Spring Lake

Spring Lake is a residential care home providing care to nine people with learning disabilities at the time of our inspection. The service can support up to 11 people.

Summary

We expect¿health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting¿people with a learning disability and autistic people and providers must have regard to it.

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

The service did not fully demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

People were not supported to have the maximum possible choice, control, independence and have control over their own lives. Whilst we saw features of positive support, including choice, participation, and inclusion, these were not consistent.

Right care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. The provider had enough appropriately skilled staff. Staff understood people’s individual communication needs.

Right culture:

Whilst people and those important to them, including advocates, were involved in planning their care, people did not lead fully inclusive and empowered lives. Reasonable adjustments were required to meet people’s needs, more so for those with sensory sensitivities. The provider did not have effective strategies to help people predict, understand and control their environment effectively.

We have made two recommendations for an enabling environment for autistic people and person-centred approaches.

There were no effective risk assessments for people at risk of scalding. During the inspection we found some shower outlets discharged water hotter than safe temperatures.

The incident investigation process was not adequate. We noted underlying and organisational factors were not considered. We judged there were limited opportunities for organisational learning because there was a focus on individual errors, as opposed to root causes.

People were not always supported to have maximum choice and control of their lives and the provider did not always assist them in the least restrictive way possible.

People’s medicines were safely stored and well recorded. There were protocols for medicines prescribed ‘as required’ (PRN) in relation to reduction of behaviours and anxieties. The provider took immediate action to correct a gap in the management of PRN medicines. The provider must continue to manage these arrangements.

Staff received regular supervision. Staff training records showed they had completed mandatory training.

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 Good (published on 4 July 2018)

Why we inspected

We received concerns in relation to the management of risk relating to hot water. A decision was made for us to inspect and examine those risks.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. 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 Spring Lake 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 regulation in relation to safe care and treatment, unnecessary or disproportionate restraint and good governance. Please see the action we have told the provider to take at the end of this report.

At the time of the inspection the service had enlisted input from a party contractor, and we noted an improvement plan had been developed which broadly mapped ways to address identified risks. The provider must invest sufficiently in the service to deliver improvements required in the water system. Our inspection of the provider in 2018 identified faults with the water system.

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 request an action plan for 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• The service ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Visitors were asked to complete a COVID-19 questionnaire, their temperature was checked, and they were provided with personal protective equipment (PPE). Visiting was permitted in a designated visiting area, which could be accessed externally. This was aimed at preventing and controlling the spread of infection.

• Staff demonstrated a good understanding of infection prevention and control measures. They had been provided with infection control training, COVID-19 training and regular updates. The home had enough and appropriate PPE. The registered manager told us that staff were asked to change their face masks every two hours, which had been confirmed to us by staff we spoke with.

•The home had a caring approach regarding ensuring that people had contact with their relatives. Contact was maintained via the telephone and the internet. People could use these to maintain regular or weekly contact with their relatives.

• Staff knew about people’s hobbies and interests and supported them with these. People were encouraged to continue participating in activities they liked. These included listening to their favourite music, arts and crafts, crosswords, puzzles and exercises. Some people were encouraged to assist with their own laundry and some household chores.

• The service provided a minibus and car for people who used the service to access the community.

• Posters and guidance regarding infection prevention and control were on display at the entrance of the home.

Spring Lake provides accommodation for up to 11 people with varying support needs including people living with learning disabilities, autism, behaviours may be challenging to staff and other complex needs. At the time of this inspection there were 9 people living at the home.

There was a registered manager in place at the home. 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 home was registered prior to Registering the Right Support (2017). However, although a larger service, we found that it was following the values that underpin this document along with 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.

Following our last comprehensive inspection of Spring Lake on 13 and 16 January 2017 we rated the home as ‘Requires Improvement.’ The care plans and risk assessments for some people living at the home did not always include information and guidance for staff about how to support people in relation to their identified needs. The home was not well maintained and the provider’s safety checks had not addressed some maintenance failures. The home had failed to ensure that they had fully followed guidance associated with the Mental Capacity Act (MCA) 2005). We also found that laundry arrangements at the home did not reduce the risk of infection to people. Although the provider had arrangements in place to assess the quality of the service provided by the home, we found that these were not robust and actions identified had not been acted upon.

We returned to the home to undertake a focused inspection of the provider’s quality assurance processes on 24 August 2017.We found that actions had been taken to address the failures that we had identified and that there was a robust system in place to ensure that quality of the care and support provided at the home was effective. We gave the home a rating of ‘Requires Improvement’ since we needed to see if improvements were maintained.

At this inspection we found that the provider had maintained the improvements that they had made since our previous visits. The quality assurance procedures for the home showed that regular monitoring and auditing of care and support had taken place. Actions resulting from these had been promptly addressed.

People’s risk assessments and care plans were person centred and included guidance for staff members on how to support people effectively and safely. We looked at the daily care records for people living at the home. Although the written records were detailed a new online system had recently been introduced and we found gaps in the records which were being maintained electronically. The registered manager told us that they would raise this with the provider in order to seek a resolution.

The home was meeting the requirements of the Mental Capacity Act 2005 (MCA). Assessments of people’s capacity to make decisions had been carried out. People had up to date Deprivation of Liberties Safeguards (DoLS) authorisations and meetings had taken place to ensure that any actions or restrictions were in people’s best interests.

The home had robust quality assurance processes in place and we saw that any actions identified as a result of these had been addressed in a timely manner. These included improvements to the home environment and the quality of care plans and risk assessments. There were processes in place to seek the views of people who lived at the home and their family members and we saw that the results of these surveys were evaluated and used to improve the service provided at the home.

Medicines were safely stored, administered and recorded. Staff members had received training in medicines administration. Regular medicines audits had taken place.

The home had taken action to reduce the risk of infection to people. The home environment was clean and free from clutter and we saw that staff members used disposable aprons and gloves for appropriate tasks. Action had been taken to ensure that soiled laundry was dealt with safely.

People were protected from harm. Staff members had received training in safeguarding adults from abuse. They understood their roles and responsibilities in ensuring that any incidents or concerns were immediately reported.

Although the home was in a good state of repair we observed that the communal areas required redecoration. We noted that a planned refurbishment was due to take place during the week following our inspection. This had been planned to take place when people were away on holiday to ensure that any disruption to their daily living arrangements were minimised.

People were supported to participate in a wide range of activities. During our inspection we saw that individual and small group activities such as cooking and sensory activities were taking place. People also went out from the home to visit local parks and shop for a forthcoming holiday. Two people regularly visited places of worship.

People were supported to maintain a healthy diet based on their individual preferences and cultural and health needs. We saw that they were supported to make choices in relation to food, drinks and snacks.

People living at the home were unable to communicate verbally. We saw that staff members engaged them in decision making and activities using words, signs and pictures that they understood.

Checks of staff members’ suitability for the work they were undertaking had taken place prior to their employment. An on-going programme of training was provided to ensure that staff had the skills and knowledge to support people effectively.

After our comprehensive inspection in January 2017, the registered provider submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook a focused inspection on 24 August 2017 to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this focussed inspection which looked at whether the service was 'well-led'. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Spring Lake on our website at www.cqc.org.uk.

Spring Lake provides accommodation for up to 11 people with varying support needs including people with learning disabilities, autism, behaviours that challenge services and other complex needs. At this inspection there were 10 people living at the service.

There was a registered manager in post who was present throughout the inspection. 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.

At this focused inspection, we found that the provider had followed their plan and legal requirements had been met.

We found the provider had put in place procedures to monitor the quality of the service. We saw evidence that regular audits on care records had been completed since our comprehensive inspection in January 2017. Audits had been carried out covering a range of areas including, medicines administration, care documentation, maintenance, health and safety and infection control. There was evidence audits were used to improve the quality of care people received.

Spring Lake provides accommodation for up to 11 people with varying support needs including people living with learning disabilities, autism, behaviours that challenge services and other complex needs. At this inspection there were 10 people living at the service.

There was 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. A registered manager was in place.

During our inspection we identified a number of concerns about the care, safety and welfare of people who used the service. The quality assurance processes in place at the service were not robust enough to assess, monitor and mitigate the risks relating to the health and welfare of people using the service and to drive service improvement.

Although relatives and professionals told us staff were kind and caring, some staff expressed concerns that people’s choices and preferences were not always respected. We saw that not all people received personalised care and support that met their needs and took account of their preferences. Improvements were required to ensure care was provided in line with people's individual needs, and to make sure people’s choices and dignity were respected.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used effectively to improve the quality of the service. Improvements were required to ensure people's concerns and complaints were acted upon.

Risks to people's safety and wellbeing were not always managed effectively to make sure people were protected from harm. We saw that some risks to people's well-being had not been identified or adequately mitigated. This had put people's welfare at risk.

Facilities at the home were not well maintained in order to meet people's needs safely and effectively. Some areas of the premises were in a poor state of repair and required attention in order to reduce risks to people. We observed that the emergency lighting system required repairing and the hot water supply and showering facilities at the home were faulty.

People were not protected against the risk of the spread of infection. Staff did not follow correct procedure to ensure laundry was processed correctly in order to reduce the risk of cross infection.

Staff did not always gain consent from some people before providing care and treatment. In one example, we saw where people did not have mental capacity to make specific decisions about their care and treatment, The Mental Capacity Act (2005) was not fully adhered to. The provider had failed to appropriately assess this person’s mental capacity in relation to restrictions of their freedom and liberty.

There were procedures in place to ensure people's medicines were managed safely. Staff regularly reviewed and audited medicines to ensure they met people’s current needs.

Staff were aware of the provider’s safeguarding policies and procedures and their role and responsibilities in keeping people safe. The provider was working with the local authority in investigating some current safeguarding concerns.

Staff received training to provide them with the skills and knowledge to care for people effectively.

People were supported to maintain balanced diet based on their preferences. Staff had a good understanding of people's preferences and supported them to make choices in relation to their nutrition.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People looked content and well supported. Staff we spoke with were knowledgeable regarding their roles and responsibilities and the needs of people who used the service. Staff demonstrated they understood aspects of the safeguarding process relevant to them.

Staff understood that they needed people's consent before providing care and support, which meant the provider acted in accordance with people's wishes.

The provider cooperated with others involved in the care of people who used the service, which meant people's health, safety and welfare was protected when more providers were involved in their care and treatment. This ensured people received continuity of care.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff respected people's privacy and knew about their roles and responsibilities in meeting the needs of people that they supported in a sensitive and respectful manner. We saw people using the service approach staff without hesitation and they accessed their bedrooms and communal areas freely within the home.

Each person had a plan of care that had been regularly reviewed, and included information about the individual support and care that people using the service needed. There were enough skilled and experienced staff to meet people's needs. Medication was stored and administered safely and records were accurate and up to date.