleasant odour. Some equipment was visibly dirty and had not been cleaned.

Prior to people moving to the service their needs were assessed. Assessments included oral healthcare. During the inspection we found that some people who required physical assistance to maintain their oral hygiene had very poor oral hygiene. People were not consistently receiving good care. Some said they were happy living at the service, and some were deeply unhappy and asked us for help to let their social workers know that they wanted to be moved.

People were not always treated with dignity and respect. People’s personal records were not always stored securely to ensure they were only accessible to those authorised to view them. People’s cultural needs were not always respected. Some people were not always supported to maintain important relationships with people when they could. Most people told us the staff were nice and kind.

Some people told us their personal care needs were not always met. People’s care records did not always evidence people had received personal care (including oral care). Care and support plans for people with long term conditions lacked detail. There were no activities taking place in the service. People told us they were bored and had nothing to do.

The provider had not followed their own complaints processes, timely action had not been taken to address people’s concerns.

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.

Right support:

People's choice was not maximised, and they could have been better supported to develop more control and independence.

Right care:

Care was not always person-centred and promotes people's dignity, privacy and human Rights. People had not always received the care and support they had been assessed to require.

Right culture:

Ethos, values, attitudes and behaviours of leaders and staff did not ensure people always lead confident, inclusive and empowered lives.

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 May 2021).

Why we inspected

The inspection was prompted due to significant numbers of concerns received about staffing levels leading to lack of care towards people, medicines management, infection control, COVID-19 testing and the mismanagement of records. A decision was made for us to inspect and examine those risks. As the risks spanned across all five domains, the inspection was a comprehensive 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.

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 monitor the service and 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: risk management, medicines management, safeguarding people from abuse, management of infection control, safe staffing levels, staff training, ensuring adequate nutrition and hydration, safety, maintenance and cleanliness of the premises, ensuring people received person centred care and support, treating people with dignity and respect, management of complaints, providing activities to meet people’s needs and ensuring systems and processes are operated effectively to assess, monitor and improve the quality and safety of the service 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 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

Little Oyster Residential home accommodates up to 64 people across three buildings. The main building is divided into two floors and annex, and there are separate bungalows and flats where people live more independently. The service accommodates people who have learning disabilities, mental health conditions and physical disabilities. The service was providing personal care to 52 people at the time of the inspection.

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

The service had improved since we last inspected it. Everyone we spoke with was positive in their

feedback. Comments included; "99.9% of staff here are caring and nice. We look at staff as friends. They are very accommodating"; "I feel very safe, and I have lifeline" and "I feel safe living here. Staff makes me feel safe. I am happy here.”

However, while there had been improvement in risk assessments, risks to people’s health and wellbeing had not always been fully assessed. People were at risk of harm because staff did not always have the information they needed to support people safely.

People were protected from abuse and the risk of harm. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices.

Medicines were stored and managed safely. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People were protected by the prevention and control of infection. There was an up to date infection control policy in place.

Accidents and incidents were reported by staff in line with the provider’s policy, and the nominated individual took steps to ensure that lessons were learned when things went wrong.

The provider made sure they monitored the service in various ways to ensure they continued to provide a good quality service that maintained people’s safety.

People were asked for feedback about the service they received.

The nominated individual attended networking events to share learning and best 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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Although the size and structure of the service was not in line with the principles of Right Support, right care, right culture, staff deliver care in a person-centred way that offered people choice, control and independence. The service had been managed in three sections, which enabled inclusiveness and empowered lives. The outcomes for people fully reflect the principles and values of Right Support, right care, right culture as people had choice and control.

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 18 February 2021) and there were breaches of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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, however some improvements were still required.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on a specific concern we had about risk management. We carried out an unannounced focused inspection of this service on 15 December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 Good. 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 Little Oyster Residential Home 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.

Little Oyster Residential Home is a care home providing personal care to 52 people at the time of the inspection. The service can accommodate up to 64 people who have learning disabilities, mental health conditions and physical disabilities across three buildings. The main building is divided into two floors and annex, and there are separate bungalows and flats where people are able to live more independently.

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

There had been some improvements within the service. However, there continued to be shortfalls in the service provided to people.

Individual risks were not always assessed and managed to keep people safe. Staff did not always follow the provider's COVID-19 policy or infection and protection government guidelines. This posed a risk where staff could transfer infection.

Risks to the environment had been considered as well as risks associated with people's mobility and health needs. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.

People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. We found no evidence that people had been harmed however, systems were not robust enough to demonstrate staff recruitment was effectively managed. We made a recommendation about this.

Although there had been audits and checks of the service completed, these were not robust. This meant the management team were not always aware of concerns identified during this inspection in relation to recruitment practice and risk management.

People had regular staff who they knew well. People told us, “It’s lovely here, I have been here two years, it is home”; “The staff and people are friendly, I like living at the service” and “I generally feel well looked after. The staff are brilliant.” We observed positive interaction between people and staff, people were seen to be smiling and were chatting and laughing which indicated they were happy.

People were well supported by competent, knowledgeable and trained staff. Staff were well supported by the management team.

Medicines were managed safely. Staff understood the importance of safeguarding and the registered manager worked closely with the local authority.

Meals and drinks were prepared to meet people's preferences and dietary needs. People told us they liked the food and everyone confirmed they had choices of meals. Meal time experiences had improved, people were treated with dignity and respect.

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.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight, referrals were made to dieticians, or if people had difficulty swallowing or had choked, they were referred to the speech and language team.

The management team carried out the appropriate checks of staff practice to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people's changing needs. The registered manager promoted an open culture and was a visible presence in 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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Although the size and structure of the service was not in line with the principles of Right support, right care, right culture, staff tried to deliver care in a person-centred way that offered people choice and control. The service had been divided into two so that staff worked in one area with people to ensure people had consistent support. People were supported to be as independent as they could be.

People received person-centred care which promoted their dignity, privacy and human rights. People were supported to follow their interests and take part in activities in the local community (when there were no COVID-19 restrictions). People were supported to be involved in the day to day running of the service. Accessible information including pictures and symbols was used to support their understanding and engagement.

The registered manager demonstrated that they were committed to ensuring that people received high-quality care and were committed to continually improving the service. The registered manager worked with a wider management team to drive changes.

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 31 December 2019) and there were breaches of regulation 10,12,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and when they would improve by.

At this inspection we found the provider had made some improvements by ensuring that staff received training and support to carry out their roles safely and staff treated people with dignity and respect. However, the provider requires further improvement in effective quality monitoring and assessing and managing risks.

This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve; Safe care and treatment (Regulation 12), Dignity and respect (Regulation 10), Good governance (Regulation 17) and Staffing (Regulation 18) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this unannounced focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 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 remained Requires improvement. 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 Little Oyster Residential Home 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 risk management, safe recruitment practice and effective systems to monitor the quality and safety of the service 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 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 service supports people in a number of buildings including some people who live in their own flats or share a small home with others.

We found the following examples of good practice.

¿ The registered manager had followed advice from other agencies relating to visitors and areas had been arranged to allow visiting which met social distancing requirements. People had been given information in a range of formats including easy read to enable them to understand social distancing and how it affected them.

¿ Staff used PPE appropriately and when people used equipment which could increase the risk of infection, staff had access to and used specific PPE and took the correct precautions. For example, using specialised masks and double gloves. Each person had PPE in their rooms for them and staff to use. There were also PPE ‘stations’ around the service to ensure PPE was readily at hand.

¿ When people chose to go out independently, staff supported them to understand the risks and explained how to use PPE to stay safe. People who went out were offered regular testing and did not enter communal areas. Adaptions had been made to the allocated smoking areas at the service to minimise the risk of people meeting and to encourage social distancing.

Further information is in the detailed findings below.

Little Oyster Residential home accommodates up to 64 people across three buildings. The main building is divided into two floors and annex, and there are separate bungalows and flats where people are able to live more independently. The home accommodates people who have learning disabilities, mental health conditions and physical disabilities.

The service was registered before Registering the Right Support was developed. Therefore, the service has not 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. Although the size and structure of the service was not in line with the principles of Registering the Right Support, staff tried to deliver care in a person-centred way that offered people choice and control. However the outcomes for people did not fully reflect the principles and values of Registering the Right Support as there was a lack of choice and control for some people.

People’s experience of using this service

People were not always supported in a safe way. People’s medicines were not managed safely, particularly when people took their medicines away from the home to take in the community. Risk assessments were not always updated when people’s needs and risks changed.

People were supported to manage complex medical conditions and to use specialist medical devices as part of their care. Staff had not had their competence to use this equipment appropriately assessed. Not all staff had received the training they needed to perform their roles.

The quality assurance systems in place had not addressed the issues with medicines management and risk assessments found in the home. They had not identified where people’s care plans were not up to date, or personalised.

The quality of people’s care plans, their experience of activities and the support they received varied across the home. While some people had high quality care plans, told us they were supported with a range of activities and had their needs met, others had a poorer experience.

There were enough staff available to support people, and they had been recruited in a safe way.

When people were involved in incidents actions were taken to ensure they were safe, and allegations of abuse were raised appropriately. However, it was not clear that lessons were shared and applied more widely to ensure everyone in the home was safe.

People were supported to access healthcare services and to link with other professionals to have their needs met. The service made adjustments to ensure people’s communication needs were met.

People’s experience of mealtimes and choices varied. While some people were offered choices, and enjoyed their meals, others did not.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Although we did see some examples where best practice had not been followed.

People were supported to practice their faith if they wished to do so. Staff were considerate of people’s diverse characteristics and ensured there was a welcoming atmosphere for different groups of people. Staff were kind to people in most of their interactions and people told us they liked the staff.

The service ensured information was made available to people in a way that was accessible to them and met the requirements of the Accessible Information Standard.

People knew how to make complaints. There were ambassadors within the service to support people who may lack confidence to make complaints. Complaints were investigated and responded to appropriately.

People were involved in making decisions about the service and were engaged through meetings and questionnaires. People’s achievements and independence were celebrated.

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 14 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Safe Care and Treatment, Staffing and Good Governance. This was because medicines and risks were not managed safely, staff had not had the training they needed to perform their roles, and the governance systems had not addressed issues with the quality and safety of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Little Oyster Residential Home 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.

Little Oyster Residential Home is a privately owned care home providing accommodation, personal care and support for up to 64 people with diverse and complex needs such as physical disabilities, acquired brain injury, learning disabilities, autism, downs syndrome and limited verbal communication abilities. At the time of our visit, 55 people who lived in the service were between the ages of 18 and 65 years.

At the last Care Quality Commission (CQC) inspection on 18 October 2016, the service was rated as Good. At this inspection, we found the service Requires Improvement.

Little Oyster was designed, built and registered before registering the right support. Therefore, the service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance.

Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this guidance and used other best practice to support people. They have applied the values under Registering the Right Support. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a manager at the service. 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.

Medicines practice was not always safe. Medicines had not always been recorded and we found gaps on the MAR chart.

The registered manager had a quality audit in place. However, at the time we inspected, the scheduled monthly audit had not been carried out. The registered manager was not aware of some of the concerns we found during this inspection.

Staff received regular training. Although staff had not been provided with appropriate support and supervision as is necessary to enable them to carry out their duties, staff told us they had regular access to the registered manager and they would not hesitate to contact her if required.

People were protected from the risk of abuse at Little Oyster Residential Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People received the support they needed to access healthcare services.

There were enough staff to keep people safe. The registered manager had appropriate arrangements in place to ensure there were always enough staff on shift.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People were supported to eat and drink enough to meet their needs.

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.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time. People were supported to maintain their relationships with people who mattered to them.

Staff showed they were caring and they treated people with dignity and respect. Staff ensured people's privacy was maintained particularly when being supported with their personal care needs.

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint.

The registered manager provided good leadership. They checked staff were focused on people experiencing good quality care and support.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

Little Oyster Residential Home is a privately owned care home providing accommodation, personal care and support for up to 64 people with diverse and complex needs such as learning disabilities, autism, downs syndrome and limited verbal communication abilities . At the time of our visit, 54 people who lived in the home were between the age of 18 and 65 year.

There was a registered manager 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.

At our previous inspection on 21 April 2015, we recommended that the provider seeks and follows the National Institute for Health and Care Excellence NICE guidance on managing medicines in care homes because medicines were not disposed off safely and medicines were not recorded in either medication administration records (MAR) sheet or home’s counting sheet when they came in. We also recommended that the provider and registered manager seek advice and guidance from a reputable source, about the user friendly and personalised communication standards. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that medicines were stored, disposed and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the home.

The home had implemented and encouraged communication with people who use the service through the development of care files that included communication passports, which provided clear descriptions of how people communicate. Communication standard for people in the home such as using pictures, objects and signing with the people with communication impairments that live at Little Oyster had been implemented.

Little Oyster had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

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.

They had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People had access to nutritious food that met their needs. We observed that people freely made their cold and hot drinks when they wanted them. The provider had fitted a new accessible kitchen that promoted people’s independence in the home.

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.

Our observation on the day showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

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

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held frequently. Staff told us they felt free to raise any concerns and make suggestions at any time to the registered manager and knew they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

Is the service safe?

People we spoke with told us they felt safe, they told us that if they were concerned about anything they would speak to the manager or the staff. Safeguarding procedures were available however not all staff were clear on what constituted abuse or when they should be reporting suspicions to the manager. This increases the risk of harm to people and fails to ensure that all abuse whatever type is reported and investigated.

The service did not have robust infection control procedures in place, for example we saw that hand wash soap and hand gels were not available in all toilets, en-suite shower rooms, main bathrooms, laundry room and people's bedroom sinks. This would put people at risk of harm.

People's health and care needs were assessed with them and there were evidence that they had been involved in writing their care plans. We found that some people were not aware of what was in their care plans. Some of the care plans did not have enough detail or risk assessments/management strategy of how to reduce people's risks. Care plans were therefore not able to support staff consistently to meet people's needs safely.

People's mobility and other needs were taken into account in relation to the buildings adaptations, enabling people to move around freely and safely.

A visitor we spoke with confirmed that they were able to see relative in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and sensitivity when supporting people. People commented, "I feel looked after here' another said 'Meals are good, if you don't like what they are offering they offer something else, not found anything I don't like' and 'The staff are very caring and everyone is well looked after here'.

The care plans were not always detailed and may not have shown people's preferences, interests, aspirations and diverse needs were not fully recorded. However, care staff spoken with appeared to understand people's individual needs and preferences and interests as well as their care and support needs

We did not find evidence that people had been involved in the preparation of their care plans, and we found plans had not been signed by the people who lived at the home or their representative to show consent. Some people spoken with did remember being part of the process, however others did not and some said they did not know what was in their care plan.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We spoke to a health professional who visits the home regularly and offers support to some of the people who lived there. The specialist nurse commented 'I am very happy with the way people are looked after in the home. The staff are very good at referring any issues to us and they follow our instructions.' I think people are well cared for at Little Oyster'.

Staff explained that they have a number of health professionals they can speak with if they have concerns about individuals they included, the person's GP, continuing care nurse, district nurse, and dentist.

Is the service well-led?

We found that the home did seek the views of people who lived in the home, their families and some health professionals. For example the home sent out a survey to people who lived in the home, families and health professionals who visit the home on a regular basis. They also had and they reviewed care plans with the person, their families and care manager normally twice a year.

Not all staff we spoke with had a good understanding of the whistleblowing policy but some were aware that the service had one. Staff had received training regarding safeguarding, however not all staff spoken with were clear about what constituted abuse.

The service has some quality audit systems in place; however we found shortfalls in their auditing. For example, there were not robust auditing systems covering Infection control, For example, medicine records were checked to ensure staff had signed for medication given. However the amount of medicines in stock did not tally with the number of medicines administered. This meant people were not receiving the medicines prescribed and the auditing system failed to recognise this short fall.

The service now worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to staff awareness of whistleblowing procedures.

We spoke with management staff, two senior staff and two care staff. Two Social Services' care managers who were visiting the service on the day of the visit spoke positively about the care the service provided.

We looked at the staff induction programme and the staff training records. These included the staff training matrix and a separate record of staff training that had taken place since the last visit to the service on 20 September 2013.

We were told that a new member of the management team had been appointed and had started work at the home at the time of the inspection visit.

We found that since the last inspection visit on 20 September 2013, an induction programme had been implemented, and staff training had been updated.

We carried out an inspection visit on 20 September 2013 in response to some concerns raised anonymously by a member of the public. The concerns were in relation to care and welfare of people, insufficient numbers of staff on duty at night time and inadequate staff training. In accordance with information sharing policies we contacted Social Services and discussed the concerns raised.

We visited the service unannounced and commenced the visit at 06.30 as this enabled us to speak with the night staff that were on duty. During the visit we spoke with the providers the general manager, members of staff and people that used the service. People told us that they were happy with the support they received, and that the staff looked after them well.

We found that there were enough qualified, skilled and experienced staff on duty at the time of the visit to meet the needs of the people that used the service.

Care records seen showed that the people were supported with their care in a way that was individual and in accordance with their wishes.

Mandatory training that included fire awareness, infection control and health and safety was not up to date for all staff. There was no thorough induction programme in place.

We found overall that the service was non-compliant with Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Where areas of non-compliance have been identified during inspection they are being followed up and we will report on any action when it is complete.

People told us that they were happy with the support they received, and that the staff looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. People said they knew who to speak to should they have any concerns, but said they had no complaints.

We saw comments from relatives that included 'Staff are welcoming and friendly, happy to answer any questions and deal with concerns as and when. Communication is good and regular updates given whilst keeping confidentiality. The level of care in my opinion has been of a good standard having residents' best interests as a central point at all times', and 'As always I was very impressed by your enthusiasm and efforts to improve the daily lives of your patients'.