Harvey Lane

Harvey Lane is a residential home providing personal care to up to 8 people with a learning disability and/or autistic people. At the time of our inspection there were 6 people using the service. Accommodation was provided on the ground floor, with each bedroom having ensuites. There was a communal lounge, dining room, and sensory area.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People did not have full control and choice over their lives. This was because staff practice did not empower people to be independent and systems to ensure they were listened to were not effective. 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. We were not assured people were receiving effective 1-1 or 2-1 staff support as required. People were not supported with their health care needs because staff did not always seek external professional support in a timely manner and when required. People were not supported to manage risks to themselves and from the environment. This placed people at risk of harm.

Right Care:

Incidents were not used to support staff learning and ensure people were receiving the right support. We were not assured staff understood how to support distressed behaviour and their support had contributed to incidents of distressed behaviour occurring. This placed people at risk of harm. People’s living environments did not promote their dignity. The support provided was not fully person-centred because staff were not following people’s care plans and these were not updated when needs changed.

Right Culture:

Governance systems in the service were ineffective as they had failed to ensure regulatory requirements were met. Leadership was weak and staff had not received effective support. Improvements to the culture were needed in order to ensure people received effective person-centred support.

We raised our concerns with the provider during the inspection. The provider took immediate action to address the risks within the service. We identified some initial early improvements between our first and second visit.

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 8 August 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the management of risk to people’s safety, medicines, and staffing. A decision was made for us to inspect and examine those risks.

Following our first visit to the service we raised our concerns with the provider. We returned on a second day to check they had taken action to address the immediate risks. We found the provider had taken effective action to make initial improvements.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, deprivation of liberty authorisations, person-centred care, and good governance.

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

Follow up

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.

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.

At the last inspection in June 2015 the service was rated Good, with one area rated as Requires Improvement. This was because the service had not been fully compliant with requirements around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). We found at this inspection in July 2017 that the service was compliant in this area and rated Good overall.

The home was safe and staff understood their responsibilities to protect people from harm or abuse and had received relevant safeguarding training. Staff were confident in reporting incidents and accidents should they occur. People were safely supported to take their medicines as prescribed.

There were effective processes in place to assess, review and mitigate risks to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk. Recruitment processes were in place to ensure that staff employed in the service were deemed suitable for the role.

Staff had received training in areas specific to the people they were supporting and this helped to make sure that people received care individual to their needs. Staff gained people’s consent before providing care.

One person had an authorised deprivation of their liberty (Deprivation of Liberty Safeguards (DoLS)) in place and staff were able to explain how they promoted choice, and supported decision making, where people had variable capacity. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access healthcare promptly wherever necessary. People were encouraged to eat a healthy balanced diet and supported to lose weight if they wished to. People were also encouraged to drink enough and make their own drinks where they were able.

People’s privacy and dignity were promoted and they had strong relationships with staff who were kind and compassionate and listened to them. People were encouraged to be as independent as possible, work towards life goals and make their own choices.

Staff had a thorough knowledge about the people they cared for and understood how to meet their needs. People planned their care with staff and relatives, and numerous activities were carried out in line with people’s preferences.

The management team was highly visible within the home and worked closely with the people living there. People and their families were encouraged to give their views on the service.

There were many systems in place to monitor the quality of the service and these were used to develop and improve the service.

On 23 October 2013 we visited Harvey Lane. We found that the provider had not been undertaking regular supervision and appraisal meetings with staff. We also found that induction records for three recently-appointed members of staff were not available. This meant that staff had not received the appropriate professional support required to enable them to deliver safe and effective care.

We brought this to the attention of the provider. The provider supplied us with an action plan which demonstrated that they would be taking action to address this issue.

During our inspection on 12 March 2014 we found that improvements had been made.

We saw that staff were knowledgeable about people's needs and promoted their independence. We found that they had a good understanding and awareness of people's care needs and preferences. We saw that care plans and risk assessments were regularly reviewed and updated.

We saw that staff did not receive regular formal support and supervision from the manager.