Archived: High View

Updated 18 June 2021

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.

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

Inspection team

The inspection was completed by two inspectors.

Service and service type

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

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was no registered manager in the service. A new manager had been appointed to lead the service three weeks prior to our inspection.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and sought feedback on its current performance from the local authority. The provider did not complete the required Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report.

During the inspection

We met briefly with both people who used the service. We also spoke with five members of care staff, the service’s new manager and the provider’s regional manager.

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

After the inspection

Following the inspection, we spoke with one person’s relatives and a further eight staff by telephone. We also sought feedback from involved professionals on the service’s current performance and received three replies. We also reviewed the information we had requested from the service during the inspection.

Updated 18 June 2021

About the service

High View is a residential care home providing personal care for up to five people with learning disabilities and or autism. At the time of our inspection two people were using the service.

The service is a detached three-story building with an enclosed rear garden. Currently one person lives on the lower floor with the other person living on the first floor. Shared communal areas and the office are also located on the ground floor. The service is located on the outskirts of Truro, Cornwall.

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

Staffing levels in the service were unsafe and insufficient to meet people’s support needs. The service was designed to provide people with support from five staff each day with an emergency minimum safe staffing level of three experienced staff. Prior to our arrival on the day of our inspection the service had been operated by two staff. They had recognised this was unsafe and would significantly impact on people’s wellbeing. As a result they had made arrangements for an additional staff member to come in for a short period and had borrowed a staff member from an adjacent service to support one person to attend their educational placement.

Rotas and other records showed the provider had regularly staffed the service at emergency minimum staffing levels. On one occasion the rota had been written up for staffing below the emergency minimum with guidance to seek support on the day from the provider’s on-call arrangements. Planning to staff the service regularly at emergency minimum levels meant any staff sickness or unexpected absence exposed people and staff to risk of harm. Staff told us, “It’s not safe for us, let alone them” and “With two staff I would say it is definitely unsafe, if [People’s names] are in a great mood they may be ok but it is definitely not safe.”

Records showed staff were regularly working significantly in excess of the contracted hours in order to ensure people were as safe as possible. On the second day of our inspection one staff member was in the process of completing 60 hours continuously on duty in the service and another staff member told us, “I ended up doing 53 hours on site and I know others have done that too.”

Prior to the inspection the provider had recognised the service was significantly understaffed and had allocated one additional staff member to support the service. This action was insufficient to address the staffing shortage.

As a result of our significant safety concerns in relation to staffing levels we made a safeguarding alert following the first day of our inspection. In addition, we sought assurances from the provider that immediate improvements would be made to staffing arrangements to ensure the service was staffed above emergency minimum levels. Assurances were provided, however unexpected staff absence meant that in the five days between the two site visits the service operated at emergency minimum levels during five out of ten shifts.

Records showed people did not get on well together and on some occasions it was clear one person’s actions were negatively impacting on the other person and causing them to become distressed. This sometimes led to them acting in ways which put themselves and others at risk. Low staffing levels meant it was difficult to avoid or manage these risks. Records showed people were unable to go out regularly as a result of the staffing arrangements. Staff told us, “We can’t go out as [Person’s name] needs three staff to go out and so it would leave no one with [the other person]” and “There should be enough staff to take people out and give them the best quality of life rather than struggling to keep them safe each day.”

There had been a significant turn-over of staff at the service. Records showed people were regularly supported by staff who did not have the skills and experience necessary to meet their needs. Recently recruited staff said, “I am still new so I do not know [the person] that well so it is better if [they] have confident staff.” While experienced staff told us, “I can’t remember the last time we were left on three and I was comfortable with the three staff we were left with.”

The provider’s on call system and other procedures designed to ensure the service operated safely were ineffective. Necessary support had not been provided when the number of staff on duty had dropped below the emergency minimum level. Quality assurance systems had failed to identify shortfalls, and senior managers had failed to respond appropriately to address the staffing shortages in the service. On one occasion staff had directly reported critical staff shortages to the providers’ chief executive. The chief executive had taken immediate action to address the specific situation however action had not been taken to address the wider staffing shortages in the service. Staff did not feel supported by the provider and told us, “Spectrum, I just feel we have no support or willingness to support us. No matter what we did we have had nothing back from them. We have been left to our own devices to manage” and “I know that [the provider] was aware, as there is a duty ring around for the day and we have been reporting that we are short staffed. It seems we were not a priority until you turned up.”

Staff had been safely recruited and understood how to appropriately raise safety concerns outside the service. Medicines were managed appropriately, and systems were in place to protect people from financial abuse.

Staff understood the need to use PPE and were participating in regular COVID-19 testing. However, staffing levels meant it would not be possible to support people individually in the event of an outbreak of the infection.

People’s needs had been assessed before they moved into the service and their care plans reflected their current support needs.

The outcomes for people did not reflect the principles and values of Right Support, Right Care, Right Culture. People were regularly unable to take trips out or live like ordinary members of the community. The organisation exhibited many of the risk factors associated with closed cultures including ; people’s level of dependence on staff for basic needs, the inability of people to access the community without appropriate support, the high turn-over of staff, and the lack of effective oversight. In addition, the provider had failed to respond appropriately to address safety concerns reported by staff.

During feedback at the end of our inspection senior managers recognised their systems for monitoring staffing arrangements were ineffective. They told us prior to the inspection they had been unaware of the severity of the situation at High View and believed it had developed in the last month. Records gathered showed that the service had been short staffed for each of the five weeks prior to the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good. (Report published 03 February 2020)

Why we inspected

The inspection was prompted in part due to concerns received in relation to staffing levels and the quality of support people were receiving. A decision was made to bring forward this inspection to examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

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 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 staffing, safe care and treatment, person centred care and governance 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 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.

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.

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.

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.