28 October and 24 November 2011
During a routine inspection
During our visit on 28 October 2011 we were introduced to the manager (not registered with the Care Quality Commission) who was in day to day control of the home as the Registered Manager was working in another home. When we returned to Santosa on 24 November 2011 the Registered Manager had returned and was in day to day control of the home. Therefore, in this report, where we refer to the 'manager' this is the person who was in day to day control of the home during our first visit. Where we refer to the 'Registered Manager' this is the person who was in day to day control of the home during our second visit.
During our visit on 28 October 2011 we looked all round the home and spoke privately with three of the five people who lived in the home. We saw the other two people but did not speak with them because one person declined to speak with us and we were told by the Nominated Individual for the organisation that we would not be able to communicate effectively with the fifth person due to the person having a hearing impairment. We also talked privately with two members of staff and examined records pertaining to the care of the people who lived in the home.
People told us that they were happy living in the home and talked to us about their interests, holidays and contact with families. People said they received the care and support they needed at the times and in the way they requested. They were also confident that any concerns or complaints they had would be dealt with satisfactorily by the staff team. People spoke confidently with the staff and appeared happy and relaxed. Staff treated people in a friendly and respectful way and were attentive and quick to recognise when people needed assistance or wanted to talk to them about a particular matter.
Following our visit on 28 October 2011 we made a safeguarding alert to the local authority as we found information showing that the particular behaviours of two people were being managed through the giving or removal of food. We made the alert as there was no evidence to show that this was up to date, contemporary practice, or had been agreed by any health or social care professionals.
When we visited on 24 November 2011 we found that there were only three people living in the home as two people had been moved by commissioners following reviews of their care.
During our visits we looked at the personal files of three people and, on 24 November 2011, spoke with three senior staff who had worked for Atlas Project Team Limited for several years. We found that, whilst there was a lot of information about people, the model of care used in the home was not based on good practice. This was because there were no person-centred planning processes in place, people were not involved in drawing up their own plans of care/support and these were not provided in formats that people could understand. People did not have up to date health action plans, were not receiving annual health checks and protocols for the administration of 'as required' medication were inadequate. There were no nutritional plans in place for people with dietary needs and no evidence of involvement from a dietician. Sensory assessments had not been carried out for people with autism and there was no forward planning of people's care to ensure that changes in their lives were properly managed. There were no communication guidelines for people and no evidence of involvement from speech and language therapists.
The management and staff team were not knowledgeable about the Mental Capacity Act and Deprivation of Liberty Safeguards and were not aware of the implications of restricting people's liberty. The risks and benefits of using the lounge for 'time out', using food as a behavioural strategy, and physical intervention practices had not been assessed or agreed by any external health or social care professionals. Relatives, representatives/advocates and health/social care professionals had not been properly consulted or involved in 'best interest' decisions relating to people's care and treatment. This meant there was no proper consultation and agreement that the way in which people's behaviours were managed in the home were in the person's best interests. People's rights to autonomy and independence were not considered at all times by the staff team. The care files were disorganised and there was no clear process of assessment, care planning, risk assessment and guidelines for staff to follow to make sure they provided care and support in a consistent manner.
There were sufficient members of staff on duty in the home who considered themselves to have the skills and training to ensure that people's health and social care needs were met. However most staff had not received essential training, none of the staff team had received any training relating to the specialist needs of the people they supported, and they were not provided with up to date information about those particular specialist needs.
The staff knew what procedures to follow should an incident of mistreatment, abuse or neglect be witnessed, suspected or alleged although it was not clear that they understood what practices constituted abuse. The organisation's own policy and procedure relating to safeguarding vulnerable adults was out of date and did not correspond with the Local Authority's procedures on safeguarding people from abuse.