We carried out a review of the data available to us about SELF Limited - 16 Park View on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about SELF Limited - 16 Park View, you can give feedback on this service.
About the service
S E L F Limited - 16 Park View is a care home and provides accommodation and support for up to eight people living with a learning disability. There were eight people living at the service when we visited.
People’s experience of using this service and what we found
Right Support
Since the last inspection, practices and the culture within the service had significantly improved. The registered manager was taking a more active role at the service and had ensured staff practices changed and people were free from unwarranted restrictions. People now had as much freedom, choice and control over their lives as possible. Staff effectively managed risks to minimise restrictions.
The provider and manager had improved staffing levels and ensured enough staff were on duty. Where people had support, they told us this was flexible and available when they needed it. People were supported safely with medicines and infection prevention and control practices reflected good practice. Staff managed the safety of the living environment and equipment well through checks and action to minimise risk. Work had been completed to repair the heating system.
The registered manager had worked with staff to improve the quality of record-keeping. Staff now kept clear and detailed care records, which were accurate, complete, legible and up to date. People were involved in discussions about their support and given information in a way they understood.
Right Care
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received additional training around how to recognise and report abuse. The provider had significantly improved how they looked after people’s money and all spending could be easily accounted for. Wherever possible people looked after their own money. People now had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations. People, those important to them and staff reviewed plans together regularly. Staff now ensured decisions about any routines in the service were based on people’s choices.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff enabled people to access specialist health and social care support in the community. People who lacked capacity to make certain decisions for themselves now had decisions made by staff on their behalf in line with the law. People benefitted from reasonable adjustments to their care to meet their needs, and their human rights were respected. This was because staff put their learning into practice.
People received support to eat and drink enough to maintain a balanced diet. People were involved in choosing their food, shopping, and planning their meals. Mealtimes were flexible to meet people’s needs.
Right culture
Since the last inspection the management team has changed. The previous team had created a closed, controlling and restrictive culture in the service, which had failed to promote people’s human rights. The provider and registered manager had critically reviewed the service and put effective measures in place to radically change the ethos in the service. The service was now open to new ways of working and practices were introduced to promote independence and inclusivity.
People received good quality care, support and treatment because trained staff could meet their needs and wishes. The new manager ensured staff placed people’s wishes, needs and rights at the heart of everything they did. They sought advice and feedback from everyone involved in people's care.
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 inadequate (published 14 January 2022). We identified breaches in relation to safe care and treatment, safeguarding, staffing and good governance.
Following the inspection, we issued the provider a warning notice and served requirement notices. The provider was required to provide actions plans detailing how these breaches would be addressed.
Why we inspected
We undertook this focused inspection to check whether sufficient action had been taken in response to the warning notice and requirement notices we served following our last inspection.
The provider completed an action plan after the inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper care and staffing levels. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
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 changed from inadequate to good. This is based on the findings at this 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 coronavirus and other infection outbreaks effectively.
S E L F Limited - 16 Park View is a care home and provides accommodation and support for up to eight people living with a learning disability. There were eight people living at the service when we visited.
People’s experience of using this service and what we found
Risks to people were not always safely managed, monitored or assessed. The service did not have effective systems to protect people from the risk of financial abuse. COVID-19 protocols were not always followed, and the service did not have effective systems to prevent and control the spread of infections.
Quality assurance systems were not effective, they lacked detail and did not include all aspects of the service. The issues we found during the inspection had not been recognised.
The service did not ensure enough staff were deployed to meet people’s needs. Staffing rotas did not always reflect the number of staff on duty and the provider’s expected staffing levels were not achieved.
A training programme was in place. Staff received supervisions and appraisals.
Medicines were managed safely. People were referred to health professionals when required.
People gave mixed feedback about the service. Some people told us they were happy whilst others expressed their dissatisfaction about the restrictions which were unlawfully placed upon them.
People were not supported to have maximum choice and control of their lives and staff did not support them in line with the legislation in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this 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.
Based on our review of the key questions of safe, effective and well-led the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support: Some controlling and unlawful practices had been adopted within the home.
Right care: People did not always receive person-centred care and support.
Right culture: Attitudes and behaviours of the management team did not ensure people using service lead confident, inclusive and empowered lives.
Care staff were compassionate about ensuring people lived full lives. They recognised the issues at the service and repeatedly raised concerns with the management team.
The provider is conducting a full investigation into the failings and have put actions in place to address restrictions immediately.
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 20 May 2019).
Why we inspected
The inspection was prompted in part due to concerns received about the safety of people using the service, staffing levels and management of the service. A decision was made for us to inspect and examine those risks.
An initial inspection took place on 2 September 2021 to establish that people were safe. We inspected and found there was a concern with staffing levels and the management of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.
This report only covers our findings in relation to the key questions safe, effective and well-led as we were mindful of the impact and added pressures of COVID-19 pandemic on the service.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Following the inspection, the provider has taken action to mitigate the risks. The provider was receptive to our feedback and has implemented new systems and procedures in response.
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 monitor the service.
We have identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and good governance at this inspection.
Please see the action we have told the provider to take at the end of this 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.
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.
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 6 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.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
16 Park View 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. 16 Park View provides care and support for up to eight people who have a learning disability, some of whom have a forensic background. Nursing care is not provided. There were eight people using the service at the time of our inspection.
The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the CQC individually we found that there were areas that were common to all three services. For example, training programme and delivery, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services.
The service had a registered manager in place. 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.
Risk assessments clearly set out how staff should protect people who may be at risk of absconding, or at risk of harm from others.
Staff did not always ensure confidential information was appropriately locked away and the registered manager needed to review arrangements in place for monitoring the movement of some people between services.
People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.
There were sufficient numbers of staff on duty to meet people’s needs and staff were aware of their safeguarding responsibilities.
All areas of the building were clean and processes were in place to reduce the risks of acquired infections. The premises were generally well maintained, with external servicing of equipment in place.
Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. These checks were refreshed after three years after external advice.
Medicines administration practices were safe and staff had been trained appropriately.
People had accessed external healthcare professionals such as GPs, psychiatrists, nurses and occupational therapists to get the support they needed. Staff liaised well with these professionals.
Staff received a range of mandatory training and training specific to people’s needs.
People were encouraged to have healthy diets and were protected from the risk of malnutrition, with meals being a communal, positive time.
The premises were appropriate for people’s needs and there were ample communal areas and bathing facilities.
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 practice.
Relatives and external professionals confirmed staff had formed good relationships with people, in part thanks to a continuity of care and a keyworker system.
People were encouraged to access their local community, which reduced the risk of social isolation.
The atmosphere at the home was communal and relaxed. Person-centred care plans were in place and regular house meetings took place. Care plans were reviewed regularly with people’s involvement and people were empowered to make their own choices.
The service had good links with a local farm, stables and college, and people pursued a range of activities and hobbies meaningful to them.
Auditing was in place but required improvement to become effective and manageable in the future.
People who used the service, relatives and professionals we spoke with gave positive feedback about the leadership provided by the registered manager and the personal interest they took in ensuring people’s day to day goals were met. The registered manager and staff had maintained a caring, person-centred culture within which people were supported to develop their independence.
This unannounced inspection took place on 21 September 2015, 25 September 2015 and 2 October 2015. As this home was registered with the Care Quality Commission on 5 December 2014, this was their first inspection.
S E L F Limited - 16 Park View provides care and support for up to eight people who have a learning disability. Nursing care is not provided. At the time of our inspection one person had been living in the home for five months.
The registered provider operates three separate services at Park View (numbers 14, 15 and 16). During this inspection we inspected all three services. Although the services are registered with the Care Quality Commission individually we found that there were areas that were common to all three services. For example, a single training programme, joint staff meetings and one set of policies and procedures across all three services. For this reason some of the evidence we viewed was relevant to all three services. Our findings for S E L F Limited - 14 Park View and S E L F Limited - 15 Park View are discussed in separate reports.
The home had a 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 person using the service said they were happy with their care. They confirmed staff were kind and considerate. They commented, “Kind staff. They have lovely staff here”, and, “I love it here.”
We observed throughout our inspection good relationships between the person using the service and staff. We saw they were happy to engage with the staff team. Likewise staff responded positively with the person using the service.
The person using the service was supported to be as independent as possible. They took part in structured activities to improve and develop their life skills. Staff said they felt the home was a safe place for people to live.
We found staff had a good understanding of safeguarding adults and whistle blowing. They knew how to report concerns. They felt concerns would be dealt well. One staff member said they, “Hadn’t seen anything.” They also said, “Management would deal with it well. They are easily approachable.”
Potential risks had been assessed and control measures identified. The registered provider used photographs to personalise the risk assessments.
Medicines records across all three of the registered provider’s services supported the safe administration of medicines. Staff had received medicines training from an independent pharmacist.
There were enough staff on duty to meet people’s needs. One staff member said, “There are more than enough [staff].”
Agreed recruitment and selection procedures had been followed. This included requesting and receiving references and carrying out disclosure and barring service (DBS) checks.
Health and safety checks were carried out to help keep the premises safe. This included checks of fire safety, emergency lighting, extinguishers, exit routes, gas and electrical safety. Incident and accident records confirmed action was taken following accidents to keep people safe.
Staff were well supported to fulfil their caring role. One staff member commented, “Very much supported.” Staff could have an ‘Individual Development Session’ anytime if they needed it. Staff received regular one to one supervision and appraisal.
Staff received all of the training they needed. Records confirmed completed training included specific workshops bespoke to the needs of individual people. Other training completed included risk management, moving and assisting, food hygiene, first aid and fire awareness.
The registered provider was following the requirements of the MCA. Some people using the registered provider’s services displayed behaviours that challenge. Personalised behaviour profiles gave details of best to support people needed when they were displaying behaviours that challenge. Detailed records of physical intervention showed it was only used as a last resort.
The person using the service said they were supported to have enough to eat and drink. They also had regular input from a range of health care professionals, such as GPs.
The person using the service had their care and support needs assessed, including identifying their care preferences. For example, taking part in community based activities and relaxing activities such as watching TV and listening to music. The assessment also considered the person’s ability to complete daily living tasks, such as eating, drinking, personal hygiene, cooking, cleaning and travelling independently. Detailed, person-centred care plans had been developed.
The person who used the service told us about their care plans and particular skills they were working on relating to their daily living. Key worker records showed the person met with their key worker to discuss the progress they had made.
The person using the service had opportunities to take part in activities both inside and outside of the home. These included outings and planned activities such as games, arts and crafts. They told us they usually spent time with people living in the other two Park View services.
The registered provider had a complaints procedure. No complaints had been received at the time of our inspection. People had opportunities to meet together to give their views.
The person using the service and staff told us the registered manager was approachable. They said, “The manager is kind.” One staff member said, “The manager is easily approachable.”
Staff said there was a positive atmosphere in the home. One staff member said, “I enjoy coming to work. The service users are lovely and the staff team are lovely.”
There were regular opportunities for staff to give their views. Staff said they had regular team meetings, handovers and start and end of duty meetings. One staff member said, “I have had a lot of help, there are staff meetings and handovers are done.” The registered provider consulted with staff and external professionals. We found positive feedback was received during the most recent consultation.
The registered provider carried out a quality audit to make sure people received good quality care. Audits included checks of fire safety, housekeeping, infection control, accidents, maintenance and medicines audits. The registered provider developed annual plans for improving the service.