The inspection took place on 18 and 19 July 2017 and was unannounced. Strawberry Fields provides care and accommodation for up to 10 people with a learning disability. There were eight people living at the home when we inspected and they ranged in age from 24 to 52 years.
All bedrooms were single and each had an en-suite bathroom with a toilet. The home has two lounges and a separate dining room which people used.
The service was previously inspected on 31 May and 1 June 2016; the service was rated as Requires Improvement and we served three requirements notices regarding the following:
• People were not always protected from abuse.
• The premises were not well maintained, clean or suitable for their intended purpose.
• A lack of effective systems and processes for assessing, monitoring and improving the quality and safety of the service, including accurate record not being maintained.
This inspection was carried out to check on how the provider was making progress on meeting these requirements. The inspection was also prompted by notifications received by us regarding the safety of people and staff.
The provider sent us an action plan of how the requirements made as a result of the inspection of 31 May and 1 June 2016 would be met. At this inspection we found action had been taken to meet these requirements. However, this was not always sufficient as the safety of people at the service remained a concern. Adequate action had not been taken by the provider’s management in response to incidents to ensure the safety of people and staff. The service has been rated as Requires Improvement at the last two inspections as well as this one. There has been a repeated failure to meet Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding systems and processes to assess, monitor and improve the quality and safety of the service. There has also been a repeated failure to meet Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding the protection of people from abuse.
At the time of the inspection the service had a registered manager who was shortly to leave the service and would be applying to cancel their registration with the Commission. 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 provider had made arrangements for a new manager to take over on an interim basis. This manager was already in post at the time of the inspection and was experienced in care home management as well as being familiar with the service. The manager was due to apply for registration with the Commission.
For many people living at the service there had been a reduction in the number of incidents of challenging behaviour which required staff intervention. However, we judged that since the last inspection in June 2016 incidents of behaviour had not been responded to effectively and did not ensure staff and people were safe.
Liaison and communication with health and social professionals took place regarding the management and review of challenging behaviour.
People and their relatives told us that safe care was provided. During our inspection, one person complained about being hurt by another person at the home. The person was given assurances of action that would be taken and signed a form to acknowledge that their complaint was dealt with.
Incidents of aggression and violence did not always result in the timely review of care and staffing to ensure the safe care of one person. Staff expressed concerns about safety in the home. Staff did not feel the training they received in dealing with challenging behaviour fully equipped them to provide safe care.
The provider had not notified the Health and Safety Executive of one injury to a staff member within the required timescales as required by Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).
Improvements had been made to the environment since the last inspection but we found areas where further work was needed to create a suitable and safe environment for people. We have made a recommendation regarding this.
At our last inspection, we identified that the provider did not have systems and processes fully established to assess, monitor and improve the quality and safety of the service. At this inspection, we found that improvements had been made. There were audits and checks but these did not always result in improvements being made. There were continued risks to people’s safety. Whilst the provider said they had looked at their actions regarding the care of one person, and there was evidence of care reviews, this had not effectively prevented risk of harm to people at the service. We found improvements were needed to ensure that previous requirements were fully met and to ensure safety at the service.
The system for the induction of newly appointed staff included a period of shadowing more experienced staff as well as attendance at training courses. While staff confirmed they received an induction, they told us that this was not well organised and that shadowing did not take place as intended. We saw one staff member’s induction plan record that had not been fully completed, which meant that the provider could not assure themselves that all staff had the necessary induction to undertake aspects of their role safely. Staff received training in relevant courses and had supervision.
Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.
Risks to people were assessed and care plans devised on how to mitigate these, which included the management of people’s behaviour. We saw there were numerous examples of staff taking appropriate action to divert people from behaviours which were challenging. During the inspection we observed staff dealt appropriately and skilfully with two incidents of challenging behaviour as well as one person who was agitated. The staff actions were successful in calming people.
There had been vacancies at the home in the months preceding the inspection, and also new staff were used in response to the need to change numbers and deployment of resources following incidents of violence. Staff told us that they did not always consider there were enough staff. Staff and some other stakeholders expressed concern at the turnover and high use of agency staff as this could have an impact on the quality and continuity of care. The provider had taken action to recruit more staff and said there were no current vacancies at the time of this inspection. Staff were assigned to work with people on a one to one or two staff to one person. These arrangements were recorded on staff duty rosters. During our site visit, we observed there were sufficient staff to meet people’s needs and judged the service had enough staff to look after people safely.
People received their medicines safely.
The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity to consent best interests meetings were held in line with the MCA guidance.
People were supported to receive adequate food and nutrition. Specialist diets and support were provided where this was needed.
People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.
Staff demonstrated a caring attitude to people who they treated with kindness and respect. Staff were committed to the welfare and well-being of people who they cared about. People were able to exercise choice in how they spent their time.
Each person’s needs were assessed and this included obtaining a background history of people. Care was individualised to reflect people’s preferences. Most of the health and social care professional we spoke with were satisfied with the standard of care, but two professionals expressed concerns that they were not kept informed about relevant incidents in a timely way.
People had access to range of activities based on an assessment of their social and recreational needs. These included access to community facilities, outings and holidays.
The complaints procedure was provided to people and their relatives. People said they had opportunities to express their views or concerns, which were listened to and acted on. There was a record to show complaints were looked into and any actions taken as a result of the complaint. We observed the operations manager discussing a complaint with one person. The operations manager listened and acted on what the person said.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the 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.