About the service Venetia house is a residential care home providing personal care for up to 10 people. The service mostly provides support to people with mental health and learning disability needs. At the time of our inspection there were nine people using the service. One of these people did not receive support with the regulated activity ‘personal care’. Where a person does not receive support from the regulated activity, we do not include them within our inspection process.
People’s experience of using this service and what we found
Systems at the service did not protect people from potential abuse. Incident records showed us that concerns were not always sufficiently investigated and safeguarding referrals were not always made in a timely way.
We were concerned about a closed culture at the service. Staff told us they were unwilling to speak to a CQC inspector (through fear of reprisals) so chose to email instead. We reported this concern to the provider, then received a whistle-blower that staff had again been discouraged from speaking to the CQC.
Care plans did not provide enough detail on how staff should manage people’s health needs. Staff were not trained in how to support people’s mental and physical health needs and had poor knowledge when asked. Incident records and daily notes were not always completed fully to ensure care could improve.
There were not enough staff to keep people safe from harm. People who received one to one care were often left unattended which resulted in harm to them. Staff were not always safely recruited to ensure they were skilled and of good character to support people at the service.
Medicines were stored appropriately. However, staff did not have clear guidance on how to administer ‘as required’ medicine. Used needles were not disposed of safely, putting staff at risk of a used needle injury.
Infection control practices were not safe, putting people at risk of COVID-19 transmission.
People’s needs were not assessed in line with current legislation and standards. People were not always supported to drink enough but were supported to eat enough. Staff had made some referrals to health professionals when people were unwell. However, professional guidance had not always been used to improve the quality of care.
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 systems in the service did not support good practice. People had multiple restrictions on their daily living without capacity assessments in place.
The service had been operating under a new registered provider for a month and a half. The new provider did not currently provide a clear strategy to provide high quality care. The provider had not fully audited the service to see where improvements were needed. Where audits had occurred, these were ineffective at recognising issues. We raised concerns about the poor quality of care and timely action was not always taken in response to our concerns. We were assured after the inspection that an action plan was in place, and the required improvements would be made.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of key questions; safe, effective and well led; we found the service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.
Right support: The model of care did not maximise people's choice, control and independence. People had consented to certain care in care records but were observed to not be happy with the type of care provided to them. The care did not always maximise people's independence.
Right care: Care was not person centred. Staff did not always ensure people received suitable and effective support when they displayed behaviour that challenged staff. Restrictive practices were used, and these did not promote people's dignity and human rights. Training records showed staff were not always skilled to support people's care needs.
Right culture: The service did not have a good ethos. Staff reported that changes to the service from the new provider had not been made without consultation with themselves and people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The service was previously registered with CQC under another provider. The rating under the previous provider was requires improvement, report published on 3 September 2019. Due to the sale of this service to a new provider, it is considered a new legal entity for this inspection. The new provider had been registered with CQC for a month and a half at the time of this inspection.
Why we inspected
We had received concerns about the quality of the management team, unsafe medicine management and people’s freedoms being unlawfully restricted. A decision was made for us to inspect and examine those risks. We completed a focused inspection into the safe, effective and well led domains.
The provider has only been registered with the Care Quality Commission for one and a half months. We therefore did not inspect all key questions and have provided an overall rating of 'inspected but not rated'
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report. The provider has completed an action plan to assist with making the required improvements at the service.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in regulations in relation to safe care, staffing, consent and good governance. Please see the action we have told the provider to take at the end of this report.
Follow up
We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect. We have also sent the provider warning notices for the breaches of regulation. The warning notices require improvements are made by a specified deadline.
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.