Spectrum (Devon and Cornwall Autistic Community Trust) East Wheal Rose Inspection report St Newlyn East Newquay Cornwall TR8 5JD Tel: 01872 510750 Date of inspection visit: 30 September 2015 Website: www.spectrumasd.org Date of publication: 04/01/2016 Ratings Overall rating for this service Requires improvement ––– Is the service safe? Requires improvement ––– Is the service effective? Requires improvement ––– Is the service caring? Good ––– Is the service responsive? Good ––– Is the service well-led? Requires improvement ––– Overall summary We inspected East Wheal Rose on 30 September 2015, the registered providers, they are ‘registered persons’. inspection was unannounced. The service was last Registered persons have legal responsibility for meeting inspected in January 2014, we had no concerns at that the requirements in the Health and Social Care Act 2008 time. and associated Regulations about how the service is run. East Wheal Rose provides care and accommodation for The service was sometimes under staffed. Staff told us up to two people who have autistic spectrum disorders. they did not think staffing levels had impacted people’s At the time of the inspection two people were living at the safety or resulted in any increased risk to people or staff. service. There was a registered manager in post. A They did tell us there was an impact on the opportunities registered manager is a person who has registered with for people to take part in activities in the community or the Care Quality Commission to manage the service. Like be supported with tasks at the service. 1 East Wheal Rose Inspection report 04/01/2016 Summary of findings The people living at East Wheal Rose did not use words to Staff had access to an effective and thorough programme communicate and had complex support needs. This of training. This included training in areas specific to the meant it took time to get to know them and understand needs of the people they supported. New employees how best to support them. Staff told us that less undertook a comprehensive induction which experienced employees sometimes lacked confidence to incorporated theoretical, classroom based training and support people without the help of more experienced shadowing more experienced staff. staff. The shortage of staff numbers meant this could be Care plans were individualised and contained detailed difficult to manage. and up to date information regarding people’s support Experienced staff were confident when working with needs. Staff told us the information was relevant and easy people and knew their needs and communication styles to access. People’s routines were clearly laid out and well. A relative told us staff were consistent in the way in there was information about what was important for and which they supported their family member. There were a to people. range of communication tools available for people which Staff told us they were a close team who got on well enabled them to make day to day choices. together. They said they had worked hard to cover staff Due to people’s health needs there were restrictions in shortages and help ensure people were supported place throughout the service. The requirements of the effectively. However they reported a lack of confidence in Mental Capacity Act (2005) and associated Deprivation of the management of the service at all levels. Staff did not Liberty Safeguards (DoLS) had been adhered to. This feel their grievances were always listened to and told us meant people’s legal rights were protected when their they did not have confidence in a recent consultation liberty was restricted. Staff worked to help ensure people process. Where concerns had been raised they felt these were supported to access the community and take part in had not been adequately listened to. activities they enjoyed when staffing levels permitted this. Regular audits were carried out to help ensure the service Strategies to support people to have as much autonomy was safe. Incidents and accidents were recorded as possible were developed. appropriately and analysed monthly in order to highlight The provider had identified where changes to the any trends. People’s views regarding the running of the environment were necessary to meet people’s needs. service were actively sought out. However, action had not been taken to meet those We found breaches of the Health and Social Care Act 2008 identified needs in a timely manner. For example a (Regulated Activities) Regulations 2014. You can see what bathroom was in need of refurbishment; although this action we have told the provider to take at the end of the had been highlighted by the provider in 2014 the work full version of the report. had not been completed. 2 East Wheal Rose Inspection report 04/01/2016 Summary of findings The five questions we ask about services and what we found We always ask the following five questions of services. Is the service safe? Requires improvement ––– The service was not entirely safe. Low staffing levels meant people were not always able to take part in activities outside the service. People were protected from abuse because staff had received safeguarding training and were confident about reporting any concerns. Staff were knowledgeable about what actions to take to reassure people if they become anxious or distressed. Is the service effective? Requires improvement ––– The service was not entirely effective. Action was not always taken in a timely manner to meet people’s identified needs. Staff received relevant training to help ensure they could support people well. The service met the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. This helped to ensure people’s rights were respected Is the service caring? Good ––– The service was caring. There was a range of communication aids available for people. Staff spoke about people with affection and were knowledgeable about their needs. People were supported to maintain relationships which were important to them Is the service responsive? Good ––– The service was responsive. Care plans were detailed and informative. The staff team communicated well with each other to help ensure they were up to date with people’s changing needs. People had access to a range of meaningful and enjoyable activities. Is the service well-led? Requires improvement ––– The service was not well-led. Due to staff concerns regarding staffing provided, the management of the service, and about Spectrum generally, staff morale was low. Staff demonstrated a shared set of values which focused on giving people choice in their day to day life. The service sought out the views of people and their families. 3 East Wheal Rose Inspection report 04/01/2016 East Wheal Rose Detailed findings Before the inspection we reviewed previous inspection Background to this inspection reports and other information we held about the home including any notifications. A notification is information We carried out this inspection under Section 60 of the about important events which the service is required to Health and Social Care Act 2008 as part of our regulatory send us by law. functions. This inspection was planned to check whether the provider is meeting the legal requirements and Due to people’s health care needs we were not able to regulations associated with the Health and Social Care Act verbally communicate with people who lived at the service 2008, to look at the overall quality of the service, and to in order to find out their experience of the care and support provide a rating for the service under the Care Act 2014. they received. We spoke with the registered manager, the Divisional Manager with oversight of the service and five This inspection took place on 30 September 2015 and was care workers. Following the inspection we contacted a unannounced. The inspection was carried out by one relative to hear their views of the service. inspector. We looked at detailed care records for two individuals, three staff files and other records relating to the running of the service. 4 East Wheal Rose Inspection report 04/01/2016 Requires improvement ––– Is the service safe? Spectrum had an on-call system in place to allow staff to Our findings access a manager at all times for support if necessary. This included if they needed support to cover shifts. However Before the inspection we had received a concern that staffing across Spectrum was low and a member of staff staffing levels at East Wheal Rose were below those told us; “On-call can’t really do anything about it.” identified as necessary to meet people’s needs. The registered manager told us there was a vacancy on the staff Although staff did not believe people had been put at risk team and another staff member was due to leave to take due to low staffing numbers some did voice concerns up a position at another service in the near future. This about the need to arrange the rota to ensure experienced would create a further vacancy. On the day of the staff were always working with those with less experience. inspection a new employee had started work at the service. They told us the needs of the people they supported were The registered manager and staff confirmed that the extremely complex and it took a long time to get to know service had run below the minimum staffing levels at times. them. As both people were non-verbal staff relied on a In response to our concerns, which we had raised with the background knowledge and understanding of their Spectrum senior management team before the inspection, non-verbal communication in order to support them the divisional manager and registered manager had effectively. Staff told us that while the induction and analysed information regarding any incidents that had shadowing period was valuable it was not sufficient on its occurred.