Archived: Quince House

Quince House accommodates six people with learning difficulty in one adapted building. At the time of our inspection five people were living at Quince House.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

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; the policies and systems in the service did not support this practice.

The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons lack of choice and control, limited independence, limited inclusion. People were not supported to develop independence, access the community and express their choices.

People were exposed to risk of harm in case of fire because the provider failed to ensure they appropriately assessed the risk of a fire and completed actions in a timely way to ensure appropriate fire protection and detection was in place. Fire Marshall training was not provided for staff responsible for running a shift in the home although this is required by

Risk assessments were not always developed and individualised for people without giving staff specific guidance in how to mitigate risks and keep people safe.

People were not always protected from the risk of infections as the environment was not well maintained and in high risk areas like the kitchen the floor and kitchen units had not been replaced when damaged.

People were at risk of social isolation because there were not enough staff employed. Funded one to one support was not always provided to people, people`s holiday was cancelled. Arrangements were not in place to ensure people could access the community and engage in meaningful activities.

Care plans were developed, however these were not effectively reviewed to evaluate if people achieved positive outcomes. Positive behaviour plans were not developed to fully address areas where people needed staff`s support to prevent behaviours that challenged them and others.

Processes to learn lessons when incidents or mistakes happened were not embedded within the culture of the staff team. Where incidents had occurred within the service, these had been documented within the care records but then not discussed as a team or reported to safeguarding authorities.

Staff were not offered opportunities to further develop. Champions roles were being developed within the service which would enable staff to have additional training in a specific area, such as safeguarding, mental capacity or learning disability. The training for these roles were all occupied by only one member of staff.

Governance and performance management was not always reliable and effective. There was a lack of clarity around the governance arrangements and authority to make decisions. The registered manager had no delegated responsibility from the provider to make decisions where a cost was involved. This had to be approved and arranged by the provider and some actions were outstanding since 2018.

Governance systems were not developed or used effectively to identify and improve the concerns we found in this inspection. The provider failed to ensure appropriate management arrangements were in place when the registered manager was absent for more than 28 days from the service.

Following the inspection, we reported our concerns to the Local Fire Service, Environmental Health and the Local Authority and Clinical Commissioning Group.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 October 2018). After this inspection we met with the provider to discuss what they were planning to do to improve. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received from the Local Authority about the lack of appropriate care and support people received. Concerns about people`s dietary needs not being met, and people not being supported to access the community due to lack of staff. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches at this inspection in relation to safe care and treatment, staffing, person centred care, consent to care, safeguarding, environment and equipment, governance, and not submitting notifications for incidents in a timely manner.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found that the provider had made the improvements required. However, we have found other areas that require improvement and have spoken about this in the body of the report. The rating remains as Requires Improvement.

Quince House provides care for up to six young people with a learning difficulty. At the time of our inspection six people were living at Quince House. Quince House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. We found that peoples dignity was not always promoted, staff interaction did not always ensure a positive experience. People were not always supported to follow their activities due to staffing.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. However, staffing numbers were not always sufficient to meet people’s individual needs.

Infection control was not always managed appropriately by all staff.

Documentations had not always been completed appropriately.

Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Complaints were recorded and responded to in line with the service policy.

People, relatives and staff were complimentary about the registered manager and how the home was run and operated.

There was a manager in post who had 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 and associated Regulations about how the service is run.

People were not consistently supported to maintain good health and have access to health and social care professionals when necessary. Staff had not followed the guidance detailed in care plans to ensure people were safe.

Safe and effective recruitment practices were not consistently followed to help ensure that all staff were suitably qualified and experienced.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service. We found that the registered manager had not reported a reportable incident to CQC.

Audits and care plan reviews were completed; however we found that these had not identified areas of concern.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Trained staff helped people to take their medicines safely and at the right time. Relatives were positive about the skills, experience and abilities of staff who worked at the home.

Staff received training and refresher updates relevant to their roles and had regular supervision to discuss and review their development and performance.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided.

The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Complaints were recorded and responded to in line with the service policy.

What people told us and what we found

An inspector from the Care Quality Commission (CQC) conducted this inspection. We looked at care records and other records pertaining to the safe running of the home. The people who live at Quince House did not have verbal communicating skills, however we saw that they were able to make their needs and wishes know to the staff. We saw that the staff clearly understood them. We spoke with the staff on duty and they were able to tell us about the needs and wishes of the people who lived at Quince House.

We inspected this home on the 07 and 09 November 2013 and we found that they were not meeting the standards in relation to nutrition, management of medicines, premises, assessing and managing the quality of the service and the storage of records. We also had information of concern relating to the home. The purpose of this visit on 05 August 2104 was to ascertain if those standards were being met and to explore the information we received. We found the people who lived at Quince House were well cared for and that home compliant in all areas.

Is the service caring?

We observed three of the five people who lived in the home. We saw that they displayed signs of wellbeing and that care had been taken to prepare them for the day. We saw staff interact with the people in a kind and caring manner.

Is the service responsive?

We did not look at this aspect of care on this occasion. However we found at the last inspection that the care and welfare of the people was promoted.

Is the service safe?

At our last inspection on 07 and 09 November 2013 we found that the people who lived at Quince House could be at risk from hazards in the home and from the possible use of out of date food. On this occasion we found that all food was labelled and that the environment was clean and safe. We found that there were systems in place to ensure that medication was ordered, stored, administered and when not used returned to the pharmacist appropriately.

Is the service effective?

We did not look at this aspect of care on this occasion. However we found at the last inspection that the people had good physical health and were integrated in to the community.

Is the service well led?

At our last inspection we had concerns that the home did not have an auditing system in place. An auditing system in needed to ensure that all aspects of people's care was reviewed on a regular basis. On this occasion we saw that the manager had introduced a system to audit the use of food supplies, the storage and administration of medication and a house keeping rota had been introduced. The people who lived at Quince House or their representative and the staff had been offered the opportunity to comment on the service offered to the people this ensured people's needs were recognised and met.

We found that people had care plans in place which were detailed and appropriate to inform staff about the level of support people required. Consent had been obtained and the consent forms had in some cases been signed, new forms were being introduced and the manager told us that they were in the process of obtaining consent from family members or advocates.

We looked noted that food had not been properly maintained and some was out of date. The provider did not have appropriate arrangements in place for the safe administration of medication and we found some medication was out of date. The quality monitoring arrangements that were in place were inadequate and the limited information that was received was not evaluated or used as a means to improve the quality of care. We noted that Records were not stored and or disposed of in a way which protected people's confidential information, or in accordance with the data protection act 1998

We were unable to speak directly to the people who use the service. We watched the interaction between the staff and the people. We found that the staff were able to understand the non verbal communications of the people and we saw that their needs were recognised and met.

We spoke with the relative of one person who told us that they were very happy with the care provided to their relative. We saw correspondence from other relatives and found that they were complementary about the staff and the home manager.

People's care needs were documented and were reviewed regularly. Risk assessments had been carried out to ensure the safety and to promote the independence of the people.

You can see our judgements on the front page of this report.