Archived: Ormidale House

Updated 20 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced comprehensive inspection on 15 and 19 March 2017. One the first day the inspection team consisted of one inspector and one inspection manager. On the second day the inspection team consisted of two inspectors and a specialist advisor who was a learning disabilities specialist.

Prior to our inspection we had received information of concern from a staff member. We also spoke with the local authority about information they held about the provider. Due to the concerns we brought forward the inspection of this service to understand if people were receiving good quality care and to understand if the provider was now meeting the breaches of regulation we identified in June 2017.

As part of the inspection we reviewed information we held about the service including, statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us by law.

Some people we spoke with were not able to tell us in detail about their care and support because of their complex needs. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with seven people who used the service, one relative and received written information from a further relative. We also spoke with six care staff, the registered manager and the provider.

We reviewed aspects of seven people’s care records, medication records and daily records. We also looked at the staff rota, staff meeting minutes, three recruitment files, the complaints policy and procedure and aspects of staff’s training records.

Updated 20 June 2018

This inspection took place on 15 and 19 March 2018, the first day of our visit was unannounced. The inspection was brought forward earlier than planned due to concerns we had received from a staff member.

At the last inspection in June 2017, the service was rated as Requires Improvement with two breach in regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-Led to at least good.

At the last inspection in June 2017, we asked the provider to take action to make improvements for the safety of the premises and their governance systems. We found the action had been completed regarding the safety of the premises, however the providers governance systems were ineffective.

At this inspection we found the service was inadequate overall, and in the key questions safe, effective and well-led. The inspection identified six breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Ormidale 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.

Ormidale House accommodates 10 people in one adapted building over two floors. There were eight people living at the home on the day of our visit.

The care service has 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 the provider had not always ensured they adopted this approach, as care and support was not always person-centred, planned, proactive and coordinated.

People who lived at Ormidale House have varied and complex needs. The provider was not clear in who they provided support to. The provider was set to support people with a learning disability, however we found older people living with dementia and people with complex mental health needs also lived in the home which was not in-line with the provider’s statement of purpose.

There was a registered manager working at the home at the time of our inspection. 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.

Where risks to people’s health were identified people had not been adequately assessed or reviewed to understand if the support in place was adequate. The guidance given to staff was not based on best practice nor had the registered manager sought help from external healthcare professionals to ensure the right support was being offered. This put people at potential harm of unsafe care and treatment. There were not sufficient staffing levels in place to keep people safe from harm and to support people safely in the community. People’s medication was managed in a safe way; however checks and reviews of people’s medicines were inconsistent.

People had not had proper assessments of their care. People, their relatives and professionals had not been involved in the planning of the care to ensure this was consistently being delivered in the right way. The registered manager had not followed the principles of The Mental Capacity Act 2005 (MCA) and could not demonstrate that care and support was being offered in people’s best interests. The registered manager did not recognise when they were restricting people and had not understood the role and responsibilities in accordance with this. The registered manager had not made any Deprivation of Liberty Safeguards (DoLS) application to the Local Authority to ensure the care was being provided in a legalised way.

Staff received online training. The provider had plans in place to check staff’s competence and understanding, however these had not been implemented at the time of our inspection. Staff had not always received training that was specific to people’s care needs. We found people continued not to be supported to eat a healthy balanced diet. Some people had diagnoses of obesity and the provider could not demonstrate how they had adequately support people, particularly given that we had identified this as an area of concern at our last inspection. We found that people had access to healthcare professionals when they became unwell or had an accident; however we found people were not supported to access healthcare services for on-going physical and mental health conditions.

Staff completed all tasks within the home which took them away from their caring role. People were not always supported to go on outings as there were insufficient staff to always support them. People’s care and support was not always delivered in a respectful way and we identified areas which compromised people’s dignity.

People did not always receive care that was responsive to their individual needs and people continued to not be supported to maintain their interests and hobbies. Information on how to raise complaints was provided to people in an easy read format, and people and relatives knew how to make a complaint if they needed to.

People and staff felt the registered manager was supportive. There continued to be ineffective systems in place to ensure the service was delivering good quality care. The provider did not understand their responsibilities in ensuring they were meeting the legal requirements and did not have a robust systems in place to identify areas for improvement. The providers had not been able to assure themselves their staff team were delivering good quality care to people.