Archived: Seagulls

Seagulls 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.

Seagulls is a local authority run care home which provides accommodation for up to six people with learning disabilities and Autism who need support with their personal care. At the time of our inspection there were five people living in the home.

The home was arranged over two floors with most of the bedroom accommodation on the first floor. There were bathrooms available to people on each floor. There were 2 communal areas in the home, which were a kitchen/dining room and a lounge.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The last comprehensive inspection of this service was in October 2015 when the service was rated Good. At this comprehensive inspection we found the service was not meeting legal requirements and required improvements in the service which was delivered.

Failures to provide safe and care and treatment, person centred care, good governance and failing to act in accordance with the Mental Capacity Act 2005 were common themes.

Quality assurance systems were not robust to monitor and review the quality of the service which was provided. These had not been used effectively to identify concerns we found or drive improvement in the service.

Records of the assessment of people's ability to make some informed decisions had been undertaken. However, the principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use restrictive practices. Staff we spoke with had a variable understanding of the Mental Capacity Act 2005.

Care plans were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a safe way. Risk assessments that related to people’s health and safety did not ensure that all risks were effectively assessed. Action had not always been taken to reduce identified risks to ensure the safety of people. This exposed people to a risk of neglect and unsafe or inappropriate care or treatment. Risk assessments were not being developed to promote independence and we saw that people were being unlawfully restricted from areas of the home in order to manage risks.

People and their relatives were not regularly involved in the assessment and the on-going reviews of their care. Care plans were not written in a way that would enable people to understand and be involved in decision-making.

The premises were not always well maintained. The registered manager had requested that the landlord carry out some works but this had not been done. One area of the home was not clean and did not provide adequate personal hygiene equipment for people. Following our inspection action was taken to address this.

Staff had not received the appropriate training, professional development and supervision to be able to support people safely.

Staff were task orientated and there were not enough staff to meet people’s needs and to enable them to engage with people and support them to be involved in the tasks of daily life.

People received their medicines as prescribed. However, we identified some areas where improvements could be made to ensure the safe administration of topical creams.

Staff received training; however, some training to meet specific needs had not been provided. Staff had not always received regular and meaningful supervision. The provider had not ensured that staff performance and progress was monitored effectively and that staff had an opportunity to voice their individual views.

Recruitment procedures were not always safe. We saw that not all of the appropriate checks, such as references had been completed before staff started working with people.

People and their families told us they felt safe living at the home. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Staff knew how to identify, prevent and report abuse.

Plans were in place to deal with foreseeable emergencies such as fire risk; staff we spoke with said they had had received training to manage such situations safely.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink. However, people were not consistently being supported to be involved in choosing and preparing food and drinks.

Staff ensured people’s privacy was maintained. People were not always encouraged to make decisions about how their care was provided. Staff’s understanding of people's needs and preferences was based on familiarity.

We received some positive feedback about the care staff and their approach with people using the service. People were supported to take part in some activities within the local community. However, we observed occasions when staff had little time to spend with people and the care provided was task orientated.

Relatives and external health professionals we spoke with were positive about the service people received and people's visitors were welcomed.

There was a complaints procedure in place to enable people to raise complaints about the service. However, complaints were not being captured and information was not presented to people in a way they could understand.

People, their relatives felt confident to approach the staff or registered manager and felt they would be listened to.

We identified that the provider was in breach of six of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulations 2009. You can see at the end of this report the action we have asked to provider to take.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

The manager had identified the risks and hazards associated with providing care within the home. These included risks associated with electrical equipment, the kitchen and fire safety. We saw care plans included risk assessments associated with specific elements of people's care, such as making a cup of tea or falling and specified the action required to manage those risks.

During our previous inspection on 30 August 2013 we found people were not safeguarded from the risk of abuse because the provider failed to respond appropriately to any allegation of abuse between people who used the service. During this inspection we saw people who use the service were safe and protected from the risk of abuse because staff were aware of the need to report abuse between people who used the service to the appropriate authority.

Systems were in place to ensure the manager and staff learnt from events such as complaints, concerns, or safeguarding events. This reduced the risk to people and helped the service to continually improve. The home had up to date policies and procedures in relation to safeguarding and whistleblowing. The home had appropriate policies and procedures in place in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had received training to enable them to understand the Mental Capacity Act and when a Deprivation of Liberty or a safeguarding application should be made. This meant people would be safeguarded as required.

The manager ensured there were enough staff working at the home to meet people's care needs. We saw that staff had received appropriate training and support to ensure they had the skills and experience necessary to meet people's needs.

Is the service effective?

We saw that although most of the people who used the service were not able to verbally communicate with staff, they were able to communicate their understanding of what they were being asked and make their wishes known. People and the relatives we spoke with told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking to staff that they had a good understanding of the people's care and support needs and they knew them well. A relative said 'Staff are very much informed about [their relative]. We have had ample chats with them. Overall we are very impressed'. Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists. Therefore people's needs were known and met effectively.

Staff received appropriate training to meet the needs of people living at the home. For example, staff within the home had received training in the management of people with autism and Down syndrome. This meant people were supported by staff who were suitably trained.

Is the service caring?

People were supported by kind and attentive staff. We observed care in the communal areas of the home and saw staff interacting with people in a positive way. For example, we saw a member of staff providing appropriate support and encouragement to a person who was eating their lunch.

We saw that although most of the people who used the service were not able to verbally communicate with staff, they were able to communicate their understanding of what they were being asked and make their wishes known. We spoke with one person who told us they 'liked' living at the home. When asked why they said, 'I like the way staff help you'.

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with their wishes.

Is the service responsive?

People had the option to engage in a range of activities and were involved in a number of outside activities such as trips out to another home, a movie club, picnics at the beach and shopping. The person we spoke with said, 'I can go out if I want to the shop or I can watch my TV or play on my Wii'. Therefore, staff were responsive to people's welfare and wellbeing which was enhanced through the availability of appropriate activities.

There was an effective compliments and complaints policy in place and we saw there was also an easy read version available to people. The manager showed us their complaints file and told us they had not received any formal complaints during the last year. The family members we spoke with told us they knew how to complain but had no reason to do so.

Is the service well-led?

We saw there was a structured quality assurance process in place to regularly assess and monitor the quality of the service people received. These included support plan audits; cleaning l audits; medication administration record (MAR) audits and fire safety equipment audits. We found some of these audits were also carried out by external professionals. Where issues were identified we saw these were responded to promptly.

There was a new staff meeting structure, where staff could raise any issues or concerns.

We also spoke with three members of staff and the manager who said they understood that people were able to make decisions for themselves and described the action they would take if people refused care. We observed care in the communal areas of the home and saw staff interacting with people in a positive way. People were relaxed when with staff, who responded to people's needs in a balanced and supportive manner. One relative we spoke with said 'Seagull is their home. They are happy here'. They added 'I would recommend it to anyone'.

We saw the home had a safeguarding policy and staff had received safeguarding training. However, people using the service were not protected from the risk of abuse, because the manager and staff had not responded appropriately to incidents of abuse between people. We also found that although there were systems in place to reduce the risk and spread of infection, these were not adhered to. We found parts of the home were not clean, and there was no soap or towels available in either of the bathrooms. We saw that personal protective equipment such as aprons were not being used appropriately by staff.

We found there was a duty roster system, which detailed planned cover and the arrangements in place to manage short term absence. The provider had a quality assurance system in place and sought the views of the families of people who use the service through an annual survey.