Reach Sistine Manor

People’s experience of using this service:

¿The service did not have a registered manager. However, the providers monitoring and auditing of the service was comprehensive which enabled them to provide a safe, effective, caring and responsive service.

¿Relatives were happy with the care provided but some feedback from them indicated communication could be better around care planning, key working and choice of meals provided.

¿People received safe care. Risks to them were identified and managed.

¿ Safe medicines practices were promoted.

¿Staff were suitably recruited, inducted, trained and supported.

¿Staffing levels were flexible to meet people’s needs.

¿People’s health needs were identified and met.

¿Staff were kind and caring and promoted person centred care.

¿People were consented with about their care and safeguards were in place for people who were unable to make decisions on their care.

¿People were supported to communicate their needs and they were encouraged to be involved in activities.

¿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

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

Rating at last inspection: The previous inspection was carried out on 24 May 2016 (Published on 5 July 2016). The service was rated Good at the time.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

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

Reach Sistine Manor provides residential care for up to 19 adults living at the service. The home is split into two, with a coach house to the side which accommodates three service users. The home provides care to people with severe learning disabilities and complex needs. At the time of our inspection, 14 people were living at the service.

Reach Sistine Manor did not have a registered manager however an application had been made by the current operations manager. A manager was in place and managing the service with the support of the operations 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.

This inspection was undertaken over two days and was unannounced.

We undertook an inspection at Reach Sistine Manor in October 2015 which was unannounced and completed over two days. At our last inspection, we found a number of breaches under requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was in breach of Regulation 10; Dignity and respect, Regulation 11; Need for consent, Regulation 12; Safe care and treatment, Regulation 17; Good governance and Regulation 18; Staffing. Sistine Manor was placed into special measures. After our inspection in October 2015, we began to look at taking further enforcement action against the provider. We decided to revisit the service after six months to assess their progress.

At this inspection, we found major improvements had been made to the service. Since our last inspection, the number of people living at Sistine manor had reduced and improvements had been made to the training and development of staff working at Sistine manor. We found these changes had a positive impact on the way people were cared for, and the way staff interacted and supported people living at Sistine Manor.

New processes and procedures had been implemented to ensure the quality of the service provision and to assess where and how improvements could be made. We saw staff had been actively involved in providing input into how Sistine Manor could improve and in turn, this had a positive impact on how they engaged and supported people living at Sistine Manor to have their voices and choices promoted.

Staff we spoke with told us they felt the service had improved, and that further training and supervision had been beneficial to their roles. Staff told us learning disability training they had received since the last inspection had helped them to understand how people with learning disabilities see the world and their environment, and gave them an understanding of how best to support people. We received positive feedback from staff on the training they had received and saw the positive impact this had on people living at Sistine Manor.

We found there was now effective governance in place to ensure the smooth running of the service. Where feedback was obtained from staff, visitors or relatives, we saw this was fed back into the service to make further improvements. For example, where complaints were made, these were acted on in line with the provider’s policy and discussed at team meetings to promote further learning and to encourage improvement. We previously had concerns about management and leadership within the service. We now found the manager was being supported to develop their understanding and skills by the operations managers. This again, appeared to have a positive impact on both staff and people living at Sistine.

At previous inspections, we raised concerns about poor culture within the service. This included poor staff practice and lack of dignity and respect shown towards people living at Sistine Manor. Since our last inspection, changes had occurred within the staff team which resulted in a culture shift. We now found staff were working together to achieve the same goal of improving the life of people living at Sistine Manor and wanting to learn and improve.

The service was in special measures as a result of the comprehensive inspection in October 2015. This inspection showed improvements had been made. Therefore the service is now out of special measures.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected against the risk of harm in relation to the Mental Capacity Act 2005. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people's best interests and in line with legal guidelines. The provider was aware of Deprivation of Liberty Safeguard (DoLS) recent changes to the legislation and had contacted the local authority for guidance. We saw applications were in place for people where it was deemed they may be deprived of their liberty.

During our inspection we saw examples of good and poor practice in relation to how people were being supported. We observed one person to be moved whilst eating without being notified. This person was known to be at risk of choking and this practice placed them at risk. We also observed staff being responsive to people's needs and involved in people's day to day lives. Risk assessments for four care plans we viewed had not been updated or reviewed since 2007. We found not all staff had completed training such as safeguarding, fire safety, and infection control in line with the providers training plan.

This meant people were not protected from unsafe practices.

Is the service effective?

We found quality monitoring was inadequate when assessing and monitoring staffs practice. Staff had not received training in line with the providers training plan with some staff members being in post for over a year. We raised concerns with management around observations at lunch. We were told 'I have spoken to staff about it'. We found appropriate recruitment procedures were in place to ensure the suitability of staff.

This meant the service effectiveness was not satisfactory.

Is the service caring?

We observed poor practice during lunch time on the first day of our inspection. Staff did not interact with people during lunch and rough handled plates and cutlery. One person had their lunch 'thrown' in front of them. People were not offered a choice of drinks with their lunch, or how much they wanted for lunch. One person was observed to be eating their dinner and pudding at the same time. Their pudding was taken away from them by a staff member and they were told 'Eat your lunch.' Staff stood over people as they had their lunch and were giving commands such as 'Eat your food', 'Move your leg' and 'Get up.' Lunch time was very hectic and rushed with staff reaching over people whilst eating. We saw one person who picked food up off the floor and ate it. During our second visit, we found interactions between staff and people who used the service had improved after our concerns were raised with management around our observations and staff practice.

This meant people may not be supported or looked after in a caring manner.

Is the service responsive?

We raised our concerns around staff practice with management and the provider after the first day of our inspection. During the second day of the inspection we saw the provider had addressed the concerns seen during our first visit and had taken appropriate action to ensure people's care and welfare was promoted. Staff were visible and available during our observations. We saw people were supported to access the community. We found documentation from health appointments were kept on file with no indication of why an appointment was made, or the outcome of the appointment.

This meant the provider was responsive to concerns addressed.

Is the service well-led?

The service had a bi-monthly quality assurance review which was undertaken by head office which highlighted areas for improvement and were actioned, however we were informed by management that they were aware of the issues raised during our visit and had spoken with staff previously. This meant quality monitoring was not followed up to ensure good staff practice and to ensure people's dignity and choices were respected consistently.

This meant the service was not well led and quality monitoring was inadequate.

We spoke with two staff who told us they supported people be as independent as possible and to work towards and achieve personal activity or social goals. We looked at four care files that demonstrated the personalised approach in place to plan to support the staff's comments. In one care pan we looked at a person who used the service could be seen pictured at the home, out and about on excursions and holidays and with friends and relatives.

The staff we spoke with demonstrated a good understanding of the different types of abuse and were able to provide good insight into the organisations safeguarding policies and that of the Local Authorities reporting processes.

We observed that the managers operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

The staff we spoke with told us that the 'key worker' system was an effective model of practice. These people told us that it enabled them to provide the appropriate levels of support needed by people who used the service so that they were able to make independent choices and decisions around the way they received their care.

We saw a lot of staff around over the course of the day. That was good as it meant people were safe. The staff were friendly and generally talked to people in a nice way. On one occasion, however, we did note a member of staff inappropriately refer to items used in some activities as 'toys'.The care plans we saw included photographs of the person at home, on day trips and when they went to see their family. There were also other pictures and photographs to help people understand what some of the papers in their care plan meant.

We found people's needs were assessed and their care was provided in line with their care plan. People were protected against the risk of abuse. Staff were supported in providing care and support to people. There was an effective system in place to assess and monitor the quality of the care people were receiving. The service looked into people's complaints.