Archived: Cygnet House

Updated 18 March 2020

The inspection

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

Inspection team

This inspection was carried out by one inspector and one assistant inspector.

Service and service type

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

The service had a new manager in post since September 2019. They had made an application to be registered with the Care Quality Commission and were awaiting confirmation of the outcome.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at the service to speak with us.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service about their experience of the care provided. We spoke with six members of staff including the operations manager, manager, deputy manager, and support workers.

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

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who know the service.

Updated 18 March 2020

About the service

Cygnet House is a residential care home providing accommodation and personal care for adults with learning disabilities, autistic spectrum disorder, and mental health needs. The service is registered to accommodate up to two people and there were two people living at the service at the time of the inspection.

Cygnet House comprises one house divided into two self-contained flats with a shared kitchen facility. There is also a secure garden space which people can access.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Risks identified were safely managed; however, for some people these were not always accurate, updated, or in place. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. Medicines were managed safely, but some documentation needed improvement. The provider had recruitment checks in place to ensure staff were suitable to work in the service. Staffing levels had improved and people were going out more; the provider understood the need to continually review staffing levels due to the often unpredictable and complex needs of people living in the service.

People were supported by staff who had completed the relevant training to give them the skills and knowledge they needed to meet their needs. People were supported to have sufficient amounts to eat and drink and were protected against the risk of poor nutrition. However, improvements are needed to ensure any fluctuations in weight are promptly addressed. 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. However, assessment documentation needed to be revised to ensure the principles of the Mental Capacity Act 2005 were being followed, and we have made a recommendation about this.

People’s care records were not always accurate or updated. It was not always evident that people had been consulted about their support plans and involved in creating them, often people had not signed to show their involvement. People were supported to express their wishes and preferences regarding their care and staff provided personalised care. People and relatives were confident to raise concerns and complaints, and these were listened to, resolved and used to drive improvements in the service.

Staff treated people in a kind and caring way. People and relatives valued the service and the support the staff provided. Staff treated people with respect and helped them to maintain their independence and dignity.

There were governance systems in place, however, they had not identified all of the issues we found and therefore need to be strengthened in some areas. The manager and operations manager were committed to making improvements in the service. The provider will need to ensure the manager has sufficient support to enable the service to meet Regulations and improve their rating to Good.

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 27 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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

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

Enforcement

We have identified breaches in relation to care records and governance at this inspection.

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

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.

We will request an improvement plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.