About the service Little Oyster Residential Home accommodates up to 64 people across three buildings. The main building is divided into two floors and annex, and there are separate bungalows and flats where people live more independently. The service accommodates people who have learning disabilities, mental health conditions and physical disabilities. The service was providing personal care to 52 people at the time of the inspection.
People's experience of using this service and what we found
People were not always safe at the Little Oyster Residential Home. Comments included, “This place is needing sorting out, they are putting on a façade because you are here. I feel unsafe here because of the staffing levels”; I want to move. Between you and me I feel very unsafe – I can’t sleep or settle”; “[A person] has started banging on my window late at night, I have reported it to staff, it scares the life out of me” and “I feel safe but there is not enough staff, they don’t have cover for sickness which means they run short.”
The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Timely action had not been taken to address issues identified within audits. People were at risk because the provider had not acted to ensure they had sufficient oversight of the service. Records were an area of concern across the service; records were not complete and accurate and had not always been stored correctly. The provider had failed to sustain the improvements and the service had declined in quality.
The provider had not developed an open and honest culture where staff were empowered to raise any safeguarding concerns. People were not protected from harm and abuse.
Risks associated with diabetes, epilepsy, catheter care and constipation had not been robustly assessed and action had not been taken to reduce risks to keep people safe. Some risk assessments were generic and did not relate to the people they were about. People were not protected from the risks in the event of a fire. Fire risks had not always been well managed.
There was a poor system in place in relation to accidents and incidents. Accident and incident records evidenced that timely and appropriate action had not always been taken to address incidents.
We were not assured there were enough staff to meet people’s needs. We observed call bells were not always answered quickly. We also observed that call bells were muted or switched off without staff attending to people to find out what they wanted or needed. Staff were not always recruited safely.
Medicines were not managed safely. Policies and processes for managing medicines were not always followed. Thickening agents prescribed for people who had swallowing difficulties were not always measured accurately when added to liquid medicines. Records were not always made when people’s medicines patches were removed or where on the body they were applied. Large amounts of unwanted medicines, clinical waste and other containers had not been appropriately disposed of.
The cleanliness of the building had declined, people were at risk from the spread of infection. Government COVID-19 guidance had not always been followed in relation to testing people and staff.
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. People’s care plans contained conflicting and confusing information about their mental capacity. It was not always clear when a person lacked capacity and when a best interests decision had been made, who had been involved in the decision making process.
Training records evidenced that some staff had not completed their training to give them the skills and knowledge of safely working with people. A large selection of staff employed were not listed on the training records, which indicated that they had not received any training
People told us that the meals were of poor quality and lacked vegetables and were not balanced. Some people told us they did not always get choices of meals and some said they didn’t know what meal choices were on offer until the food was brought to them. Food and drink did not always meet people’s assessed needs.
People had not always had access to medical appointments for their health needs to be met. People’s health records evidenced that several people had not seen their dentist since 2019.
Maintenance tasks had not always taken place in a timely manner, which could put people at risk of harm. We observed there were areas of the service that were not clean; carpets were stained and dirty in places, bathroom, toilets and ensuite floors were dirty and stained in places and there was an unpleasant odour. Some equipment was visibly dirty and had not been cleaned.
Prior to people moving to the service their needs were assessed. Assessments included oral healthcare. During the inspection we found that some people who required physical assistance to maintain their oral hygiene had very poor oral hygiene. People were not consistently receiving good care. Some said they were happy living at the service, and some were deeply unhappy and asked us for help to let their social workers know that they wanted to be moved.
People were not always treated with dignity and respect. People’s personal records were not always stored securely to ensure they were only accessible to those authorised to view them. People’s cultural needs were not always respected. Some people were not always supported to maintain important relationships with people when they could. Most people told us the staff were nice and kind.
Some people told us their personal care needs were not always met. People’s care records did not always evidence people had received personal care (including oral care). Care and support plans for people with long term conditions lacked detail. There were no activities taking place in the service. People told us they were bored and had nothing to do.
The provider had not followed their own complaints processes, timely action had not been taken to address people’s concerns.
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.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
People's choice was not maximised, and they could have been better supported to develop more control and independence.
Right care:
Care was not always person-centred and promotes people's dignity, privacy and human Rights. People had not always received the care and support they had been assessed to require.
Right culture:
Ethos, values, attitudes and behaviours of leaders and staff did not ensure people always lead confident, inclusive and empowered lives.
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 04 May 2021).
Why we inspected
The inspection was prompted due to significant numbers of concerns received about staffing levels leading to lack of care towards people, medicines management, infection control, COVID-19 testing and the mismanagement of records. A decision was made for us to inspect and examine those risks. As the risks spanned across all five domains, the inspection was a comprehensive inspection.
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.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
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 continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to: risk management, medicines management, safeguarding people from abuse, management of infection control, safe staffing levels, staff training, ensuring adequate nutrition and hydration, safety, maintenance and cleanliness of the premises, ensuring people received person centred care and support, treating people with dignity and respect, management of complaints, providing activities to meet people’s needs and ensuring systems and processes are operated effectively to assess, monitor and improve the quality and safety of the service at this inspection.
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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we