Archived: Spode Close

Spode Close is a residential care home which was providing care to three people living with learning disabilities at the time of the inspection. Spode Close is a purpose-built block of self-contained studio style apartments. The service can provide accommodation and support for up to seven people with learning disabilities, autistic spectrum disorder, physical disabilities or a combination of these kinds of impairment.

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 of 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

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. There were sufficient staff with the correct skill mix on duty to support people with their needs and keep them safe. Effective and safe recruitment processes were consistently followed by the provider. Medicines were managed safely.

People were cared for in a clean and homely environment by staff who were caring, competent and knowledgeable about people's needs. Training and supervision were arranged to ensure staff had the skills that were necessary to carry out their role. Staff spoke positively about working for the service and said that they received support from the management team. People were provided with 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 promoted this practice. Staff supported people to maintain a healthy diet in line with their assessed needs. People were assisted to access health care if this was needed.

Assessments and support plans were in place identifying what was important to people and how people needed to be supported. The support people received was centred around them and they were involved in any decisions made regarding their care. Staff supported people to enjoy a range of activities which reflected people's individual interests. The provider had a complaint's process which people were aware of to share any concerns. At the time of the inspection, no one was being supported at the end of their life.

People and staff felt supported by the registered manager. The provider had effective systems and processes in place to ensure the quality and safety of service. Spot checks and audits were completed to ensure the quality of the service was maintained. Some of the relatives of people living at Spode Close told us that communication could be improved as they did not always feel informed about and involved in the care of people using the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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.

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 22 January 2020). 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 21 January 2021. During this inspection the provider demonstrated that improvements had 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 carried out an unannounced comprehensive inspection of this service on 10 December 2019. Multiple breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do improve and set up a timeframe for improvement action. The service needed improvement in the following areas: notifications of other incidents, person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and staffing.

We undertook the latest focused inspection to check whether 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, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to 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 Spode Close 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.

Spode Close is a residential care home providing care to four people living with learning disabilities at the time of the inspection. Spode Close is a purpose-built block of self-contained studio style apartments. The service provides accommodation and support for up to seven people with learning disabilities, autistic spectrum disorder, physical disabilities or a combination of these kinds of impairment.

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support because people using the service did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

The provider did not have effective systems in place to consistently assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.

Medicines were not always managed safely.

Care plans did not always incorporate enough information to make sure measures were in place to protect people and staff from harm. People and staff told us they sometime did not feel safe.

Accidents and incidents were not always investigated or summarised in order to analyse for trends and patterns. Some incidents reports did not include any detail of actions taken to prevent reoccurrence. The provider failed to notify us about some incidents taking place in the service.

There were gaps in health and safety checks.

People were not supported to have maximum choice and control of their lives. Staff did not provide care to people in the least restrictive way possible and in their best interests; the policies and systems in the service did not promote this practice.

People and their relatives told us they knew how to complain. However, relatives of people using the service were not always satisfied with the way their complaints had been actioned upon. Complaints and their outcomes were not always recorded to ensure they were appropriately investigated.

Staff members had access to training organised by the provider. They took part in one to one meetings with management and participated in regular team meetings. However, staff told us that training provided was not always sufficient to meet people's particular needs.

People were supported to maintain good health, have a balanced diet and access to healthcare services where required.

People were treated with kindness and respect. People’s right to privacy and confidentiality was respected.

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 2 October 2018). The provider had completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we saw that not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns we received regarding a police incident which led to evacuation of the housing estate. A decision was made for us to inspect and examine risks relating to the incident. This inspection was also carried out to follow up on the action we told the provider to take at the last inspection. We found evidence that the provider still needed to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

At this inspection we identified breaches in relation to the management of medicines, gaps in health and safety checks, service not notifying us about incidents, and lack of effective systems to monitor the service. During this inspection we identified breaches of regulations 9, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also recorded breach of regulation 18 of Care Quality Commission (Registration) Regulations 2009.

Full information about the CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Spode Close is a residential care home providing care to five people living with learning disabilities at the time of the inspection. Spode Close is a purpose-built block of self-contained studio style apartments. The service provides accommodation and support for up to seven people with learning disabilities, autistic spectrum disorder, physical disabilities or a combination of these kinds of impairment.

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because people using the service did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Risks relating to people were not always appropriately assessed and recorded. They did not always incorporate people’s personal circumstances to make sure measures were in place to protect them, staff and other people living at the service from harm.

The provider followed safe recruitment checks. However, where agency staff were employed to provide people with care and support, there was no evidence the manager ensured they were suitable to work with people.

People and their relatives told us they knew how to complain. However, relatives of people using the service were not always satisfied with the outcome. Complaints and their outcomes were not always recorded to ensure they were appropriately investigated.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and acted in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain good health, have a balanced diet and access healthcare services where required. People and their relatives were involved in making decisions about people’s care and support needs. People’s privacy and dignity were respected, and their independence promoted.

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 7 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, safe care and treatment, receiving and acting on complaints and good governance 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 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 request an action 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 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.

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

Spode Close is a purpose-built block of self-contained studio style apartments. The service provides accommodation and support for up to seven people with a learning disability, autistic spectrum disorder, physical disabilities or a combination of these kinds of impairment. At the time of the inspection three people were living at the service.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. 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.

At our last inspection on 13 July 2017 we had rated the service 'Requires Improvement' as we had identified breaches to legal regulations. These related to risks identified in support plans not being always followed by appropriate risk assessments, health and safety checks, auditing, and the provider not following their disciplinary procedure.

Following the last inspection, we asked the provider to complete an action plan. We needed the provider to inform us on how they intended to improve.

There was no registered manager in post. 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. The service was run by a manager who was to become registered with the Care Quality Commission (CQC).

During the inspection we found that the risks identified in support plans were not always followed by appropriate guidance to staff on how to minimise the risks. However, despite the lack of written guidance staff were knowledgeable on how to minimise the identified risks. They were able to consistently explain to us how would they act in order to mitigate the risks. We brought this to the attention of the manager who produced a detailed risk assessment on the day of the inspection.

People's capacity was assessed in accordance with the Mental Capacity Act 2005 (MCA). However, information regarding people's consent was not always recorded. We reported this to the manager. As a result, they provided us with evidence they had recorded people's consent where needed.

There were gaps in the records. Quality assurance systems were in place but had failed to identify the issues which we found at the inspection.

People told us they feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise whether people were at risk and knew what action they should take in such instance.

Accidents and incidents were monitored and relevant action was taken to keep people safe.

Medicines were managed safely. Staff were recruited safely and in sufficient numbers, but the deployment of staff within the service did not ensure people could always participate in meaningful activities.

Staff were supported to undertake training to support them in their role, including nationally recognised qualifications. They received on-going supervision and appraisal to support them to develop their understanding of good practice and to fulfil their roles effectively.

People were supported to make choices about their food and drink. Staff ensured people received meals which suited their nutritional needs to help them maintain a healthy weight.

People told us staff were kind and caring and respected their privacy and dignity. Staff supported people to identify their individual wishes and needs by using people’s individual methods of communication. People were encouraged to make their own decisions and to be as independent as they were able to be.

Activities were provided basing on people's preferences, both within the service and the wider community. However, staff told us that some staff members did not feel confident enough to take one person out for a longer period of time.

There were systems in place for people or their relatives to complain or provide feedback on how the service could be improved.

Staff and the provider understood their roles and responsibilities. The provider had a clear vision and values for the service and staff understood and acted in accordance with. The provider worked in partnership with other agencies to develop and share best practice.

People, their relatives and staff felt the service was very well managed and praised the management team. The manager was perceived as very accessible and listened to the views of others and acted on them. Staff found the manager to be approachable and felt well supported by the management team. People had very positive relationships with staff and the management, which enhanced their day-to-day experience.

Spode Close is a purpose-built block of self-contained studio style apartments. The service provides accommodation and support for up to seven people with a learning disability, autistic spectrum disorder, physical disabilities or a combination of these kinds of impairment. At the time of the inspection three people were living at the service.

At the time of inspection there was no registered 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 2008 and associated Regulations about how the service is run. In the absence of the registered manager the service was run by a peripatetic manager. The peripatetic manager is a type of manager who travels to different care homes and stays for a short time at each location to ensure that they are appropriately managed.

During the inspection we found that the risks identified in support plans were not always followed by appropriate guidance to staff on how to minimise the risks. As a result, the service was unable to ensure people received care and support which met all their needs with potential risks appropriately managed.

Medicines were administered safely. However, the system to ensure that fridge temperatures were recorded and action taken if outside of the safe limits was not effective.

People were not always protected from environmental risks. Health and safety checks were not completed in accordance with the provider’s policy.

Staff did not always receive appropriate on-going training to enable them to deliver safe care. As a result, the service failed to ensure that people were protected by staff who knew how to meet their specific needs.

The service did not always act in accordance to the Mental Capacity Act 2005 (MCA). In some care plans there was no evidence of any best interest meetings or any mental capacity assessments, or the information regarding the lasting power of attorney (LPoA) was out of date.

There was a complaints policy available in an easy-to-read format, however, it was not displayed in the communal areas. The complaint policy available at the reception contained some out of date information which might be confusing to some people.

The provider followed their disciplinary procedure, however, results of internal investigations had not always been reported to the DBS.

Staff had a clear understanding of how to recognise and report safeguarding concerns and knew who to contact and how. Staff understood how to whistleblow and had access to essential phone numbers to call to report any issues.

Staffing levels were adequate and recruitment practices were safe as relevant checks had been completed before staff worked unsupervised.

People were supported to eat enough food and drink sufficient amounts of liquids, and their care plans included information about their dietary needs and risks identified in relation to nutrition and hydration.

People's dignity and privacy were respected and promoted by staff. Staff knew each individual's specific communication methods and were aware of changes in people needs.

Staff had a thorough knowledge of each person they supported and helped people to identify their individual needs and the goals they wanted to achieve in the future.

Auditing was insufficient or non-existent in some areas, for example, the health and safety checks, risk assessments and care plans were not thoroughly audited. The service had made improvements in other areas such as reviewing daily notes, creating hospital passports and health action plans. The service had their own quality assurance systems in place to make further enhancement.

The peripatetic manager was respected and valued by people, their relatives and staff.

We found two breaches of regulations, namely Regulations12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have advised the provider to take at the end of this report.