Selborne House

About the service

Selborne House is a ‘care home’ and accommodates up to 15 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 11 people were living at the service.

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

At our previous inspection we found a breach of regulation11, 13, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. This was due to risks to people not being managed effectively. There was a lack of intervention around assessing incidents as they arose and taking appropriate action, people were exposed to the risk of ongoing harm. Decision were made by the provider on the person’s behalf without ensuring these were taken in the persons best interest in line with the law. The provider had not ensured appropriate audits and governance systems were in place within the service and there were failures in effective reporting systems. At this inspection we found that improvements had been made and breaches had been met.

Some further improvements were needed to ensure the quality systems in place were fully effective and imbedded into day to day practice.

Risks to people had been assessed and staff had a good understanding of these risks and how to minimise them. People were supported to receive their medication as prescribed and staff demonstrated a good knowledge of types and signs of abuse and how to report concerns of abuse.

People were supported to access healthcare professionals when required.

Improvements had been made to the training and support that staff received so they had the skills to meet people’s needs. Where further training was needed plans were in place to provide this. Not all staff understood the importance of seeking people’s consent before providing support.

People's care records were person centred and guided staff on the way they preferred their care and support to be provided. 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. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

People

The care service had not been designed and developed 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. The building layout and design was not always suitable for people with complex needs and challenging behaviour. There are long narrow corridors, numerous internal doors, internal locked doors with key coded pads, bedrooms close to communal areas. The environment is not conducive for its intended purpose.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 Inadequate (report published March 2019)

This service has been in Special Measures since our inspection in January 2019. During this inspection, the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any key question. Therefore, the service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Selborne House is a ‘care home’. People in care homes receive accommodation and 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. Selborne House accommodates up to 15 people with learning disabilities in one building that contains two separate units. Many of the people living at the service were also diagnosed with mental health conditions and had complex support needs.

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. 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.

A registered manager was in post. 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 were exposed to the risk of serious harm due to the provider’s failure to identify key risks and to take appropriate action to mitigate against these risks. Where safeguarding concerns had arisen these were also not always identified, reported and appropriate action taken to protect people. Care staff were not always deployed effectively or as outlined in their people’s plans. People were not always protected by robust infection control practices.

The provider had failed to ensure that robust governance and quality assurance systems were in place. The provider’s own systems had not identified the level of risk we found people were exposed to. Where people’s care and support did not meet their individual needs this had not been identified and corrective action had not been taken.

People’s rights were not upheld by the effective applicaton of the Mental Capacity Act 2005. Where people did not have capacity to provide consent, decisions had not always been made in their best interests in line with the Act.

People were supported by a committed staff team although they had not always been equipped with the skills needed to manage risk effectively. People’s health needs were not always monitored in line with their needs. Concerns were not always proactively identified to enable the appropriate intervention from healthcare professionals.

People enjoyed the food they ate and were encouraged to prepare meals independently wherever possible. People received their medicines as prescribed.

People were not consistently supported in a kind, caring and compassionate way. People’s independence was promoted and their privacy and dignity respected.

People’s care and support did not always meet their needs. People’s care plans were not updated on a regular basis with the full involvement of the person.

People were supported to access a range of leisure opportunities and community activities. People and external professionals did not always feel they could raise concerns and complaints directly with the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The provider was in breach of the regulations surrounding safe care and treatment, safeguarding people, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report. 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.

We had previously inspected this service on 28 November and 01 December 2016. We found that people were not consistently receiving a good or a safe service. We found the provider was not meeting all of the legal regulations, and we used our enforcement powers to ensure this situation improved.

In June 2017 the provider was acquired in its entirety by CareTech. On 12 and 13 July 2017 we undertook a further inspection to check on the progress that had been made by the provider to meet the legal requirements. We identified that some improvements had occurred, however these had not been adequate to ensure that people all received a safe, quality service, or to achieve compliance with the legal requirements. We found the provider was in continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection we imposed conditions on to the provider’s registration that placed a restriction on admissions to the home and also required the provider to submit monthly reports to us to evidence how they were providing effective oversight and governance of the home.

At this most recent inspection we found the provider had made some improvements and was no longer in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, they remained in continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we also identified a new breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Further improvements were required to ensure people consistently received safe, effective, caring support.

Selborne House 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. Selborne House is registered to provide accommodation for up to 15 people who have a learning disability. On the day of the inspection there were 13 people living at the home. The home is divided in to two areas called Ascot and Beverly.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and 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. The provider told us they were in the process of evaluating how the service worked for people living there and was considering making improvements to the layout and design of the building in order to better meet people’s needs.

There was a registered manager in post however they had recently submitted an application to remove their registration. In their absence a new manager had been appointed in December 2017 who took responsibility for the day to day management of the home. They told us they planned to submit an application to become registered manager of Selborne House. A registered manager is a person who has registered with the Care Quality Commission (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.

Although improvements had been made in relation to people being kept safe further action was required to ensure risks were adequately assessed and people receive support to manage those risks. Risks posed by an emergency event, such as a fire required review, and this was underway at the time of the inspection visit. The provider had made improvements to the way they managed incidents and reviewed risks following events at the home. People told us they felt safe and were supported by staff who had been safely recruited. Systems used for the administration and management of medicines were safe.

People were not always supported by staff who had the skills, knowledge and confidence to meet their needs. Some newer staff members had not received an induction when they began working at the home. People were asked for their consent before care was provided and staff understood people’s individual communication styles. Where people were deprived of their liberty conditions applied to DoLS had not always been actioned in a timely way. People received inconsistent support to manage their health needs and action was needed to ensure some people’s healthcare needs were reviewed without delay. People were supported to eat and drink sufficient amounts to maintain their health and where people had specific dietary needs staff were aware and provided appropriate support. Improvements were being made to the home environment and decoration at the time of the inspection visit, to offer people a more relaxed spacious environment.

People were supported by staff who were friendly and treated them with respect. People were encouraged to decorate their own rooms according to their own diverse needs and personal tastes. Staff treated people as individuals, recognise their needs and involved them in decisions about daily life. People were encouraged to be independent where possible and staff involved advocacy services as well as family members in decisions, where appropriate to ensure people’s feelings and wishes were fully represented.

People were involved in the planning and review of their care. Improvements had been made to people’s care plans to ensure they received support that was tailored to their individual diverse needs. People were supported to identify their own individual interests and staff supported people to take part in activities they enjoyed. People were offered opportunities to give their feedback on the care they received and there was a system in place to manage and respond to complaints.

Systems used to offer oversight of the service and ensure people received safe effective care and support had been recently introduced and required further development to ensure they were effective at driving the required improvements. Improvements had been made to audits carried out to check the quality of care and care plans and risk assessment were in the process of being reviewed to ensure they were up to date and reflective of people’s individual needs. Staff spoke positively about the changes that had been introduced and expressed confidence in the management team. The provider had complied with the conditions imposed on their registration and had informed us of incidents and events as required by law.

We last inspected this service on 28 November and 01 December 2016. We found that people were not consistently receiving a good or a safe service. We found the provider was not meeting all of the legal regulations, and we used our enforcement powers to ensure this situation improved. At this inspection, we identified that some improvements had occurred, however these had not been adequate to ensure that people all received a safe, quality service, or to achieve compliance with the legal requirements.

There was a registered manager in place at the time of our 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.

Changes had been made to the systems used to audit the safety and quality of the service however these were still not effective. They had failed to ensure that all of the improvements needed were acted upon. The leadership of the service had not ensured that people lived in a home with a positive, empowering culture. People did not always receive an individual service that was respectful and which upheld their dignity. Action that the registered manager and registered provider had told us they would take to improve the service and to comply with the requirements of the law had not all been completed within the timescales agreed. The home remained in breach of two regulations and they had not increased their rating from Requires Improvement. You can see what action we told the provider to take at the end of this report.

While this inspection identified that improvements had been made to people's safety, we found that people were not consistently provided with a safe service. Risks people faced had not all been effectively managed, and reports of incidents had not always been used to review and change the support people received. Effective plans to reduce the risks that people presented to themselves and to others had not all been managed well. We have made a recommendation that professional, published guidance on the use of physical interventions is obtained. The management of medicines had improved, and our inspection confirmed that people were receiving their medicines as prescribed. Recruitment practices had improved, and people were now supported by staff that had been subject to robust checks before starting work.

The formal systems in place to ensure that restrictions to people's liberty were identified, and the required applications made to the supervisory body were good. However the knowledge of staff providing direct care about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) would not ensure people would be supported consistently or safely. This was brought to the attention of the registered provider at our last inspection, and the necessary improvements had not occurred.

The culture of the home was not consistently enabling and did not promote people's independence or involvement. There were limited opportunities for people to pursue hobbies and activities that were of interest to them, and which would reduce the risks associated with social isolation. The care and support provided was not always respectful and did not always uphold people's dignity. This was brought to the attention of the registered provider at our last inspection, and the improvements required had not been undertaken.

People were supported to see a wide range of health professionals and to eat and drink adequate amounts to maintain good health. Not all care needs had been effectively planned.

People were supported to stay in touch with people who were important to them. Visitors were made welcome at the home.

There was a formal system in place to raise concerns. This had not been provided in a format accessible to people who had additional communication needs. Informal systems including individual talk time meetings and unit meetings had not been regularly held. However people we spoke with told us they had little confidence that their feedback impacted the service provided.

The systems in place to ensure the quality and safety of the service (Governance) were also ineffective. We are currently considering what further action we need to take.

Selborne Houses provides accommodation and personal care for 15 adults who have a learning disability. There were 13 people living at the service when we inspected. The home is split into two separate areas called Ascot unit and Beverley unit.

There was a registered manager in place at the time of our 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.’

The systems in place to audit the quality of the service were not effective because they failed to identify where improvements were needed. The service was not always led in a way that promoted the wellbeing and safety of the people who lived at Selborne House, recruitment practice did not ensure that only staff that were suitable were recruited, medicine management did not ensure people were protected from risks associated with medicine management and care was not always provided in a way that was person centred. Improvements were needed to ensure the home complied with the regulations. You can see what action we told the provider to take at the end of this report. 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.

Medicines were not always managed effectively to reduce the risks associated with them. The provider’s recruitment procedures were not always implemented effectively to ensure that staff were recruited safely. Risk to people were not always well managed and the environment was not always maintained in a way that ensured people’s safety.

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 had received some training however further training was needed. Staff lacked an understanding of what Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) meant in practice for the people they supported, which showed that systems were not in place to show that staff training was effective.

People were not always involved in decisions about their care and opportunities to promote people’s independence and life skills were not always acted upon by staff. People were not always supported to pursue hobbies and activities that were of interest to them. People were supported to access healthcare professionals and had access to food and drink.

Visitors were welcomed to the service and the provider had a system in place for responding to people’s concerns and complaints. However, systems were not in place to ensure that the views of the people that lived at the service were sought and acted upon to influence how care was provided.

We spoke with one person that lived there and observed how other people were supported by staff. This was because with the exception of one other person, who did not communicate verbally everyone else had gone out for the day. We spoke with two relatives, a health care professional and the local authority that commissions a service for the provider.

We also spoke with the registered manager and two team leaders that were on duty. Our conversations with people helped us to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All of the relatives spoken with told us that they felt that the care provided was safe. One relative told us, 'I am happy with the care X receives and she is safe there.'

We saw that people's care was planned and any risks associated with providing the care was assessed and managed appropriately.

Whilst we saw that the environment within the home was maintained to ensure it was safe. We found that not all areas of the premises were suitable maintained for people to use.

We saw that there were appropriate numbers of staff to meet the needs of people that lived at the home. Relatives spoken with had no concerns about the staffing at the home. A relative told us, 'There is continuity of staff at the moment.'

Systems were in place to make sure that managers and the staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

All records that we looked at were clear up to date and maintained so as to ensure that people received a safe service.

Where there had been issue about staff conduct the provider had taken appropriate action that ensured that people were safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. We saw that where it was necessary the home followed appropriate procedures under these safeguards to ensure that people's rights were protected and they were safe.

Is the service effective?

All of the people and their relatives spoken with told us that they were receiving the care that they needed.

On the day of our inspection all but two people were going out to do activities in the community. We spoke with the one person who told us that they went out when they wanted to. A relative told us, 'They do take X out shopping.'

We saw that the home sought the views of people that lived there and their relatives and staff to help in improving the care provided. We saw that meetings were held with people that lived at the home, so that they were involved in making decisions about the day to day management of the home and things that affected them.

Care plans were detailed and kept under regular review, so that staff had up to date information on how to care for people.

We saw that where people needed independent support to help them make life changing decisions staff supported them to access advocacy services.

Health information was detailed so that staff had the information they needed to support people safely.

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. A relative told us, 'The staff are caring.'

We walked around the home and watched to see how staff treated people. We saw good interactions between people and staff. We saw one person talking to staff about a meeting that was arranged with their social worker. We saw that the staff member patiently explained when the meeting was to take place.

We saw that people were dressed in clothing appropriate to their age, gender and the weather. We saw that everyone looked well groomed before they went out for the day.

Is the service responsive?

Relatives spoken with said they visited the home whenever they wanted to. A relative told us, 'When I visit, I visit unannounced and have never had any concerns.'

We saw that clear procedures were in place for handling complaints and concerns. Complaint records that we sampled were thoroughly investigated.

We saw from care records looked at that the home involved other professionals in supporting people's care as required. A health care professional told us, 'They work well with us and have acted on advice given. They have managed incidents fairly well.'

Is the service well led?

All the people and their relatives that we spoke with had no concerns about the service. Systems were in place to monitor the quality of the service. Incidents and accidents were analysed and handled effectively. People were confident that their concerns would be listened to and investigated.

There were reporting procedures in place to enable the provider to have an overview of how the home was being managed.

We saw that the home had a staffing structure that enabled the service to be managed appropriately. This included a manager that was registered with us and was responsible for the day to day running of the service. People and their relatives were consulted about the quality of service they received. We saw that comments and concerns were analysed and improvements were put in place where they had been identified. All staff spoken with said they thought that the home was well managed.

Staff referred people to health professionals for advice where needed to meet their healthcare needs.

Staff did not always support people who had complex needs to ensure their dignity and wellbeing which meant that some people's needs were not always met.

Systems were in place to ensure that people living at the home were safeguarded from harm.

People had been given their medicines as they had been prescribed by their doctor to ensure their health and wellbeing.

Recruitment processes were robust which meant that suitable staff were employed to work with people living there to ensure their safety. One person said, 'I can talk to the staff, they are okay.'

People were asked for their views about the home and audits of the quality of care that people received were completed. One person said, "Staff give me choices, they explain them to me and any risks that may be involved with making them."

At our inspection on 20 June 2012 we saw that people that lived at the home gave consent to the day to day care that they received. However we found that the provider did not act fully in accordance with the legislation where people lacked capacity to make informed decisions about their care. During this visit we found that the provider had put in place appropriate systems to address this shortfall and to ensure that people's rights were protected.