I'm sorry, I can't ignore the open tabs, so I'm back with more inadequate care.
@ASDSpectrumASD St Erme is the third report I've covered from Spectrum this month.
I keep banging on about why @chtycommission don't take action; looks like they are
api.cqc.org.uk/public/v1/repo…
1/
@ASDSpectrumASD St Erme is the third report I've covered from Spectrum this month.
I keep banging on about why @chtycommission don't take action; looks like they are
api.cqc.org.uk/public/v1/repo…
1/
On 14 July @ChtyCommission issued a press release saying they were opening an inquiry due to safeguarding concerns gov.uk/government/new…
They're not a safeguarding regulator and make clear substantive safeguarding matters will be investigated by regulators and/or police
2/
They're not a safeguarding regulator and make clear substantive safeguarding matters will be investigated by regulators and/or police
2/
Now we just need @ChtyCommission to open inquiries into some of the large national charities with failing provision and poor campaigning records, rather than just the smaller local ones - more here
But I guess it's good they're looking at Spectrum
3/
https://twitter.com/GeorgeJulian/status/1551985337462915074
But I guess it's good they're looking at Spectrum
3/
[Back to St Erme, here on in my comments in these square brackets, anything else is quotes from @CareQualityComm report. I may remove odd word for brevity, but never if it changes the meaning]
St Erme is a care home providing personal care for up to twenty autistic people.
4/
St Erme is a care home providing personal care for up to twenty autistic people.
4/
At the time of the inspection 12 people were living at the service.
Accommodation is across three separate houses all within the grounds.
The houses are known as The Lodge, The House and St Michaels.
There is also a small office building on site.
5/
Accommodation is across three separate houses all within the grounds.
The houses are known as The Lodge, The House and St Michaels.
There is also a small office building on site.
5/
The service is part of Spectrum (Devon and Cornwall Autistic Community Trust) which has 15 active services in Cornwall providing care and support for autistic adults and/or adults with a learning disability.
6/
6/
[There's a thread here about East Wheal Rose which requires improvement
and one here about The Beach which also requires improvement
both published this month.
Back to St Erme - which is inadequate]
7/
https://twitter.com/GeorgeJulian/status/1552739130966245376
and one here about The Beach which also requires improvement
https://twitter.com/GeorgeJulian/status/1543966848273743872
both published this month.
Back to St Erme - which is inadequate]
7/
Service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Staff and relatives told us there had been a high turnover of staff and recruitment drives to recruit permanent staff had not been successful.
8/
Staff and relatives told us there had been a high turnover of staff and recruitment drives to recruit permanent staff had not been successful.
8/
The provider relied on agency staff to increase staffing levels.
These agency staff routinely worked very long hours.
Some agency staff were committed to the service and hoped to move to the area and become permanent members of the team.
9/
These agency staff routinely worked very long hours.
Some agency staff were committed to the service and hoped to move to the area and become permanent members of the team.
9/
However, there remained concerns about the stability of the team and new staff not knowing people well or having a good understanding of their needs in order to provide good outcomes for people.
Inadequate staffing levels impacted on many aspects of the service.
10/
Inadequate staffing levels impacted on many aspects of the service.
10/
This included providing support in line with commissioned hours, developing trusting relationships with people and supporting people to take part in activities outside of the service.
11/
11/
This was compounded by a lack of drivers working at St Erme to support people to go out and do things.
[This isn't exactly a surprise is it? Stick people out in the countryside, in rural Cornwall. Up a long drive. Hide people]
12/
[This isn't exactly a surprise is it? Stick people out in the countryside, in rural Cornwall. Up a long drive. Hide people]
12/
[Then act surprised when out of area agency workers aren't confident driving around Cornish lanes. In an area they don't know. With poor mobile signal.
If ppl wanted to walk into village, where nothing goes on anyway, this is route once out long drive. Not best for walking]
13/
If ppl wanted to walk into village, where nothing goes on anyway, this is route once out long drive. Not best for walking]
13/
[Almost like we could have seen problems with campus living decades ago. Oh wait... we did.]
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests
14/
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests
14/
The policies and systems in the service did not support this practice.
There had been a high turnover of managers at the service.
The last registered manager deregistered in August 2021.
15/
There had been a high turnover of managers at the service.
The last registered manager deregistered in August 2021.
15/
Two external consultants were working at the service as manager and deputy manager.
The manager had applied for registration until a more permanent manager could be appointed.
[More consultants, but social care is broke apparently. They pay support workers £10 an hour]
16/
The manager had applied for registration until a more permanent manager could be appointed.
[More consultants, but social care is broke apparently. They pay support workers £10 an hour]
16/
Neither of the consultants lived locally and were not at the service at the weekend.
[Oh no, I mean why would they be there at the weekend, nothing ever happens at the weekend in the non-lives people lead]
17/
[Oh no, I mean why would they be there at the weekend, nothing ever happens at the weekend in the non-lives people lead]
17/
They were particularly focused on The House and a service manager had day to day oversight of The Lodge and St Michael's.
18/
18/
Staff, relatives and professionals told us the management situation had improved although there remained concerns about the temporary arrangements for managing the service.
[From a baseline of no management hard not to improve really]
19/
[From a baseline of no management hard not to improve really]
19/
The service is based in a campus style setting.
People had exclusive possession of their own rooms, in shared accommodation.
The environment was not well maintained, and people's sensory needs had not been considered when designing the service.
20/
People had exclusive possession of their own rooms, in shared accommodation.
The environment was not well maintained, and people's sensory needs had not been considered when designing the service.
20/
People were not consistently supported in the least restrictive way.
At certain times of the day people were unable to move around communal areas freely.
[eg clean the dining room and lock it so 'they' don't make a mess. That's what you all do in yr own homes isn't it?]
21/
At certain times of the day people were unable to move around communal areas freely.
[eg clean the dining room and lock it so 'they' don't make a mess. That's what you all do in yr own homes isn't it?]
21/
Cupboards and doors were routinely locked and some people were not able to access drinks or snacks when they wanted.
The new manager was working to reduce some of the restrictions in place.
[Working to... always future focused. Just take the locks off, problem solved]
22/
The new manager was working to reduce some of the restrictions in place.
[Working to... always future focused. Just take the locks off, problem solved]
22/
Staff recorded any incidents, including when people had been restricted.
There was limited learning from incident records which meant the risks of similar incidents reoccurring were not reduced.
[Well we've got to keep the PBS consultants employed; mustn't learn too much]
23/
There was limited learning from incident records which meant the risks of similar incidents reoccurring were not reduced.
[Well we've got to keep the PBS consultants employed; mustn't learn too much]
23/
Staff supported people to receive their medicines safely and in the privacy of their own rooms.
People did not always have access to homely remedies and we have made a recommendation about this in the report.
24/
People did not always have access to homely remedies and we have made a recommendation about this in the report.
24/
[Homely remedies are over counter painkillers etc. TY @_louiseheatley for explaining that earlier this month]
Staff enabled people to access health and social care support in the community.
25/
Staff enabled people to access health and social care support in the community.
25/
The service did not have enough appropriately skilled staff to meet people's needs and preferences.
This placed further restrictions on people as they were not able to go out when they wanted.
[Non-lives, contained in the Cornish countryside, perpetual lockdown]
26/
This placed further restrictions on people as they were not able to go out when they wanted.
[Non-lives, contained in the Cornish countryside, perpetual lockdown]
26/
People's access to activities was limited, both in and out of the service.
There were few opportunities to try new experiences.
People generally went on local walks or shopping trips.
[Same old walk, down same old lanes, to same old non-destination. This is not a life]
27/
There were few opportunities to try new experiences.
People generally went on local walks or shopping trips.
[Same old walk, down same old lanes, to same old non-destination. This is not a life]
27/
People's care plans did not always accurately reflect their needs.
Staff were unaware of some of the information which described how to support people when they were sad or anxious.
28/
Staff were unaware of some of the information which described how to support people when they were sad or anxious.
28/
People were not leading inclusive and empowered lives because the provider and staff had low expectations for them.
There was a culture of presuming people were unable to progress, gain skills or set goals in order to live full and rich lives.
[Non-lives, non-futures]
29/
There was a culture of presuming people were unable to progress, gain skills or set goals in order to live full and rich lives.
[Non-lives, non-futures]
29/
Staff turnover was high; recruitment practices did not focus on quality.
People were not receiving consistent care from people who knew them well and were committed to delivering a high-quality service.
30/
People were not receiving consistent care from people who knew them well and were committed to delivering a high-quality service.
30/
People's rights were not respected.
The provider had failed to make reasonable adjustments for people to manage their sensory sensitivities.
[This place is dire. Imagine being stuck there, literally stuck there]
31/
The provider had failed to make reasonable adjustments for people to manage their sensory sensitivities.
[This place is dire. Imagine being stuck there, literally stuck there]
31/
Last rating for this service was inadequate and there were breaches of the regulations (published 14 December 2021).
At this inspection not enough improvement had been made and the provider was still in breach of regulations.
[So much apathy, so little care to improve]
32/
At this inspection not enough improvement had been made and the provider was still in breach of regulations.
[So much apathy, so little care to improve]
32/
We identified seven breaches in relation to the provision of person-centred care, dignity and respect, safety and risk management, safeguarding people from abuse, maintenance of the premises, staffing levels and management of the service.
Six of these were repeat breaches.
33/
Six of these were repeat breaches.
33/
[Then the report highlights how @CareQualityComm approach failing provision, details special measures, all the stuff I've typed over and over this month. I'll not repeat but its in the report if you want to see it.
Let's look a bit closer at what life is like in St Erme]
34/
Let's look a bit closer at what life is like in St Erme]
34/
At the time of our inspection there was no registered manager in post.
The manager had submitted an application to the CQC to register as the manager of the service.
The inspection site visits took place on 3, 6 and 7 May 2022. This inspection was unannounced.
35/
The manager had submitted an application to the CQC to register as the manager of the service.
The inspection site visits took place on 3, 6 and 7 May 2022. This inspection was unannounced.
35/
[Safe - inadequate]
At the last inspection this key question was rated as inadequate.
At this inspection this key question has remained the same.
This meant people were not safe and were at risk of avoidable harm.
[Imagine being stuck here, at risk of avoidable harm]
36/
At the last inspection this key question was rated as inadequate.
At this inspection this key question has remained the same.
This meant people were not safe and were at risk of avoidable harm.
[Imagine being stuck here, at risk of avoidable harm]
36/
At the last inspection the provider had failed to provide sufficient numbers of staff to ensure people living at the service were safe.
This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
37/
This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
37/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 18.
There were not sufficient numbers of skilled staff available to support people in line with their identified needs.
38/
There were not sufficient numbers of skilled staff available to support people in line with their identified needs.
38/
There is a condition on the registration of St Erme whereby the provider is required to provide information about staffing levels to CQC every month.
The records provided for April 2022 showed the service had failed to have the commissioned number of staff hours on 14 days.
39/
The records provided for April 2022 showed the service had failed to have the commissioned number of staff hours on 14 days.
39/
On one day they fell below the provider's contingency levels.
This was the minimum number of staff required to ensure people were safe as defined by the provider.
This meant the provider had exposed people to the risk of unsafe care.
40/
This was the minimum number of staff required to ensure people were safe as defined by the provider.
This meant the provider had exposed people to the risk of unsafe care.
40/
There were occasions when there were not enough staff to enable people to go out when they wanted to.
Staff meeting minutes read;
"Due to staffing shortages and no drivers [Name] has not been able to go out."
41/
Staff meeting minutes read;
"Due to staffing shortages and no drivers [Name] has not been able to go out."
41/
Commissioners had assessed some people needed support from two members of staff for a period of the day.
Rotas showed people did not always receive this planned support.
An external professional confirmed they had observed people did not get their allocated support.
42/
Rotas showed people did not always receive this planned support.
An external professional confirmed they had observed people did not get their allocated support.
42/
Low staffing numbers impacted on the quality of care provided and people's opportunities to live full and meaningful lives in the way they wish.
There was a heavy, frequent reliance on agency staff who worked long hours.
43/
There was a heavy, frequent reliance on agency staff who worked long hours.
43/
This meant that if they had unplanned leave their shifts were difficult to cover at short notice.
This was compounded by the service frequently being staffed at low numbers which did not enable people to have support from two members of staff.
44/
This was compounded by the service frequently being staffed at low numbers which did not enable people to have support from two members of staff.
44/
This meant there was a risk people would not be able to take part in planned activities or attend appointments if staffing numbers fell below the expected level.
45/
45/
On the first day of the inspection it was one person's birthday.
A member of staff had planned to take them out for the day, but they were absent due to sickness.
There were not enough staff available to rearrange this, so the person was unable to go out.
[Their birthday]
46/
A member of staff had planned to take them out for the day, but they were absent due to sickness.
There were not enough staff available to rearrange this, so the person was unable to go out.
[Their birthday]
46/
Relatives commented;
"There has been a turnaround which has meant a loss of continuity"
and
"There has been a shift because of losing staff, not getting the hours [name] needs with the right people and skills."
47/
"There has been a turnaround which has meant a loss of continuity"
and
"There has been a shift because of losing staff, not getting the hours [name] needs with the right people and skills."
47/
External professionals told us staff did not always have the skills required to support people.
Comments included;
"Staff I have directly worked with have tended to lack understanding and training of learning disability, autism and communication skills..."
48/
Comments included;
"Staff I have directly worked with have tended to lack understanding and training of learning disability, autism and communication skills..."
48/
"... for some time after they start working with complex individuals"
[Which is a sure fire indication that there isn't enough skill or knowledge in the existing staff team, or the skills and knowledge there aren't any good. That 'for some time' is doing some work there]
49/
[Which is a sure fire indication that there isn't enough skill or knowledge in the existing staff team, or the skills and knowledge there aren't any good. That 'for some time' is doing some work there]
49/
and
"There continues to be high numbers of agency staff and/or new Spectrum staff working with the individual, who are unfamiliar to them, and are not confident in supporting them and do not understand their needs, such as important routines."
50/
"There continues to be high numbers of agency staff and/or new Spectrum staff working with the individual, who are unfamiliar to them, and are not confident in supporting them and do not understand their needs, such as important routines."
50/
This was a continued breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
[I gotta go get paper, and feed dog/cat and scream into the void as I freely move about my life and think of those that can't. More later]
51/
[I gotta go get paper, and feed dog/cat and scream into the void as I freely move about my life and think of those that can't. More later]
51/
Recruitment checks were not always robust. One person had not been asked for references from their previous employment where they had provided care and support to older people.
This was contrary to Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities)
52/
This was contrary to Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities)
52/
Following the inspection we highlighted this to the provider who subsequently requested and received a reference from the previous employer.
[Imagine your service being in special measures and you don't even bother to do the basics, unless @CareQualityComm tell you to]
53/
[Imagine your service being in special measures and you don't even bother to do the basics, unless @CareQualityComm tell you to]
53/
At the last inspection the provider had failed to ensure people received safe care.
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
54/
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
54/
Not enough improvement had been made at this inspection and provider was still in breach of regulation 12.
Risk assessments had been completed for staff working long hours. These stated staff should not work more than 84 hours per week with a minimum of one day off each wk.
55/
Risk assessments had been completed for staff working long hours. These stated staff should not work more than 84 hours per week with a minimum of one day off each wk.
55/
[There was a comment earlier about agency staff being from out of area. What's the story do you think? Are they recruiting staff in and providing accommodation, in the middle of the Cornish countryside with no transport so they do nothing but work?]
56/
56/
These assessments recognised that staff tiredness could impact on the accuracy of record keeping, medication management and on the staff members psychological wellbeing.
[I mean staff lack of skill or knowledge around learning disability/autism could impact on that too]
57/
[I mean staff lack of skill or knowledge around learning disability/autism could impact on that too]
57/
However, risk assessments did not identify any risks in relation to the quality of support provided by tired staff, working excessive hours.
These risk assessments had not been complied with.
[Performative paperwork - risk asst to say its been done, not to actually follow]
58/
These risk assessments had not been complied with.
[Performative paperwork - risk asst to say its been done, not to actually follow]
58/
On the week beginning 24 April 2022, three members of staff had worked 14 hour shifts on seven consecutive days; a total of 98 hours.
[Another example of why health and social care shouldn't be compared to the airline industry, the basics aren't there #ptsafety]
59/
[Another example of why health and social care shouldn't be compared to the airline industry, the basics aren't there #ptsafety]
59/
Working this number of hours significantly increased the risk of staff becoming tired.
This unnecessarily exposed both the staff member and people they supported to a risk of harm to their health and well-being.
60/
This unnecessarily exposed both the staff member and people they supported to a risk of harm to their health and well-being.
60/
Staff had access to walkie talkies so they could call on each other for help if they needed it.
This was particularly important as some people were often supported by a single member of staff in their own accommodation.
61/
This was particularly important as some people were often supported by a single member of staff in their own accommodation.
61/
If staff needed additional support walkie talkies cld enable them to request this without leaving the person alone.
We found walkie talkies that had not been charged so staff could not rely on them if they needed to.
[Joanna Bailey's inquest, phones not charged, she died]
62/
We found walkie talkies that had not been charged so staff could not rely on them if they needed to.
[Joanna Bailey's inquest, phones not charged, she died]
62/
Fire checks were not consistently completed.
For example, no tests of fire extinguishers in The House had been recorded since the 6 March 2022.
Fire alarms and automatic door release devices were last recorded as having been tested on 20 January 2022.
63/
For example, no tests of fire extinguishers in The House had been recorded since the 6 March 2022.
Fire alarms and automatic door release devices were last recorded as having been tested on 20 January 2022.
63/
There were no fire exit signs in place throughout the service.
A list of fire safety competent staff and wardens listed five members of staff.
None of them were still working at the service.
[None]
This meant staff did not have access to the most up to date information.
64/
A list of fire safety competent staff and wardens listed five members of staff.
None of them were still working at the service.
[None]
This meant staff did not have access to the most up to date information.
64/
This was a continued breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
[How many continued breaches before someone says enough is enough? These are people's lives at risk]
65/
[How many continued breaches before someone says enough is enough? These are people's lives at risk]
65/
At the last inspection the provider had failed to ensure systems to prevent the spread of infection were embedded.
This contributed to a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
66/
This contributed to a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
66/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 12.
We were not assured that the provider was preventing visitors from catching and spreading infections.
67/
We were not assured that the provider was preventing visitors from catching and spreading infections.
67/
During the inspection inspectors were not always asked for proof of a recent negative lateral flow test and temperature checks were not always completed before they were admitted into the service.
68/
68/
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
69/
69/
At the last inspection the provider had failed to learn from untoward incidents.
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
70/
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
70/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 12.
Systems to support learning from incidents and accidents were not robust.
71/
Systems to support learning from incidents and accidents were not robust.
71/
Incident reports were shared with a Positive Behaviour Support practitioner based at head office who then used the information to help them understand why people were becoming distressed and how they might be better supported.
72/
72/
Daily records sometimes indicated people had become distressed leading to incidents.
Corresponding incident reports had not always been completed.
The failure to complete the records meant opportunities to drive improvements might be lost.
73/
Corresponding incident reports had not always been completed.
The failure to complete the records meant opportunities to drive improvements might be lost.
73/
When risks had been identified action to minimise the risk was not always taken.
CQC had received a notification in respect of an incident when one person had left the service without support when they were not being observed as appropriate.
74/
CQC had received a notification in respect of an incident when one person had left the service without support when they were not being observed as appropriate.
74/
During inspection we saw staff inappropriately leave the person alone whilst they attended to laundry.
This indicated no measures had been put in place to minimise risk of the person again leaving the service without the correct level of support putting them at risk of harm
75/
This indicated no measures had been put in place to minimise risk of the person again leaving the service without the correct level of support putting them at risk of harm
75/
This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
76/
76/
At last inspection the provider had failed to ensure people were safeguarded from abuse and improper treatment.
This was a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities)
77/
This was a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities)
77/
Not enough improvement had been made at this inspection and the provider remained in breach of regulation 13.
People were subjected to restrictive practices that were not proportionate or appropriate.
One person had their access to drinks restricted due to health reasons.
78/
People were subjected to restrictive practices that were not proportionate or appropriate.
One person had their access to drinks restricted due to health reasons.
78/
This could cause them to become anxious and distressed.
Daily records showed staff had improperly used access to drinks as a reward.
For example; "Due to his behaviour we were waiting for some good, calm company from him so that he could have coke as a reward..."
79/
Daily records showed staff had improperly used access to drinks as a reward.
For example; "Due to his behaviour we were waiting for some good, calm company from him so that he could have coke as a reward..."
79/
"...and that was communicated to [Name], but that never came"
[There is so much, so wrong, with this. Where to even start. Name is not a dog. Name should not be subjected to behavioural conditioning in the first place. Especially so inappropriately used]
80/
[There is so much, so wrong, with this. Where to even start. Name is not a dog. Name should not be subjected to behavioural conditioning in the first place. Especially so inappropriately used]
80/
"On the way back [Name] asked to have lemonade. I offered him other drinks as fizzy drinks are used to reinforce positive behaviour and thus it was not applicable, which I explained to [Name]. [Name] then went into incident in the garden."
[Don't blame them, I would too]
81/
[Don't blame them, I would too]
81/
This potentially restrictive practice was not in their care plan and was not in accordance with good practice.
[It's abuse]
At the last inspection we noted people were not able to keep to their preferred routines and were restricted about where they went and when.
82/
[It's abuse]
At the last inspection we noted people were not able to keep to their preferred routines and were restricted about where they went and when.
82/
This remained the case at this inspection.
One person routinely got up early and indicated they wanted to come downstairs but were often told it was 'too early.'
83/
One person routinely got up early and indicated they wanted to come downstairs but were often told it was 'too early.'
83/
This approach was not consistent, on occasion they would join night staff downstairs while at other times they were told they needed to wait until day staff came on shift.
84/
84/
This had sometimes resulted in the person becoming distressed leading to an incident when they had set fire alarms off disturbing other people living at St Erme.
[They're communicating how hacked off they are, don't blame them in the slightest]
85/
[They're communicating how hacked off they are, don't blame them in the slightest]
85/
Systems to ensure people had access to their own money were not robust.
A manager who had the sole mandate to people's accounts had been absent for several months.
This meant no-one was able to withdraw money on people's behalf so people did not have access to their money.
86/
A manager who had the sole mandate to people's accounts had been absent for several months.
This meant no-one was able to withdraw money on people's behalf so people did not have access to their money.
86/
There had been some surplus cash available, but this had now run out and the provider had loaned people money.
The manager told us they expected the situation to be resolved in the next two to three weeks.
[No words. No access to their own money. When is this ever ok?]
87/
The manager told us they expected the situation to be resolved in the next two to three weeks.
[No words. No access to their own money. When is this ever ok?]
87/
Further restrictive practices were in place which were not fully understood by staff. This is covered in the 'effective' section of the report.
This was a breach of Reg 13 (Safeguarding service users from abuse and improper treatment) of Health and Social Care Act 2008
88/
This was a breach of Reg 13 (Safeguarding service users from abuse and improper treatment) of Health and Social Care Act 2008
88/
People did not have access to over the counter medicines or homely remedies for treatment of minor ailments.
Staff contacted the GP for all medicines.
[Imagine waiting for a GP appointment when you have a headache, cant just get a paracetamol]
89/
Staff contacted the GP for all medicines.
[Imagine waiting for a GP appointment when you have a headache, cant just get a paracetamol]
89/
This meant people might have had a delay in obtaining medicines that cld be bought over the counter.
Medicine records were not always clear.
90/
Medicine records were not always clear.
90/
Although accurate in terms of medicine name, dose and directions, handwritten medicines administration records did not contain all the required information, for example additional warnings about drowsiness or gaps between doses.
91/
91/
There was a recent audit of medicines systems and processes that identified some areas for improvement.
[Some]
We recommend the provider ensures that medicines processes meet best practice guidance.
92/
[Some]
We recommend the provider ensures that medicines processes meet best practice guidance.
92/
[Effective - inadequate]
At the last inspection this key question was rated as inadequate. At this inspection this key question has remained the same.
This meant there were widespread and significant shortfalls in people's care, support and outcomes.
93/
At the last inspection this key question was rated as inadequate. At this inspection this key question has remained the same.
This meant there were widespread and significant shortfalls in people's care, support and outcomes.
93/
At the last inspection the provider had failed to ensure they were acting lawfully when people were deprived of their liberty.
This was a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008
94/
This was a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008
94/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 13.
People had restrictions on their liberty.
These were not always understood by staff.
One person had snacks kept in a cupboard which was kept locked.
95/
People had restrictions on their liberty.
These were not always understood by staff.
One person had snacks kept in a cupboard which was kept locked.
95/
One member of staff told us this was because the person would eat all the food if they were able to access it.
However, a fridge in the same room also contained snacks and this was not locked.
Staff confirmed the person did not take food from here without support.
96/
However, a fridge in the same room also contained snacks and this was not locked.
Staff confirmed the person did not take food from here without support.
96/
The provider had not identified or assessed whether this restrictive act was proportionate to the risk of harm.
Another member of staff told us the cupboard was locked because otherwise another person living at the service would enter the flat and take the food...
97/
Another member of staff told us the cupboard was locked because otherwise another person living at the service would enter the flat and take the food...
97/
...although both people were supported at all times by at least one member of staff.
[Which of course means cupboards should never need locked]
The disparity in explanations for locking the cupboard showed staff were unsure of the reasons behind the restrictive practice.
98/
[Which of course means cupboards should never need locked]
The disparity in explanations for locking the cupboard showed staff were unsure of the reasons behind the restrictive practice.
98/
The service was not acting in line with the conditions of the DoLS authorisation which stated food cupboards were to be locked when the person was alone.
When staff were present, they were to be unlocked to enable the person to help themselves to their choice of snacks.
99/
When staff were present, they were to be unlocked to enable the person to help themselves to their choice of snacks.
99/
Another person had a locked cupboard which contained games and stationery.
Staff told us this did not need to be kept locked.
100/
Staff told us this did not need to be kept locked.
100/
This was a breach of Regulation 13 (Safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
101/
101/
At our last inspection we found the service was not operating in line with the principles of Right Support, Right Care, Right Culture.
At this inspection we found this remained the case.
102/
At this inspection we found this remained the case.
102/
There were plans in place to physically separate the buildings, but this had not been completed.
There were no specific plans to address the more basic issue of ensuring people were supported to live a life like any other citizen.
103/
There were no specific plans to address the more basic issue of ensuring people were supported to live a life like any other citizen.
103/
People's needs were assessed, and the information used to develop care plans.
The care records were large with a lot of information.
Professionals told us they were difficult to navigate.
104/
The care records were large with a lot of information.
Professionals told us they were difficult to navigate.
104/
This was particularly concerning due to the high turnover of staff meaning new staff would routinely be required to gain a good understanding of people's assessed needs.
Some information was incorrect and staff were unaware of it.
105/
Some information was incorrect and staff were unaware of it.
105/
One care plan stated staff could use heat pads to distract the person when they were sad. Staff did not know what these were.
One person had a specific health need. There was no corresponding care plan to guide staff on how best to support the person in this area.
106/
One person had a specific health need. There was no corresponding care plan to guide staff on how best to support the person in this area.
106/
This contributed to the breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
107/
107/
At the last inspection the provider had failed to ensure records for staff training and supervision were available.
This contributed to a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
108/
This contributed to a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
108/
Improvements had been made to how training and supervision records were maintained.
However, the service remains in breach of Regulation 17.
Please see the Well-Led section of the report for details.
109/
However, the service remains in breach of Regulation 17.
Please see the Well-Led section of the report for details.
109/
New staff, including agency staff completed a 'fast track' induction before starting work at the service.
Staff told us they received regular supervision. One commented, "It's gone from nothing to almost too much!"
110/
Staff told us they received regular supervision. One commented, "It's gone from nothing to almost too much!"
110/
At the last inspection the provider had failed to provide people with a healthy diet in line with their personal preferences.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
111/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
111/
Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 9 in this particular area.
[Altho ppl still couldn't access their own snacks in locked cupboards]
112/
[Altho ppl still couldn't access their own snacks in locked cupboards]
112/
People were sometimes able to make personal choices about what they ate. Menu boards in The House showed meal plans were specific to individuals.
Daily records showed ppl were supported to make choices about what they ate.
[Except fizzy drinks, which were kept as bribery]
113/
Daily records showed ppl were supported to make choices about what they ate.
[Except fizzy drinks, which were kept as bribery]
113/
At the last inspection the provider had failed to adequately maintain the environment. This contributed to a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
114/
114/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17 with regard to good governance.
Please see the well-led findings below.
The provider was also in breach of Regulation 15 of the Health and Social Care Act 2008
115/
Please see the well-led findings below.
The provider was also in breach of Regulation 15 of the Health and Social Care Act 2008
115/
Some improvements had been made to internal environment, flooring had been replaced and radiator covers fitted.
There remained areas where improvements were required in order to provide a comfortable and sensory environment which met people's physical and emotional needs.
116/
There remained areas where improvements were required in order to provide a comfortable and sensory environment which met people's physical and emotional needs.
116/
One kitchen had damaged worktops. These were unsightly and difficult to keep clean.
The top to a tap in the bathroom was missing.
Staff told us this was removed at times to stop person potentially flooding the bathroom.
[Person who no doubt was meant to be accompanied]
117/
The top to a tap in the bathroom was missing.
Staff told us this was removed at times to stop person potentially flooding the bathroom.
[Person who no doubt was meant to be accompanied]
117/
They were unable to locate the missing component.
This meant the person could not be supported to use the bathroom sink.
Alternative solutions, such as a self-closing tap, had not been considered.
118/
This meant the person could not be supported to use the bathroom sink.
Alternative solutions, such as a self-closing tap, had not been considered.
118/
The outside of the service appeared uncared for.
[People's home in the scenic Cornish countryside]
Old chairs had been left outside of The Lodge and immediately outside the front door there were three bins and a recycling box.
119/
[People's home in the scenic Cornish countryside]
Old chairs had been left outside of The Lodge and immediately outside the front door there were three bins and a recycling box.
119/
On the first day of the inspection there was an old sofa outside The House, staff told us they were waiting for it to be collected and it had been there several days.
When the Nominated Individual arrived, they arranged for it to be picked up later that day.
120/
When the Nominated Individual arrived, they arranged for it to be picked up later that day.
120/
A fence had been damaged in storms but had not been fully replaced even though maintenance requests had been submitted since February 2022 meaning the garden was not secure for one person.
[3mths later. Trapped inside]
121/
[3mths later. Trapped inside]
121/
Because of a risk of the person leaving the service without support this meant they were unable to spend time in their garden if and when they wished.
122/
122/
This failure to ensure the premises were secure and well-maintained was a breach of Regulation 15 (Premises) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
123/
123/
One person's care plan directed staff to monitor a particular aspect of their health to ensure they consulted with professionals in a timely manner if there were any changes.
The monitoring records were not consistently completed.
124/
The monitoring records were not consistently completed.
124/
People's access to external healthcare professionals had improved since our inspection in October 2021.
Records showed people had attended GP appointments and had met with other healthcare professionals.
[Inspection induced healthcare; so guess CQC need to visit more]
125/
Records showed people had attended GP appointments and had met with other healthcare professionals.
[Inspection induced healthcare; so guess CQC need to visit more]
125/
[Caring - requires improvement]
At the last inspection this key question was rated as requires improvement. At this inspection this key question has remained the same.
This meant people did not always feel well-supported, cared for or treated with dignity and respect.
126/
At the last inspection this key question was rated as requires improvement. At this inspection this key question has remained the same.
This meant people did not always feel well-supported, cared for or treated with dignity and respect.
126/
At the last inspection the provider had failed to ensure people were supported to make choices about how they lived their lives and developed their independence.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008
127/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008
127/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 9.
128/
128/
At the last inspection we found people were not free to live life according to their preferred routines.
At this inspection we found the situation had not changed.
129/
At this inspection we found the situation had not changed.
129/
One person liked to get up early and often indicated they would like to go to the shared lounge.
Daily logs showed staff would normally tell them it was 'too early' and the person needed to wait for day staff to arrive on shift.
[This is abuse. In someone's home]
130/
Daily logs showed staff would normally tell them it was 'too early' and the person needed to wait for day staff to arrive on shift.
[This is abuse. In someone's home]
130/
An action plan stated;
"Please ensure all service users can use their own apartments and communal areas without restriction."
This was not being complied with and did not demonstrate there was always a caring and courteous approach to supporting people.
131/
"Please ensure all service users can use their own apartments and communal areas without restriction."
This was not being complied with and did not demonstrate there was always a caring and courteous approach to supporting people.
131/
On occasion the person was allowed to sit with night staff in the lounge.
This showed the approach of staff was not consistent and caused confusion and anxiety for the person.
132/
This showed the approach of staff was not consistent and caused confusion and anxiety for the person.
132/
Plans to ensure people had access to sensory experiences were not implemented in a timely way.
A sensory shed was planned for one person, this had been purchased but not erected.
Records showed requests to maintenance had been made regularly since 3 March 2022.
133/
A sensory shed was planned for one person, this had been purchased but not erected.
Records showed requests to maintenance had been made regularly since 3 March 2022.
133/
This meant the person's need for sensory regulation and support was not addressed in a caring, therapeutic and timely manner.
[We'll buy the shed to perform to @CareQualityComm and commissioners that we're equipped to provide support, and leave it in the box somewhere]
134/
[We'll buy the shed to perform to @CareQualityComm and commissioners that we're equipped to provide support, and leave it in the box somewhere]
134/
Staff did not consistently support people according to their needs and with respect for their communication preferences.
We saw one person indicating they wanted a drink.
A member of staff told them they needed to wait an hour.
135/
We saw one person indicating they wanted a drink.
A member of staff told them they needed to wait an hour.
135/
The manager told us the person did not have their fluids restricted and would not understand the concept of an hour.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
136/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
136/
We saw some examples of positive and patient interactions between some staff and people.
We observed staff responding to people when they wanted to interact and taking time to check they understood what the person was asking for.
137/
We observed staff responding to people when they wanted to interact and taking time to check they understood what the person was asking for.
137/
Relatives told us that, although staff had not always had the time to develop an understanding of people's needs, they generally found them to be caring.
Comments included;
"Staff absolutely treat [Name] in a caring way, with kindness"
138/
Comments included;
"Staff absolutely treat [Name] in a caring way, with kindness"
138/
At the last inspection systems to capture people's views and experiences were not well established.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
139/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
139/
Not enough improvement had been made at this inspection and provider was still in breach of Reg 9.
There were no robust systems in place for capturing people's views.
[Setting fire alarms off feels pretty robust way of sharing your views, but then if nothing is done...]
140/
There were no robust systems in place for capturing people's views.
[Setting fire alarms off feels pretty robust way of sharing your views, but then if nothing is done...]
140/
There was a culture of not attending to people's views or taking them seriously.
Daily records for one person described an occasion when they were agitated.
141/
Daily records for one person described an occasion when they were agitated.
141/
The records stated;
"[Name] responded with light physical aggression, mainly in the form of hitting surfaces and shouting out, but this has become standard [Name] behaviour."
[This makes my head scream. Name is communicating. Stop ignoring them]
142/
"[Name] responded with light physical aggression, mainly in the form of hitting surfaces and shouting out, but this has become standard [Name] behaviour."
[This makes my head scream. Name is communicating. Stop ignoring them]
142/
People's opportunities to be involved in day to day decisions were sometimes restricted due to low staffing.
On the first day of the inspection a member of staff had come into work to do a food shop for people as this had not been completed the day before as planned.
143/
On the first day of the inspection a member of staff had come into work to do a food shop for people as this had not been completed the day before as planned.
143/
They commented;
"Ideally we would support every person to do their own shopping, but we don't have the drivers."
Staff meeting minutes stated;
"We sometimes struggle with drivers to complete weekly food shopping..."
144/
"Ideally we would support every person to do their own shopping, but we don't have the drivers."
Staff meeting minutes stated;
"We sometimes struggle with drivers to complete weekly food shopping..."
144/
"...looking forward we are hoping to get a bank card to make it easier to shop on-line for delivery.
Between three flats there will be products available to prepare an evening meal."
[All about staff convenience, nothing about living a life. Also food sharing by default]
145/
Between three flats there will be products available to prepare an evening meal."
[All about staff convenience, nothing about living a life. Also food sharing by default]
145/
This demonstrated there were times when people's personal choices about their diet would be limited.
[Wonder if the person would have come in to do the food shop if CQC weren't in too, or whether people would have had to mix n match with whatever was available on campus]
146/
[Wonder if the person would have come in to do the food shop if CQC weren't in too, or whether people would have had to mix n match with whatever was available on campus]
146/
At the last inspection people were not consistently treated with respect or supported to develop their independence.
This was a breach of Regulation 10 (Dignity and respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
147/
This was a breach of Regulation 10 (Dignity and respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
147/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 10.
At the last inspection we saw one person did not have suitable equipment in place to support their independence.
148/
At the last inspection we saw one person did not have suitable equipment in place to support their independence.
148/
A kitchen was set up in a small cupboard space and was locked when not in use.
This was not working so a tabletop oven was available for use.
[A kitchen in a cupboard, like a short term AirBnB solution; except this is someone's home, where they never get to leave]
149/
This was not working so a tabletop oven was available for use.
[A kitchen in a cupboard, like a short term AirBnB solution; except this is someone's home, where they never get to leave]
149/
If placed at the front of the table, the person using it had a habit of forcefully pushing it back against the wall when they had completed any task which meant there was a risk of scalding.
If it was placed against the wall it was directly under plug sockets.
150/
If it was placed against the wall it was directly under plug sockets.
150/
The wall was not porous and there was no splash back.
The equipment made available to them did not respect the development or maintenance of the person's independent living skills.
151/
The equipment made available to them did not respect the development or maintenance of the person's independent living skills.
151/
No improvements had been made to rectify this.
A member of staff told us;
"[Name's] kitchen has not changed; we keep asking but nothing is done. It's as frustrating for us as it is for him."
[Non-lives endured in non-care homes]
152/
A member of staff told us;
"[Name's] kitchen has not changed; we keep asking but nothing is done. It's as frustrating for us as it is for him."
[Non-lives endured in non-care homes]
152/
We found indicators staff did not always respect that St Erme was people's own home.
The area immediately outside The House was littered with discarded cigarette ends.
[Wonder how many of the residents, who aren't allowed to pick their own snacks, are allowed to smoke]
153/
The area immediately outside The House was littered with discarded cigarette ends.
[Wonder how many of the residents, who aren't allowed to pick their own snacks, are allowed to smoke]
153/
[Imagine, standing outside someone's home and just flicking your fag butt on the floor.
Imagine if your postman did that. Just left your garden/front step littered with fag ends.
Your home]
154/
Imagine if your postman did that. Just left your garden/front step littered with fag ends.
Your home]
154/
Language used by staff was not consistently respectful. One member of staff referred to 'the su' and another described one person as 'kicking off.'
This was a breach of Regulation 10 (Dignity and respect) of the Health and Social Care Act 2008
[No words]
155/
This was a breach of Regulation 10 (Dignity and respect) of the Health and Social Care Act 2008
[No words]
155/
[Responsive - inadequate]
At the last inspection this key question was rated as inadequate.
At this inspection this key question has remained the same.
This meant services were not planned or delivered in ways that met people's needs.
156/
At the last inspection this key question was rated as inadequate.
At this inspection this key question has remained the same.
This meant services were not planned or delivered in ways that met people's needs.
156/
At the last inspection the provider had failed to ensure people's care was designed in a way which met their preferences and needs.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
157/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
157/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 9.
At our previous inspection we identified one person was often incontinent during the night.
158/
At our previous inspection we identified one person was often incontinent during the night.
158/
There was no continence care plan in place to guide staff on how to support the person in this area.
This showed an acceptance of the issue with no drive to improve matters and help the person have more comfortable nights.
[Lying in your own urine, for evermore]
159/
This showed an acceptance of the issue with no drive to improve matters and help the person have more comfortable nights.
[Lying in your own urine, for evermore]
159/
An action plan developed following the inspection stated care plans should be developed for anyone with incontinence and referrals made for support.
This was marked as 'complete'.
However, there was no care plan in place and manager confirmed no referral had been made.
160/
This was marked as 'complete'.
However, there was no care plan in place and manager confirmed no referral had been made.
160/
[Fraud again I guess. Or lying. Certainly no candour.
I'd love to know how much resource @CareQualityComm actually have to monitor and follow up these so called action plans once failings are identified.
Suspect they're frequently gamed]
161/
I'd love to know how much resource @CareQualityComm actually have to monitor and follow up these so called action plans once failings are identified.
Suspect they're frequently gamed]
161/
Low staffing numbers impacted on people's choice and control in their day to day lives.
Daily records showed people were unable to go out when they wanted.
162/
Daily records showed people were unable to go out when they wanted.
162/
They were not routinely involved in shopping due to the pressure on the staff team to complete the job with limited number of staff who could drive.
163/
163/
In The House people had not been supported to identify goals.
The manager told us they were arranging for a member of staff from The Lodge to work with staff to develop their skills in this area. This had not yet been completed.
[Improvement always on the distant horizon]
164/
The manager told us they were arranging for a member of staff from The Lodge to work with staff to develop their skills in this area. This had not yet been completed.
[Improvement always on the distant horizon]
164/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
165/
165/
At the last inspection the provider had failed to ensure people's care was designed in a way which met their preferences and needs.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
166/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
166/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 9.
At the previous inspection we saw some people used Makaton, a simple signing system, to support their communication.
167/
At the previous inspection we saw some people used Makaton, a simple signing system, to support their communication.
167/
Staff had not completed training in the use of Makaton.
At this inspection we identified that staff still had not received the training.
A relative told us; "Staff know him, but have difficulty communicating leaving him frustrated."
168/
At this inspection we identified that staff still had not received the training.
A relative told us; "Staff know him, but have difficulty communicating leaving him frustrated."
168/
[To be honest if I lived here I suspect I'd be setting off fire alarms, punching holes in walls, chances are punching those supposedly providing me with support in the face, out of sheer and utter frustration.
Reading this makes me want to yell. Imagine being stuck there]
169/
Reading this makes me want to yell. Imagine being stuck there]
169/
Person's daily logs stated;
"Having this one on one time with staff who understand his signs seemed to help [Name] relax."
This demonstrated importance of staff knowledge of people's preferred communication systems.
[Imagine writing it down, but not providing training]
170/
"Having this one on one time with staff who understand his signs seemed to help [Name] relax."
This demonstrated importance of staff knowledge of people's preferred communication systems.
[Imagine writing it down, but not providing training]
170/
Communication tools were not being used to support people's understanding.
One person's care plan stated they should have a schedule sheet on their bedroom wall so they would be aware of what was planned for the day.
This was not in place.
171/
One person's care plan stated they should have a schedule sheet on their bedroom wall so they would be aware of what was planned for the day.
This was not in place.
171/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
172/
172/
At the last inspection the provider had failed to ensure people's care was designed in a way which met their preferences and needs.
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
173/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
173/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 9.
People were not supported to regularly take part in activities that they enjoyed.
174/
People were not supported to regularly take part in activities that they enjoyed.
174/
For example, one person's care plan stated they enjoyed swimming and horse riding.
The daily logs for April showed they had gone riding once during this period and had not been swimming.
[One opportunity to do something you enjoyed in an entire month. One]
175/
The daily logs for April showed they had gone riding once during this period and had not been swimming.
[One opportunity to do something you enjoyed in an entire month. One]
175/
One person had an activity plan which outlined a variety of activities the person cld do over a fortnight.
These included bowling, cinema trips, visits to the pub, shopping trips, walks and visits to local attractions.
[Write it down to placate CQC, don't actually do it]
176/
These included bowling, cinema trips, visits to the pub, shopping trips, walks and visits to local attractions.
[Write it down to placate CQC, don't actually do it]
176/
Daily records for April showed they had played football golf once, gone swimming once and been on a bike ride.
Apart from these three activities they had been shopping five times and been on four walks.
[30 days - 3 activities, 5 shops, 4 walks. That's it]
177/
Apart from these three activities they had been shopping five times and been on four walks.
[30 days - 3 activities, 5 shops, 4 walks. That's it]
177/
On one occasion they had been for a drive but this appeared to be to accompany staff to pick up another member of staff from a different Spectrum service.
[I am just so enraged at this, and so tired of the same duplicitous non-activities recorded in ppl's non-lives]
178/
[I am just so enraged at this, and so tired of the same duplicitous non-activities recorded in ppl's non-lives]
178/
On 16 days in April they had not left St Erme grounds.
There was a period of seven consecutive days when they had not left the service.
[Perpetual lockdown. No job to distract you]
Relatives told us access to activities inside and outside of the service had been limited.
179/
There was a period of seven consecutive days when they had not left the service.
[Perpetual lockdown. No job to distract you]
Relatives told us access to activities inside and outside of the service had been limited.
179/
Comments included:
"[Name] does not have any interests. It is important to try"
"Things have been limited in that sense. [Name] has had occasional trips to the cinema"
[Cinema. Like the constant social care provision of a TV, but on a larger screen. Easy for staff]
180/
"[Name] does not have any interests. It is important to try"
"Things have been limited in that sense. [Name] has had occasional trips to the cinema"
[Cinema. Like the constant social care provision of a TV, but on a larger screen. Easy for staff]
180/
"[Name's] world is just to sit in his bedroom, he needs to go out more as that is not good for him. It is all too easy to say; 'he refused to go out', staff need to be more proactive"
[Exactly that; far easier to scribble down someone refused, than actually try]
181/
[Exactly that; far easier to scribble down someone refused, than actually try]
181/
"There are no in-house activities. The only break out space is a shed that they have shown movies in, not a full service or social life."
[Movies. TV.
Constant companion and secret to the provision of non-care. On super loud. On repeat. Just blaring.
This is not a life]
182/
[Movies. TV.
Constant companion and secret to the provision of non-care. On super loud. On repeat. Just blaring.
This is not a life]
182/
During the inspection we did not see much evidence of people being involved in pastimes while in the service.
There was some involvement in preparing food and drinks.
Otherwise people were left alone unless they pro-actively sought out staff support.
183/
There was some involvement in preparing food and drinks.
Otherwise people were left alone unless they pro-actively sought out staff support.
183/
One relative commented;
"People seem to be milling around rather than any meaningful activity. There is no creativity."
[No creativity. No urgency. No care.
And how much taxpayers money is being spent to provide this so called non-care? And pay all the consultants]
184/
"People seem to be milling around rather than any meaningful activity. There is no creativity."
[No creativity. No urgency. No care.
And how much taxpayers money is being spent to provide this so called non-care? And pay all the consultants]
184/
This was a breach of Regulation 9 (Person-centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
185/
185/
Two people enjoyed working in the large gardens with the support of a gardener who had worked at Spectrum for many years and knew them well.
Relatives told us this was important to those individuals.
[I bet they did. A little solace in enduring misery]
186/
Relatives told us this was important to those individuals.
[I bet they did. A little solace in enduring misery]
186/
There were no systems in place to proactively support and encourage people to make suggestions and raise concerns and complaints.
187/
187/
Although people's behaviour sometimes demonstrated they were unhappy with aspects of their care and support, eg frequently indicating they were ready to start their daily routine before staff were ready, no action had been taken to adapt the service provision accordingly.
188/
188/
[Well-led - inadequate]
At the last inspection this key question was rated as inadequate. At this inspection this key question has remained the same.
This meant there were widespread and significant shortfalls in service leadership.
189/
At the last inspection this key question was rated as inadequate. At this inspection this key question has remained the same.
This meant there were widespread and significant shortfalls in service leadership.
189/
Leaders and the culture they created did not assure the delivery of high-quality care.
At the last inspection we identified the provider did not have effective oversight of the service and had failed to ensure people experienced good outcomes.
190/
At the last inspection we identified the provider did not have effective oversight of the service and had failed to ensure people experienced good outcomes.
190/
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17.
191/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17.
191/
We were not assured there was a positive culture within the service which supported people to be independent, have good outcomes and a good quality of life.
192/
192/
We observed many restrictive practices in use which were over and beyond those covered by people's Deprivation of Liberty Safeguard authorisations (DoLS) which the service had not identified and addressed.
193/
193/
For example, drinks were restricted for some people, people's doors, wardrobes and cupboards were locked.
During the inspection we heard an alarm continually going off.
194/
During the inspection we heard an alarm continually going off.
194/
Staff told us this was used to alert staff when one person went in and out of their room.
The alarm was activated so frequently that it was not possible to ascertain if they were entering or leaving their room.
195/
The alarm was activated so frequently that it was not possible to ascertain if they were entering or leaving their room.
195/
Furthermore, it was loud and could have been disruptive to others living at the service.
We discussed this with the deputy manager who decided this should be turned off during the day.
[Imagine living in this place. Constant alarm going off, impossible to turn off]
196/
We discussed this with the deputy manager who decided this should be turned off during the day.
[Imagine living in this place. Constant alarm going off, impossible to turn off]
196/
People were not always receiving appropriate care that reflected their choices, needs and considered their preferences.
The provider failed to have systems and processes in place to ensure people received their care in a dignified and respectful way.
197/
The provider failed to have systems and processes in place to ensure people received their care in a dignified and respectful way.
197/
This meant people's care was provided in a way that was not personalised, appropriate and person-centred.
There was an established culture of low expectations for people.
198/
There was an established culture of low expectations for people.
198/
An external professional commented;
"Individuals are perceived as doing well if they have less incidents. Risk assessments are based around risk of incidents but do not take into account risks to quality of life or access to the community or loss of skills."
[What QOL?]
199/
"Individuals are perceived as doing well if they have less incidents. Risk assessments are based around risk of incidents but do not take into account risks to quality of life or access to the community or loss of skills."
[What QOL?]
199/
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
200/
200/
At the last inspection the provider had failed to be open and honest with people's representatives when things went wrong.
This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
201/
This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
201/
Improvements had been made and the provider was no longer in breach of Regulation 20.
The manager had an understanding of the Duty of Candour and was proactively communicating with people's relatives to keep them up to date with their family member's needs.
202/
The manager had an understanding of the Duty of Candour and was proactively communicating with people's relatives to keep them up to date with their family member's needs.
202/
At the last inspection we identified the provider did not have effective oversight of the service and had failed to ensure people experienced good outcomes.
203/
203/
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17.
204/
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17.
204/
There had been a high turnover of managers at the service.
The previous registered manager had deregistered on 6 August 2021.
The manager in post at the time of the inspection had applied for registration.
205/
The previous registered manager had deregistered on 6 August 2021.
The manager in post at the time of the inspection had applied for registration.
205/
They were an external consultant and did not live in the area. They worked at the service Monday to Friday.
There was no managerial oversight of The House at the weekends.
Altho staff were able to contact the providers on-call system this required them to be pro-active.
206/
There was no managerial oversight of The House at the weekends.
Altho staff were able to contact the providers on-call system this required them to be pro-active.
206/
As part of the inspection process two inspectors visited the service on a Saturday.
Although meeting minutes stated there was either a specific member of staff working at The House or a senior person working in The Lodge there was no senior on shift in either house.
207/
Although meeting minutes stated there was either a specific member of staff working at The House or a senior person working in The Lodge there was no senior on shift in either house.
207/
A member of staff contacted a senior who lived close by and they came to St Erme to support the inspection.
[Can you imagine the phone call. Feck CQC have turned up, there's no-one here, can you come?
Impressed with CQC, but wouldn't want anyone I knew or loved in here]
208/
[Can you imagine the phone call. Feck CQC have turned up, there's no-one here, can you come?
Impressed with CQC, but wouldn't want anyone I knew or loved in here]
208/
Staff told us the new manager and deputy manager were effective.
One commented;
"They are doing a good job; they engage the team well. But they are both interim, they could leave quickly, and we would go into no management again."
209/
One commented;
"They are doing a good job; they engage the team well. But they are both interim, they could leave quickly, and we would go into no management again."
209/
Audits of the service were completed by an external consultant.
These looked at medicines, infection control and whole service. We requested copies of the audits.
[So many external consultants for a so called cash poor system. No quality control of them either... ]
210/
These looked at medicines, infection control and whole service. We requested copies of the audits.
[So many external consultants for a so called cash poor system. No quality control of them either... ]
210/
Whole service audit was for a different Spectrum service, although we asked to be sent the correct audit this was not received.
This meant we were unable to assess whether the service had been audited and how effective and robust the audit had been.
[Cos it didn't exist]
211/
This meant we were unable to assess whether the service had been audited and how effective and robust the audit had been.
[Cos it didn't exist]
211/
The monitoring system was not fit for purpose and the provider had not identified all shortfalls found at the inspection in order to drive improvements to the overall quality and safety of care delivery.
[Copy and paste audits, from copy and paste consultants]
212/
[Copy and paste audits, from copy and paste consultants]
212/
An external healthcare professional commented;
"The current care home manager has been open and honest and I am mindful that he is trying to make significant changes, however my observations over the last 3 years are that head office micro manage from afar..."
213/
"The current care home manager has been open and honest and I am mindful that he is trying to make significant changes, however my observations over the last 3 years are that head office micro manage from afar..."
213/
"...and I am unsure how effective leadership can be demonstrated if care staff and managers are not facilitated or encouraged to do so, with a "top heavy approach" from Head Office."
[Always the same. So many charities, scrimping on the basics while top heavy]
214/
[Always the same. So many charities, scrimping on the basics while top heavy]
214/
This contributed to the breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities.
215/
215/
There were indications of a closed culture within the organisation.
Since the beginning of 2022 until 14 May 2022 there had been ten anonymous concerns raised by staff about the service.
[Much respect for those staff. Imagine being that desperate and unsupported]
216/
Since the beginning of 2022 until 14 May 2022 there had been ten anonymous concerns raised by staff about the service.
[Much respect for those staff. Imagine being that desperate and unsupported]
216/
Seven of those were concerned with staffing and eight referred to poor management and distrust of the organisation.
[I can't believe this, 2 anonymous tip offs to @CareQualityComm a month in 2022. Good for them, but what a state to be in]
217/
[I can't believe this, 2 anonymous tip offs to @CareQualityComm a month in 2022. Good for them, but what a state to be in]
217/
It was concerning that staff did not feel able to share their concerns with the organisation or share their contact details with @CareQualityComm.
This meant staff were not supported to speak out in line with good practice.
[The state of @ASDspectrumASD]
218/
This meant staff were not supported to speak out in line with good practice.
[The state of @ASDspectrumASD]
218/
A relative also expressed their concerns about voicing their opinions.
They commented; "It worries me that they are not well-led from the top. I need to voice that; I don't think that the senior management team are good enough..."
219/
They commented; "It worries me that they are not well-led from the top. I need to voice that; I don't think that the senior management team are good enough..."
219/
"...I know I am potentially rocking the boat and I am reticent to say as I am worried for my relative. It worries me to say it."
[The tightrope that so many relatives walk, when, or if to speak out, incase it makes things worse. And they're dire already]
220/
[The tightrope that so many relatives walk, when, or if to speak out, incase it makes things worse. And they're dire already]
220/
People were not involved in a meaningful way in development of their care and support and info was not provided in a way which met people's individual communication needs.
A poor staff culture created a lack of professional challenge that impacted on people's safety.
221/
A poor staff culture created a lack of professional challenge that impacted on people's safety.
221/
All of this reinforced the closed culture within the service
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
222/
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
222/
The provider did not instil a learning culture and reflective practice at the service in order to improve care delivery.
This meant that poor practice, such as disproportionate restrictions and control, continued to be found.
223/
This meant that poor practice, such as disproportionate restrictions and control, continued to be found.
223/
Although an action plan had been developed following our previous inspection, and many areas marked as being complete we found only minimal improvements had been made.
[Performative scrutiny, again, I'm boring myself now]
224/
[Performative scrutiny, again, I'm boring myself now]
224/
These had not impacted on people's opportunities or the quality of their day to day lives. The service still failed to support people in accordance with the Health and Social Care Act 2008.
Approaches to staff recruitment did not demonstrate a strong focus on quality.
225/
Approaches to staff recruitment did not demonstrate a strong focus on quality.
225/
Provider had a heavy reliance on agency staff from outside of the local area.
They frequently worked 84 hours a week and there was a high turnover.
This meant people were not always receiving consistent care from staff who knew them well and were committed to the service.
226/
They frequently worked 84 hours a week and there was a high turnover.
This meant people were not always receiving consistent care from staff who knew them well and were committed to the service.
226/
An external healthcare professional commented;
"Staff who are newer to the organisation often do not have experience with other settings and therefore lack the optimism and ambition for their residents to develop their skills and independence."
227/
"Staff who are newer to the organisation often do not have experience with other settings and therefore lack the optimism and ambition for their residents to develop their skills and independence."
227/
This was a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
228/
228/
External healthcare professionals told us there had been improvements in the willingness of the service to engage with multi-disciplinary working.
However, they said there were often delays in receiving requested information.
229/
However, they said there were often delays in receiving requested information.
229/
[@ASDspectrumASD St Erme have to write another report, telling @CareQualityComm what they'll change.
No doubt they'll do that, write action plan, tell them things are complete and ppl will be left stagnating in non-care.
Here's hoping CQC are taking more extreme action]
/END
No doubt they'll do that, write action plan, tell them things are complete and ppl will be left stagnating in non-care.
Here's hoping CQC are taking more extreme action]
/END
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