Archived: Optima Care Limited - 37 Spenser Road

37 Spenser Road is a residential care home providing personal care to 11 people the time of the inspection. The service can support up to 13 people in two buildings.

Services for people with learning disabilities and or autism are supported

The service was registered to provide support to up to 13 people and there were 11 people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. The service was not person centred, and people were not supported to maximise their independence.

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

There had been very little improvement since our last inspection in May 2019. There remained serious short-falls within the service which exposed people to risk.

Risk assessments were not in place to support people living with health conditions including constipation, and epilepsy. Manual handling guidelines were not in place for a person who required support moving and transferring. Most of the staff team did not have in date manual handling training.

Environmental risks had not been assessed, as there was a bath hoist that had not been serviced. Provider audits did not identify this issue.

Staff lacked the training guidance and support to fulfil their roles. For example, staff had not received training in key areas such as positive behaviour support. The provider did not recruit staff in a safe way to ensure people were suitable to work with vulnerable adults.

Risks relating to covid-19 had not been identified by the provider. For example, staff were not using the appropriate personal protective equipment in line with government guidelines.

There was a lack of oversight and learning in relation to incidents and accidents. Improvements had not been implemented and embedded and as a result incidents re-occurred.

The culture of the service was not positive. The changes in management had left staff morale low. There had not been a registered manager at the service since July 2018. This had impacted on the quality of the service, and outcomes for people.

Checks and audits had been ineffective. Issues identified at our last inspection remained and we identified further concerns. There was a lack of leadership, consistency and oversight at the service. Regulatory responsibilities had not been met.

The service didn’t always (consistently) 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 for the following reasons; lack of choice and control, limited independence, limited inclusion for example, people were not engaged in meaningful activities.

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 July 2019) and there were two 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing, risks to people, lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led key question 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 37 Spenser Road 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 risks to people not being mitigated, people being at risk of abuse, staff not being recruited safely, notifications not being submitted and checks and audits being ineffective at this inspection.

We imposed positive conditions on the providers registration.

Optima Care Limited - 37 Spenser Road is a 'care home' providing personal care for up to 13 people with a with a learning disability and physical disabilities. At the time of our inspection 10 people were living at the service.

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

People were not protected against risks associated with their care. The environment and equipment were not always clean or properly maintained. These concerns were raised at the last inspection but had not been addressed. Staff were not always raising concerns around about neglect and abuse. The local authority were not always being informed when safeguarding incidents occurred.

People’s medicines were not always being managed in a safe way. Accidents and incidents were not always recorded, and not enough action was taken to reduce further risks to people.

There was an insufficient number of staff deployed to ensure that people received their care when needed. The registered manager and provider did not have appropriate systems in place to review the dependencies of people to ensure sufficient staff were on duty.

The leadership at the service was not robust and there was a lack of auditing to review the quality of care provided. Staff did not always feel supported or valued. Notifications were not always being sent to the CQC when it was appropriate to do so.

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always supported with their independence. Staff did not always have an understanding of the support and care people needed to enable them to have a fulfilled life. The was a closed culture at the service where practices were at time institutionalised.

Right support:

• Model of care and setting did not maximise people’s choice, control and Independence

Right care:

• Care was not person-centred and did not promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

Following this inspection, we worked closely with the local authority (Kent County Council) and the Clinical Commissioning Group (CCG) to ensure people were safeguarded from ongoing harm. Alternative placements are being sought for some people.

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 22 October 2020) and there were multiple 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 sufficient improvements had not been made and the provider remained in breach of regulations.

This service has been in Special Measures since 22 October 2020. During this inspection the provider was unable to demonstrate that improvements had been made. The service is rated as inadequate in the key questions Safe and Well Led. Therefore, this service remains 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 received concerns in relation to people not being safeguarded from the risk of abuse. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, 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 Optima Care Limited - 37 Spenser Road 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 people not being protected from the risk of neglect and abuse, risks related to the care being provided to people, the lack of suitably qualified staff and the lack of robust provider and management oversight at this inspection.

We took action against the provider and cancelled their registration for Optima Care Limited - 37 Spenser Road. Everyone moved out of the service, and we have de-registered Optima Care Limited - 37 Spenser Road with the Care Quality Commission.

We found the following examples of good practice.

People were reminded about the importance of social distancing and isolating in their rooms when necessary, to help keep them safe.

Changes had been made to the service as a direct result of the pandemic. Staff wore personal protective equipment (PPE), such as masks, aprons and gloves. There were PPE 'stations' around the service to help ensure PPE was available to staff when needed.

Guidance was available to staff about how to work during the pandemic.

The service was clean and staff carried out more frequent cleaning on areas that were frequently touched, such as door handles.

The manager kept relatives up to date with people’s well-being by phone and e-mails.

The service was engaged in the national testing programme for staff and people who lived at the service.

The manager had sought advice and guidance from other agencies about infection control and prevention and had updated staff practice accordingly.

Further information is in the detailed findings below.

37 Spenser Road is a residential care home that provides personal care for up to 13 people who may have a learning disability, or autism. At the time of our inspection there were 12 people living there.

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

People’s experience of using this service:

People were engaged in some activities of their choosing, however during the inspection we observed people without person centred interactions or activities for long periods of time. People had activity planners in place, however these were not consistently followed, and we did not see any evidence of alternative activities being offered on the day of our inspection.

The service had been through a transition following the registered manager leaving the service in June 2018 which had impacted on the quality of documentation. Staff and a relative informed us this period had been unsettling. We identified that risk assessments and care plans had not been updated for significant periods of time, however, permanent staff had a good understanding of people’s needs.

People were supported to live healthy lives, for example, being part of a gym or taking part in ‘talk and walk’ sessions. People had access to healthcare professionals and their needs were reviewed and re-assessed when their needs changed.

The environment had some adaptations; corridors were wide enough for wheelchair access, and there was easy access to the patio garden. People were involved in the preparation of food, and people with visual impairments had adapted utensils to enable them to be as independent as possible.

We observed kind and caring interactions between people and staff. Staff had a good understanding of people’s histories and likes and dislikes and used this to support people effectively. Staff used a range of communication techniques to support people, for example picture cards or different forms of sign language.

The home had not always been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieved the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence. The people living at the service did not consistently receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

Rating at last inspection:

At the last inspection the service was rated Good. (14 June 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

37 Spenser Road provides personal care and support to 13 people with learning disabilities. The house is in a residential part of Herne Bay and there is another bungalow at the back which is also part of this registration.

Rating at last inspection

At the last inspection, the service was rated Good and Requires Improvement in the ‘Well Led’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 October 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act Regulated Activities Regulations 2014, Good governance. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Optima Care Limited – 37 Spenser Road on our website at www.cqc.org.uk.

At this inspection we found the service remained Good overall and is now rated Good in the Well Led domain.

Why the service is rated Good

The registered manager told us that improvements had been made since the last inspection. The company had appointed a new operations director who visited the service regularly. To further support the registered managers the company had implemented a mentoring programme where managers supported each other and discussed good practice.

Staff told us the manager had good leadership skills and they worked hard as a team. They said they always had confidence in the registered manager and improvements had been made by the organisation to make them feel more valued.

People, their relatives and staff were asked for feedback about the quality of the service; however the outcome of the surveys was not presented in a meaningful way to inform the people living at Spenser Road what, if any, improvements had been made. A recommendation had been made in this report.

Senior managers carried out checks on the service to ensure the quality of the service was being monitored and improved. Accidents and incidents had been recorded, and analysed to look for patterns and trends to reduce the risk of them happening again.

The service had links with the community to ensure that people enjoyed an active social life visiting cafes, and other venues.

Staff ensured people received personalised care with equality, dignity and respect. Staff said that the registered manager was always available for practical support, assistance and advice.

Residents meetings were held regularly to ensure people were involved in their care and had the opportunity to voice their opinions.

Staff were supported by the registered manager through their supervision sessions, staff meetings and appraisals.

The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

37 Spenser Road provides residential care and support for up to 13 people with learning disabilities. At the time of our inspection there were 13 people living at the home.

The service 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.

People, relatives and staff spoke highly of the registered manager who they described as approachable, caring and responsive. However, we were told the provider did not have a regular presence in the home and staff felt their concerns were not always listened to at provider level. There was little face to face contact with the provider's senior management and limited feedback which meant the registered manager and staff did not feel consistently supported.

Relatives and staff told us people who lived at the home were safe. Staff told us they would follow the provider's safeguarding policies and procedures and knew what actions to take if they had any concerns about people's wellbeing. Staff were effective in identifying risks to people’s safety and ensured the focus was on managing risks rather than imposing restrictions on people by removing risks entirely.

There were enough staff on duty to meet people's care and welfare needs and keep them safe. Checks were carried out prior to staff starting work to ensure their suitability to work with people who lived in the home. New staff received an induction into the home which covered all the training considered essential to support people safely and effectively.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making. When people were not able to give consent to their care and support, staff knew they must act in people's best interests.

Care plans contained information for staff to help them provide personalised care and to ensure people remained safe and to maintain their health. Care was reviewed regularly with the involvement of people and their relatives.

Staff supported people to manage their physical and mental health and supported them to attend medical appointments. People were given their medicines safely and as prescribed.

Staff were thoughtful and considerate in their interactions with people and took time to listen to what they had to say. Staff had a good understanding and knowledge of people’s needs, routines and preferences. Relatives were confident that staff treated people with dignity and respected their privacy and independence. Staff supported people to maintain family relationships which were important to them. People knew how to complain and could share their views and opinions about the service they received.

We found a 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 the report.

People received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests in the home and out in the community. People were assisted to attend health care checks and community health professionals were involved to provide advice and support when needed.

The home was safe and suited people's needs. Each bedroom was single and personalised and reflected people's interests. There was a maintenance plan and generally the home was well maintained. Some repairs and redecoration were needed in areas where there had been some water damage that the provider had noted. People had the equipment they needed that was well maintained and suitable for their needs.

There was a good staffing level to support people with their lifestyles. The majority of the staff team had worked together for several years and had got to know the people using the service well.

The home had clear well organised documentation and records.

People received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests in the home, at the day centre and out in the community. People were assisted to attend health care checks and community health professionals were involved to provide advice and support when needed. A healthy balanced diet was offered to people who were able to choose the food they ate from discussion with the staff. People were supported to develop their independence skills, including making snacks and drinks.

People were assisted to express their views and make important decisions because the staff helped them with their communication and spent time with them.

There was a stable staff team and a clear recruitment process. People were helped to express themselves if they had a complaint and families were encouraged to air their views and give suggestions for improvement.