Sinon House Therapeutic Unit

Accommodation was provided over three floors. There were two communal lounges and a small garden and utility room to the back of the care home.

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

Young people told us they liked the staff that supported them. We observed young people were relaxed and at ease in staff's company.

Quality monitoring systems were inconsistent to be able to identify shortfalls and drive continuous improvement in the service. We found concerns with fire safety, incidents, and clinical support for assistant psychologists.

We signposted the provider to infection control guidance to be assured they were making sure infection outbreaks could be effectively prevented or managed.

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

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care maximised people’s choice, control and independence. Young people views were actively sought and acted on and they were involved in planning their care.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. Everyone told us that young people were treated with dignity and respect.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives. Although there was a high turnover of staff at the service, the registered manager led by example and provided a positive environment for young people and staff.

Young people benefitted from the positive culture at the service. The registered manager was open, approachable and listened and responded to young people and staff. Family members described the registered manager as, “Fantastic”, “Really positive” and “Amazing” in the support they gave to young people.

Assessment of risk include clear guidance for staff on how to keep young people safe. Staff understood how to follow safeguarding policies and procedures to help keep young people safe.

Young people's health and well-being was monitored, and liaison took place with a range of health and social care professionals to support this. Staff understood there were challenges in supporting young people to eat healthy. Young people received the support they needed with their medicines.

Young people were treated well and with dignity and respect which had a positive impact on their well-being. Family members told us staff had developed positive relationships with young people. One family member told us, “I said to X (young person) I really think you are in the best place you could be, and X responded that they agreed”.

The service was responsive to young people’s needs. Young people had opportunities to go out and take part in things they were interested in.

Staff were checked that they were suitable to work with young people before they started to support people. There were enough trained staff available, so people received support when they needed it. The staff team felt well supported and listened to by other team members and the registered manager.

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 2 May 2019). The rating at this inspection has changed to Requires Improvement.

Why we inspected

The inspection was prompted in part due to concerns received about keeping young people safe and the overall management of the service. A decision was made for us to inspect and examine those risks and undertake a comprehensive inspection.

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.

Follow up

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

Sinon House Therapeutic Unit is a specialist residential care home. It accommodates up to three young people who require support during their transition into adulthood due to a learning disability, autism spectrum disorder, mental health diagnosis or eating disorder. At the time of the inspection there were three young people living at the service between the ages of 17 and 19 years.

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.

People’s experience of using this service:

• Young people said that the employment of a new manager had led to improvements in their care and support.

• The manager had been employed in the role for two months and was working towards changing the culture of the service, so it met its aims and values. These were to support young people to maintain and develop life skills and take steps towards their independence. Young people had 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 practice.

• The service was well-led. Young people’s views about the quality of care was actively sought. Quality assurance processes had been strengthened and improvements to the service implemented.

• Young people told us they were responsible for meal planning and preparation, budgeting and washing their own clothes. They said they could follow their interests and were able to go out in addition to spending time at the service.

• Staff knew young people well and communicated with them in a kind and respectful manner.

• There were enough trained staff available, so people felt safe and received support when they needed it. Risks to people's safety had been assessed, monitored and managed to make sure people were protected from harm.

• Young people’s health and well-being was monitored, and liaison took place with a range of health and social care professionals to support this. People received the support they needed with their medicines.

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

Rating at last inspection: Requires Improvement (last report published 6 April 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule.

Sinon House Therapeutic Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to three people with learning disabilities, autism spectrum disorder, mental health issues and eating disorders. There were three people living at the service at the time of the inspection.

The provider, Independence Development Ltd, offers a semi-independence training program for young people aged 16-30 years of age who are leaving care and require ongoing support during their transition into adulthood.

The service was run by a registered manager who was present on the day of our visit. 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.

The service was last inspected on 11 May and 14 June 2017 when the area of ‘Well-led’ was rated as inadequate and the overall rating was Requires Improvement. At that time we found seven breaches of Regulation. These were with regards to the provider failing to: Regulation 9, ensure care plans were personalised; Regulation 11, follow the principles of the Mental Capacity Act 2015; Regulation 12, safely manage risks to people; Regulation 17, operate effective quality auditing systems; Regulation 18 (HSCA) provide adequate staff to meet people’s assessed needs; Regulation 19, employ fit and proper persons; and Regulation 18 (Registration Regulations) notify CQC of events and incidents without delay.

After the inspection the provider sent us an action plan which detailed how they planned to address the breaches of Regulations and they regularly updated this to evidence what had been completed. The last update was received on 3 January 2018.

We also made recommendations regarding meeting outstanding actions in the service’s fire risk assessment and including people’s likes, dislikes and preferences within their plans of care.

At this inspection, we found improvements had been made and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we have made three recommendations with regards to healthy eating, inducting new staff and the environment.

This is the second time the service has been rated Requires Improvement.

Quality assurance processes had improved and identified shortfalls in the service had been addressed. However, there had been a five month delay in installing emergency lighting which was completed on the day of our inspection visit. There was no redecoration and improvement programme in place to ensure wear and tear in the environment was addressed proactively. We have made a recommendation about this.

People had their health and nutritional needs assessed but we have made a recommendation in relation to supporting people to have a balanced diet.

New staff received a structured induction and were provided with a programme of training in areas essential to their role. We have made a recommendation about ensuring staff induction is effective.

The aims of the service were to promote people’s independence and life skills. Most health and social care professionals reported that these aims were met. However, it was not always easy to identify from records the progress of people’s development.

Improvements had been made in assessing potential risks and guidance was in place and available to staff to make sure people were protected from harm. There were systems in place to monitor and respond to accidents and incidents.

Staffing levels were based on people’s assessed needs and appropriate checks were undertaken to ensure suitable staff were employed at the service.

Staff understanding of the principles of the Mental Capacity Act 2005 had improved. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had not needed to submit any DoLS applications to ensure that people were not deprived of their liberty unlawfully.

The care planning process had been developed to include people’s views, likes, dislikes and preferences. People were involved in decisions about their care and treatment and knew how to make a complaint.

People had access to the health and mental health support they required.

People were supported by staff who were trained to recognise the signs of abuse and the provider had reported concerns about people's safety to the relevant authorities.

The systems in place for the management of medicines had been reviewed and there were clear records and checks in place to make sure people received their medicines as prescribed by their GP.

Staff communicated with people in a kind manner and treated them with dignity and respect. People responded positively about the level of staff support they received.

People had opportunities to go out and take part in sport, leisure, education and work experiences.

Following the first day of our inspection we sent the registered provider a Letter of Intent (LOI). This is a document which outlines the serious concerns that had been found and requests an action plan to be sent, which detailed the action taken by the registered provider. These included people’s documentation, the recording and monitoring of incidents/accidents, the failure to keep people safe, protect them from harm and ensure staff were skilled and competent. The registered provider sent an action plan containing information regarding the changes that had been made to the service being provided to people. Following the second day of our inspection we were satisfied that the serious concerns we raised in the LOI had been actioned.

Sinon House Therapeutic Unit is registered to provide accommodation for young people between the ages of 16-31 who require a high level of therapeutic care and supervision. Support is given to people who have learning disabilities, mental health needs, behaviour that challenges themselves or others and those requiring supervision due to legal cases in court. At the time of our inspection, three people were living at the service.

Sinon House Therapeutic Unit was last inspected in June 2016, when it was rated as Good. On the first day of the inspection we found that risks to some people had not been properly addressed or minimised in a number of areas. These included risks to people's health, safety and well-being from a lack of behavioural management strategies, potential risks of abuse not being assessed and the risk of serious harm had not been effectively monitored. On the second day of our inspection, following the serious concerns we raised with the registered provider, action had been taken to develop a more robust risk assessment methodology. However, the recording of risk was inconsistent.

At the time of our inspection there had not been a registered manager in post for a period of 11 months. A registered manager is a person who is 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.

Systems designed to protect people from the potential risk of abuse and harm had not been effectively operated. High risk behaviours were not monitored to reduce the risk of reoccurrence.

On the first day of our inspection, there were insufficient skilled or trained staff available to meet people’s needs. Staff had received most standard training but had not been trained to meet people’s complex specialist needs. On the second day of our inspection, following the serious concerns we raised with the registered provider, action had been taken to ensure increased staffing levels and provide staff training in specific specialist needs.

Recruitment processes were not sufficiently robust to make sure that only suitable staff were employed to work with people.

The principles of the Mental Capacity Act 2005 had not been applied to people living within the service. People’s ability to consent to specific decisions about their lives had not been assessed or recorded. There was a lack of knowledge of the action that needed to be taken to assess people’s capacity. Mental capacity assessments had not been completed and decisions had not been made in people's best interests.

On the first day of our inspection, one person at high risk of malnutrition was not supported to maintain their nutrition and hydration. Records were not accurate in relation to people’s food and fluid intake. On the second day of our inspection, following the serious concerns we raised with the registered provider, action had been taken to ensure monitoring of people’s food and fluid intake, and to updated care plans. People were encouraged to eat healthily when making meal choices.

Pre-admission assessments had not been completed to ensure the service and staff were able to meet the persons’ needs. Care planning was not person-centred and did not reflect people’s individual personalities and preferences. People had an individual activity planner and chose whether to participate in the arranged activity, but were not involved in deciding the activities available to them.

People were encouraged to increase their independent living skills. Staff had supported two people to start work in a local charity shop. People were asked for their feedback about the service; however this was not always acted on.

A system was in place to monitor and respond to complaints that had been made. Incidents that the provider is required to tell us about by law had not been sent to the Care Quality Commission.

Quality assurance systems were not effective. There was inadequate oversight by the registered provider to identify and remedy the issues we found during this inspection. As a result we found a number of breaches of Regulation relating to people’s health, safety and well-being.

You can see what action we told the registered provider to take at the end of this report.

Sinon House Therapeutic Unit is registered to provide accommodation for young people between the ages of 16-31 who require a high level of therapeutic care and supervision. Support is given to people who have learning disabilities, mental health needs, behaviour that challenges themselves or others and those requiring supervision due to legal cases in court. At the time of our inspection, three people were living at the service.

At the time of out inspection the unit manager had been in post since the previous registered manager had left in May 2016. The unit manager had applied to the Care Quality Commission to become the 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the unit manager told us that no one living at the service had a DoLS authorisation in place. The unit manager and staff understood their responsibilities under the Mental Capacity Act 2005 and the DoLS. Mental capacity assessments and decisions made in people’s best interest were recorded.

People told us they felt safe. Staff had received training about protecting young people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put in place to manage any hazards identified. The premises were maintained and checked to help ensure the safety of people, staff and visitors.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. Medicine audits were regularly carried out by the unit manager.

There were enough staff with the right skills and knowledge to meet people’s needs. Staff received the appropriate training to fulfil their role and provide the appropriate support. Staff were supported by the unit manager and the provider who they saw on a regular basis. Staff worked well as a team and felt supported by one another. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People told us their privacy was respected by staff. People were treated with kindness and respect. People’s needs had been assessed to identify the care they required. People’s individual therapeutic care plans were person centred and gave staff the information and guidance they required to give people the right support. Detailed guidance was available for staff to follow to support people who displayed any behaviour which caused a risk to themselves or others.

People had access to the food that they enjoyed and were able to access drinks when they wanted to. People’s nutrition and hydration needs had been assessed and recorded. People were encouraged and supported to be as independent as possible. People were supported to remain as healthy as possible with the support of healthcare professionals.

People were supported to participate in a wide range of activities they enjoyed within the unit and in the local community. People were supported to complete educational courses to develop their skills and confidence. People were supported to gain employment within their local community.

People’s views were actively sought and acted upon. Processes were in place to monitor and improve the quality of the service being provided to people.

During this visit we found that improvements had been made. The home was adequately maintained to provide a comfortable environment for the two people who lived there.

Overall we found that this service had achieved compliance with the standard we inspected.

We reviewed the care records for both of the people who used the service. We found that people received care and support that was well planned and sensitively delivered.

The maintenance of the premises was not adequate to ensure people who lived in the home were comfortable and benefitted from a homely environment. The home was cold. One person said, "It's always freezing." The other person told us they did not mind the cold.

Overall we found that this service was had not achieved compliance with all the standards we inspected. We have judged there to be a moderate risk to people who lived in the home.