Background to this inspection
Updated
24 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was undertaken by two inspectors.
Service and service type
105 Water Lane 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 service did not have a manager registered with the Care Quality Commission. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection which included concerns we had received. We sought feedback from the local authority and spoke to four professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection-
We observed care and support during the inspection by staff around the home. We spoke with three relatives about their experience of the care provided.
We spoke with twelve members of staff including the regional director, regional quality manager, the provider’s specialist support practitioner, interim managers, shift leaders, support staff and agency staff.
We reviewed a range of records. This included four people’s care records and medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
24 October 2019
About the service
105 Water Lane is a residential care home providing accommodation and personal care to older and younger adults with a learning disability or autism. At the time of the inspection there were four people living at 105 Water Lane, some with complex needs. The service can support up to eight people.
The service had 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 did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to eight people. Four people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People were not safe from potential harm because known risks to people were not effectively being monitored by the management and staff team. People who had known risks of ingestion, and where incidents had already occurred, still had access to items that could cause them potential harm.
There were inadequate numbers of permanent staff and the service was reliant on agency staff.
There were not sufficient staff with suitable skills, knowledge and experience deployed to meet the needs of the people.
Relevant recruitment checks were conducted before staff started working at the service to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.
Environmental risks were not managed effectively; fire alarm tests were not up to date as recommend by fire safety regulations. People did not have regular fire evacuations to keep them safe. The home was dirty and in need of cleaning and the service needed redecoration.
People were not supported to eat a balanced diet. There were not meaningful activities and access to the community for people to reduce the risk of social isolation. People were not always treated with dignity and respect.
Medicines were not always safe, and people did not have pain relief available to them when needed.
Staff did not receive regular support and one to one sessions or supervision to discuss areas of development and to enable them to carry out their roles effectively. Training had fallen behind, and we could not be assured staff had appropriate training in place to keep people safe.
People’s rights were not always protected because staff did not always understand and work within the principles of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. These were in the process of being reviewed.
Each person had care plans in place although there was not always sufficient detail to guide staff and plans were not always up to date. We found staff did not always follow the guidance and some plans contained inaccuracies and missing information. There were concerns with missing entries and gaps in charts to monitor people’s food and fluid and bowel movement.
During our inspection we found there was a lack of effective management and leadership in the home. Staff felt unsupported and let down by management and morale was low amongst staff.
The provider had failed to ensure effective oversight of service provision. Care plans were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 23 February 2019).
Why we inspected
The inspection was prompted due to concerns received about staffing, accidents and incidents, management oversight, medicines, support plans, records and the maintenance of the building. 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 information in the report.
Enforcement
We have identified breaches in relation to safe care and treatment, staffing, person centred care, dignity and respect, meeting nutritional and hydration needs, premises and equipment and good governance at this inspection.
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 would normally follow up as per the guidance below but the provider following receipt of the report has decided to close the service.
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.