About the service:

Seven Springs – Care Home Physical Disabilities is a residential care home that was providing personal care for up to 32 people with physical disabilities and a range of other complex needs. At the time of the inspection 29 people were using the service. Most people lived in the main building and there were bungalows on site to promote independence for others. Some of the people had limited verbal communication due to their disabilities.

People’s experience of using this service:

Although people were happy and relatives told us their family member was safe we found people were not always being kept safe. Medicines were managed safely and some risks had been identified with ways to mitigate them. However, people were placed at risk of potential harm from pressure ulcers and dehydration. People were placed at risk of ingestion of harmful chemicals when they were left unaccompanied around the home.

The provider and management had completed a range of audits to identify concerns and issues at the service. However, these had not always identified concerns found during the inspection. Additionally, when concerns had been found these had not always been resolved in a timely way.

People and staff felt there were enough staff except at weekends. The management were already in the process of trying to resolve this. Staff had received a range of training considered mandatory by the provider. However, there were occasions that training for staff had not been provided in line with people’s specific needs.

Some people in the service lacked capacity to make specific decisions and there were systems in place to make them. When people were deprived of their liberty systems were in place to ensure it was lawful. People were involved in making choices about their day to day care and these were respected by staff.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals including access to onsite physiotherapists.

People were supported by kind and caring staff who knew them incredibly well. Staff respected people’s privacy and dignity throughout the inspection. Good links had been developed with the community.

More information about the detailed findings can be found below.

Rating at last inspection:

At the last inspection, published on 4 November 2016, this service was rated good.

Why we inspected:

This was a planned inspection based on previous rating.

Enforcement:

We have made one recommendation about staff training being in line with people’s needs.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment and good governance.

Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Seven Springs on the 3 October 2016 and the inspection was unannounced. Seven Springs is a care home providing accommodation, personal care and support for up to 32 people with physical disabilities and other associated needs. The service is part of the Leonard Cheshire Disability group and is located in Tunbridge Wells. There were 28 people using the service at the time of our inspection. The registered provider told us they only accommodated a maximum of 30 people in the service unless couples requested a shared bedroom. The service was provided in a range of accommodation including the main house and bungalows for people to live more independently on the same site.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection, in September 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the safe management of people’s medicines and the effectiveness of the governance systems. The registered provider sent us an action plan detailing when they would become compliant with the regulations. This inspection took place to check that the registered provider had made improvements in these areas. We found that the required improvements had been made.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe management of medicines and kept relevant records that were accurate.

There was an effective system for monitoring the quality and safety of the service to identify any improvements that needed to be made. The registered manager had a clear improvement plan for the service and had made a number of positive changes since our last inspection in September 2015.

People told us they felt safe living at the service. People were protected by staff that understood how to recognise and respond to the signs of abuse. Risks to people’s wellbeing were assessed and staff knew what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

Seven Springs is a purpose built residential home which meets the specific needs of people with physical disabilities. The accommodation was spacious and comfortable for people to use.

The premises were safe and had generally been well maintained. The service was clean and hygienic. Staff understood how to reduce the risk of infection spreading in the service and they followed safe practice.

There were a sufficient number of staff on duty at all times to meet people’s needs in a safe way. The registered provider had systems in place to check the suitability of staff before they began working in the service. People and their relatives could be assured that staff were of good character and fit to carry out their duties. We have made a recommendation that the registered manager maintain records to demonstrate the training and qualifications of agency staff supplied to work in the service.

People told us that staff had the knowledge and skills to meet their needs. Staff received essential training to enable to carry out their roles effectively. They were given the opportunity to practice their skills before they were required to support people. Staff were encouraged to gain qualifications relevant to their roles.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No one using the service was subject to a DoLS authorisation or required an application for one. Staff sought and obtained people’s consent before they pr

This inspection was carried out on 22 September 2015 and was unannounced.

Seven Springs - Care Home Physical Disabilities provides personal care and accommodation for up to 32 people who have a physical disability. There were 26 people living at the service at the time of our inspection.

There was a registered manager in post. 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 registered manager was supported by a deputy manager and a team of senior carers to ensure the daily management of the service.

We last inspected Seven Springs - Care Home Physical Disabilities in October 2014. At this time we found that the registered provider was not compliant with the regulations. There were shortfalls in safeguarding, consent, records and the quality monitoring of the service. The registered provider sent us an action plan and told us they would make the improvements by 31st July 2015.

At this inspection we found improvements had been made. Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. However, some staff did not know how to contact the appropriate external agencies with any concerns should they need to. We have made a recommendation about this. People had been asked for their consent to their care and treatment. Where they had been unable to give this the requirements of the Mental Capacity Act 2005 had been followed to ensure a decision was appropriately made in their best interests. Accurate and complete records were maintained of the care provided to people.

The registered provider had made improvements to the systems for checking the quality and safety of the service. Regular audits were taking place and an improvement plan had been developed. However, they had not always ensured that action was taken to make improvements where needed. You can see what action we told the provider to take at the back of the full version of the report.

The registered provider had not ensured people’s medicines were managed safely. There were shortfalls in the safe receipt and storage of medicines. You can see what action we told the provider to take at the back of the full version of the report.

Staff training was up to date and was renewed annually, and staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular supervision sessions, but had not received an annual appraisal to ensure they were supporting people based on their needs. We have made a recommendation about this.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

There were sufficient staff on duty to meet people’s needs. Staff had time to spend supporting people in a meaningful way that respected individual needs. Staffing levels were calculated according to people’s needs and were flexible to respond to changes in need. There were safe recruitment procedures in place.

People lived in a clean and well maintained environment. Staff had a thorough understanding of infection control practice that followed the Department of Health guidelines, which helped minimise risk from infection. The premises had been designed to meet the needs of people with physical disabilities.

The service provided meals, in sufficient quantity that were nutritious and well balanced. People were offered hot drinks and snacks throughout the day. Staff knew about people’s dietary preferences and restrictions.

People were referred to health care professionals when needed and in a timely way.

Staff communicated effectively with people and responded to their needs promptly. Staff treated people with kindness and respect. We observed frequent friendly engagement between people and staff and staff responded positively and warmly to people. People were satisfied with how their care and treatment was delivered.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed. This ensured that the staff knew about their particular needs and wishes when they moved in.

People were involved in decisions about their day to day care. People’s care plans were reviewed with their participation or their representatives’ involvement. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People were supported to take part in activities that interested them and to access community leisure facilities.

The service took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon.

The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.

Seven Springs - Care Home Physical Disabilities provides personal care and accommodation for up to 32 people who have physical disabilities. People were accommodated in the large main house and in bungalows on the site. There was  a hydrotherapy pool and a day centre where people took part in a range of activities. In the main house there were two passenger lift between floors and all areas of the accommodation were accessible to people who used wheelchairs.

The service had a registered manager who was present during our inspection. 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.

This inspection took place on 27 October 2014 and was unannounced. An inspection was carried out in August 2013 when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to take action to make improvements in the management of medicines. We did an inspection in November 2013 to follow this up and found this action has been completed.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. Individual risks to people’s safety and welfare were not always identified to make sure people were safe. Some essential training for staff had not been completed or was not kept up to date. There were not always sufficient numbers of staff and safe recruitment procedures were not always followed. Quality assurance systems were not effective in recognising shortfalls in the service. Action and improvements plans were not developed to make sure people received a quality service. Records relating to people’s care and the management of the service were not well organised or adequately updated.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, we found that the registered manager understood when an application should be made and how to submit one and was aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

People told us they felt safe. The provider had taken steps to make sure that people were protected from abuse. Some improvement was needed to make sure that staff training in safeguarding was up to date. Although staff had information about reporting abuse, staff did not know how to contact any external agencies.

Each person’s care plan contained risk assessments, some of these had been personalised to make sure staff knew how to protect the person from harm. The majority of risk assessments were identical to one another, which meant that individual risks to people’s safety and welfare had not been identified.

There were not always enough staff deployed in the home to meet people’s needs. People told us drivers were not always available to drive the minibuses so they could go out and they were “Frustrated when we’re desperate for the loo, if the staff are on breaks”. The provider did not always follow safe recruitment procedures because suitable references and photographic identification were not always obtained. There were plans in place to make sure that people were safe in the event of an emergency. Medicines were safely stored. Safe administration procedures were followed so that people got their medicines when they needed them.

Staff training records were not up to date so it was not possible to see if staff had the essential training or the updates required. Staff told us they had not received safeguarding training ‘recently’. Records showed that 24 out of 49 staff had attended training on the Mental Capacity Act 2005 (MCA). People had capacity to make decisions. Where people were not able to sign consent forms due to physical disabilities and non verbal communication, these were not signed by an appropriate person. Staff were regularly supervised and given opportunities to discuss any concerns they might have. Records showed that staff met regularly with their manager and these meetings were documented.

People’s weights were not monitored and recorded regularly to make sure they were getting the right amount to eat and drink. There were no risk assessments about nutrition or hydration. People told us they enjoyed the food and there was always enough. Staff made sure that people’s choices and special dietary needs were catered for. People who needed support to eat were helped discreetly.

People were supported to manage their health care needs. A chiropodist and a district nurse who visited the service regularly told us staff were quick to refer people when there were any concerns and followed advice about their on-going care. A physiotherapist employed at the service had developed personalised plans with each person to promote their health and improve their physical wellbeing.

People were involved in planning how they wanted their care to be delivered. Those who were able to had signed their care plans to show their agreement. People were supported to be as independent as possible. People said, “The staff are brilliant we have a laugh”. Staff were kind, caring and patient in their approach and had a good rapport with people. Staff supported people in a calm and relaxed manner. Staff initiated conversations with people in a friendly, sociable manner and not just in relation to what they had to do for them.

Staff showed respect for people’s dignity and were careful to protect people’s privacy. People told us they were treated with dignity and respect. Staff made sure that any personal care people needed were carried out in private. People’s information was treated confidentially.

Some people told us that complaints they had made had not been addressed. People knew who to talk to if they had a complaint. Some people told us they were listened to and action was taken to address their concerns. The registered manager told us that there were no recent complaints. We have made a recommendation about this.

Care records did not contain sufficient detail or up to date information to enable staff, particularly new or agency staff, to provide personalised care to each person. Staff knew people well including what they wanted to eat and drink and what they would like to do. Staff knew how to communicate with people who had communication difficulties. People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time.

There was a day centre on site where people could take part in a range of activities. The registered manager told us that there were strong links between the home and the local community. For example, students from a local school were involved with events and often visited the home. People from the home had been involved with initiatives to improve disabled access at a local hospital.

Most people spoke positively about the service and told us they found the management team helpful. One person said, “I love it here, I wouldn’t move”. A few people raised concerns about the leadership of the service and told us the manager was not visible around the home.

Quality assurance systems were not effective in recognising shortfalls in the service. Action and improvements plans were not developed to make sure issues were addressed in a timely manner.

There were no regular staff meetings where staff could express their views or raise any concerns about the service. There were no recent minutes of ‘residents’ meetings available or customer satisfaction surveys to show that people were consulted and their views taken into account in the way the service was delivered. Records relating to people’s care and the management of the service were not well organised or adequately recorded.

You can see what action we told the provider to take at the back of the full version of this report.

We inspected Seven Springs Cheshire Home on 13 August 2013 and found non – compliance in the area relating to the management of medicines. . This was a follow up inspection to check compliance against that area. We spoke with the manager and three members of staff during the inspection. We did not speak with people who used the service on this occasion.

During this inspection we spoke with four people who lived at the home. People told us that they liked living at Seven Springs and that they liked the staff. They told us that "Staff are nice" and "It's good here, staff take me out and I have made friends".

People said staff supported them in the ways that they preferred and understood their individual needs. People knew that their care and support needs were recorded in their individual care plans and confirmed that they had been consulted about what was recorded in them.

During our inspection we spoke individually with nine people living at the home and with

seven members of staff.

People living at the home told us that staff supported them in the ways that they preferred and staff were kind, polite and respectful.

They said that they were involved in making decisions about their daily lives, such as when to get up and go to bed, what to eat and how to spend their time during the day.

People liked their rooms and said that the standard of cleanliness throughout the home

was good.

People said that that overall the meals were good, they were offered a choice of meal and were provided with weekly menus so that they could choose meals in advance.

People said that although staff provided them with the support they needed and

understood their needs, there were occasions when staff seemed under pressure. This

had been more apparent recently due to the holiday period.

People told us they felt safe at the home. They said they felt the premises were safe and staff supported them in a safe way.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We observed how people spent their time during the day, how staff met their needs and how people communicated and interacted with staff. We spoke with nine people who were living at the service and with eight members of staff.

People told us they made choices about their lives and staff respected their decisions. They said that they had been consulted about how they wished to be supported and that overall they were satisfied with the care and support they received. People said that staff respected that they liked to be as independent as possible; one person said “all I need is help to shower in case I slip”.

People told us that they received their medicines when they needed to. However we found that people's medication was not always handled safely and there was insufficient training and guidance in place for staff on the use of some medicines.

People said staff were responsive to their needs and that they liked the staff. One person said “staff are good fun”. People said that on some days there seemed to be less staff on duty than on others. They said generally this did not make a difference to the level of support they received, although two people told us that on occasions it had taken staff a long time to answer call bells. People told us that they knew who to speak with if they had any concerns or complaints and that they were aware of the complaints procedure.

The provider had systems in place to monitor the quality of the service provided and to make sure the service was safe for people to live in. People were consulted as part of this process.