Selborne Mews

Selborne Mews is a care home and accommodates up to 20 people with learning disabilities. Some people living at the service were also diagnosed with mental health conditions and had complex support needs.

At the time of our inspection 13 people were living at the service.

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

At our last inspection we found care and treatment was not always provided in a safe way. There was also a lack of provider oversight which meant risks to people’s safety had not always been identified and responded to appropriately.

At this inspection we found that improvements had been made and the breach of safe care and treatment had been met. Improvements had been made to the providers monitoring of the service, but further embedding of the systems and oversight were needed.

Improvements had been made to the physical standards of the service and some further work was needed and the provider had plans in place for this.

Staff understood what action to take if they suspected somebody was being harmed or abused. Incidents and accidents were monitored for future learning. Staff knew people's needs.

There was enough staff on duty to meet people's needs and recruitment processes were in place to safely recruit staff. Vacant posts were being recruited to and contingency plans were in place should these be needed.

People received their medicines when needed. We saw kind interactions with people. Staff felt supported by the interim manager and told us improvements had been made since our last inspection of the service.

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 able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service was a large home, bigger than most domestic style properties. However the size of the service having a negative impact on people was mitigated in part by people being provided with individual living accommodation. Some people had been supported to move to a different flat. This had been significant for some people because their new living environment was more suited to their needs, for example it provided a quieter living environment. The use of technology was being introduced for some people to support their communication needs. Reviews of people's needs were also taking place to determine their future plans

The last rating for this service was inadequate (published July 2021).

The service has improved to requires improvement.

Why we inspected

At our last inspection we found a breach of safe care and treatment and also a breach of the providers quality monitoring systems. We imposed a condition which meant the provider was required to tell us each month about the improvements they were making at the service. This inspection took place so we could monitor the improvements the provider told us they had made.

We looked at the safe and well led key questions only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to requires improvement. This means the service will no longer be in special measures.

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.

Enforcement

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 a repeated breach regarding good governance. 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Selborne Mews on our website at www.cqc.org.uk.

Follow up

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.

Selborne Mews is a care home and accommodates up to 20 people with learning disabilities. Some people living at the service were also diagnosed with mental health conditions and had complex support needs.

At the time of our inspection 13 people were living at the service.

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

Care and treatment was not always provided in a safe way. There was a lack of provider oversight which meant risks to people’s safety had not always been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm.

Systems in place to manage the control of infection were not effective and did not always follow current government guidance in relation to COVID19.

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 able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The service was a large home, bigger than most domestic style properties. However the size of the service having a negative impact on people was mitigated in part by people being provided with individual living accommodation. Not all the people had been supported to live inclusive and empowered lives. The service had not supported all people living there to personalise their own living environments and not all people's communication needs were being met effectively.

People received their medicines when needed. Staff knew people's needs and felt supported by the management team. Staff understood what action to take if they suspected somebody was being harmed or abused. Arrangements were in place to ensure staff received the required physical intervention 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 requires improvement (published January 2020) and there was two breaches of the regulations. 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 the required improvements had not been made. We found that regulation 12 safe care and regulation 17 good governance were not met. There was also a new breach of regulation 18 failure to notify CQC about incidents at the service in a timely way.

Why we inspected

We undertook this focused inspection due to incoming information of concern about incidents that had taken place at the service and we were concerned about people's safety. We also wanted to check if the provider had followed the action plan they sent us to confirm they had met the legal requirements.

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 ratings from the previous comprehensive inspection for the key questions of effective and responsive were not looked at on this occasion the ratings from the last inspection were used in calculating the overall rating at this inspection.

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 six months to check for significant improvements.

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.

Selborne Mews is a care home and accommodates up to 20 people with learning disabilities. Some people living at the service were also diagnosed with mental health conditions and had complex support needs.

At the time of our inspection 13 people were living at the service.

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

At our last inspection on 06 May 2021 we found care and treatment was not always provided in a safe way. There was a lack of provider oversight which meant risks to people’s safety had not always been identified and responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. Systems in place to manage the control of infection were not effective and did not always follow current government guidance in relation to COVID-19.

At this targeted inspection we only looked at the progress on the management of Infection Prevention and Control. We found the required improvements had been made and the warning notice in relation to regulation 12 (2) (h) was met.

Checks were carried out on visitors to the service to prevent the spread of COVID-19. Regular testing in line with government guidelines for COVID-19 took place for people and the staff team. Staff were wearing Personal Protective Equipment (PPE) appropriately. There were sufficient supplies of PPE located around the service and arrangements were in place for staff to safely remove and dispose of PPE. People's health and wellbeing was monitored. People were observed for symptoms of COVID-19 and other potential infections. The home was clean. Cleaning schedules had been enhanced to include additional cleaning in relation to COVID-19. The management team communicated regularly with people, staff and relatives about COVID -19 to make sure everyone understood the precautions in place to keep people safe.

For more details and for full information on the enforcement action taken on other shortfalls following our inspection on 06 May 2021 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 inadequate (published June 2021) and there were three breaches of the regulations.

Why we inspected

We undertook this targeted inspection to monitor progress on the Warning Notice we issued in relation to Infection Prevention and Control and the management of COVID 19.

We found the following examples of good practice.

Staff had completed training to don and doffing of Personal Protective Equipment (PPE) correctly and wore it in line with current government guidance. PPE stations were located in each person's flat and key areas throughout the home.

Testing of staff and people was completed in line with current government guidance. People and staff had begun to receive their COVID-19 vaccinations.

The manager had established a one way system through the home to reduce the risk of people coming into contact with each other.

Social distancing was maintained where possible, people had their own flats and avoided using communal areas. Staff worked in teams and were allocated to people for the duration of their shift which minimised staff movement and the risk of infection.

The manager had carried out risk assessments with staff at greater risk from COVID-19 and the provider supported people through an employee wellbeing scheme.

Selborne Mews is a care home and accommodates up to 20 people with learning disabilities. Some people living at the service were also diagnosed with mental health conditions and had complex support needs. At the time of our inspection 15 people were living at the service.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 16 people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated in part by people being provided with individual living accommodation. There were some identifying signs that this was a care home. For example, the building had the name of the service on the building. Some steps had been taken to minimise the signs that it was a care home. The industrial bins were in an enclosed area and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

At this inspection December 2019 we found that systems in place for the management of risk was not always robust and risks to people were not always identified or action taken to mitigate risk. The providers quality assurance system failed to identify where improvements were needed, or where the system had identified a shortfall they had not always taken timely action to address this.

There were systems in place to protect people from the risk of harm, but these had not always been followed by staff so concerns about people’s safety were not always reported. People received their prescribed medicines, but improvement was needed to the management of medicines taken on an as needed basis.

Staff were recruited safely and inducted. Staff felt supported in their role and received supervision. There was a planned approach to training and staff were receiving training some training specific to the needs of the people living at Selborne Mews so they had the required skills and knowledge to meet their needs.

People were supported to do things they enjoyed doing and to maintain relationships that were important to them. The provider had a system in place to ensure any complaints received would be logged, investigated and responded to and any learning used to improve the service provided.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc.

People were supported to have choice and control of their lives although improvements were needed to show that people had been fully consulted with regarding making decisions about their care.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. People with varied and diverse needs were living together and these needs were not always compatible.

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

Rating at last inspection

The last rating for this service was good (published July 2017)

Why we inspected

The inspection was brought forward, prompted in part due to concerns received about the service.

Enforcement

We have identified breaches in relation to the management of risk and quality monitoring of the service.

Please see the action we have told the provider to take at the end of this report.

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.

A manager was in post but not yet registered with the Care Quality Commission (CQC) . A registered manager is a person who has registered with the CQC 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.’

There were systems and processes in place to assess and monitor the quality and safety of the service.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision and staff training was monitored by the provider. Staff were recruited in a safe way and employment checks were completed before they started to work at the service.

People had been involved in decisions about their care and received support in line with their care plan. The provider had made appropriate applications to the local authority so that people’s rights could be protected. Although, not all staff were clear about which applications had been authorised.

People were supported by staff that were caring and knew people’s care needs including their personal preferences, likes and dislikes. Staff were respectful of people's diverse needs and the importance of promoting equality.

People were supported to maintain good health and had regular access to healthcare professionals. People received their medicines as prescribed. Arrangements were in place to ensure that people made choices about the food they ate and specialised meals were provided when needed.

People were supported to take part in interests and hobbies that they enjoyed. People who could tell us told us they could speak to staff if they needed to, and the provider had a system for listening and responding to complaints.

All the people that we spoke with told us that they were happy living at the home and that their needs were being met. One person said, 'Happy living here.' Another person said, 'Staff know me well and they know how to support me." We found that people experienced care, treatment and support that met their needs and protected their rights.

People that we spoke with told us that they liked the staff that supported them. We found that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

All the people that we spoke with were happy with the care they received. We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

People that we spoke with told us that they would raise any concerns they had with the manager or any of the staff. We found that there was an effective complaints system available.