Background to this inspection
Updated
15 January 2020
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 one inspector.
Service and service type:
Ciderstone House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. This means that they 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 comprehensive inspection was unannounced.
What we did:
Before our inspection
We reviewed information we held about the service. This included the last inspection report, information received from local health and social care organisations, and statutory notifications. A notification is information about important events, which the provider is required to send us by law, such as, allegations of abuse and serious injuries. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During our inspection
We spoke with the assistant regional director, the registered manager, deputy, and a manager who had just started working in the service. We spoke with three members of staff who work at Ciderstone on the day of the inspection. We also spoke with the Positive Behaviour Support Specialist. To help us assess how people's care needs were being met we reviewed two people’s complete records and referred to the other people’s records for information about risks. We also looked at the medicines records for all people, and a range of records relating to the running of the service. We carried out general observations of care and support and looked at the interactions between staff and people who used the service.
After our inspection
We continued to seek clarification from the provider to validate evidence found. We emailed and heard back from a number of staff who work at the service. We also spoke with three relatives for their feedback about the service. After the inspection, we also spoke with the nominated individual who is responsible for supervising the management of the service on behalf of the provider.
Updated
15 January 2020
About the service
Ciderstone House is a residential care home providing personal care and support for up to six adults with learning disabilities and autism. At the time of the inspection, six people were being supported.
Ciderstone House accommodates four people in one building and two people in self-contained annexes attached to the building.
The service has 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 should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The registered manager and provider were not providing consistent leadership and support at Ciderstone House. Staff felt unsupported and felt their views were not respected or valued. Management had not demonstrated the principles of good quality assurance and therefore systems and processes to provide an overview of the service were unclear and confusing leading to risk.
People’s safety was not always optimised. Relatives did not feel fully confident that family members supported at the service were always safe. Staff did not always have the level of experience necessary to work with people with complex needs. We found improvements needed in respect of staff training in safeguarding and other aspects of safety such as infection control and food safety. This training had not been completed as per the provider’s policy. Therefore, staff did not have the relevant learning to support people effectively and safely. Not all staff we heard from were confident about raising concerns internally with the provider. Information about risks associated with people’s needs were not clear and readily accessible. The management of medicines needed improvement. The provider acknowledged that lessons had been learnt in the acquisition of the service and provided assurance that areas of improvement were being worked upon.
People’s needs had not been reviewed to ensure best practice guidance was used to achieve effective outcomes. Staff did not have the support in place to ensure they felt confident to deliver care to people with complex needs. People’s health need requirements, such as specialist health appointments, were not always known about so that the provider and registered manager had a good overview to manage people’s health conditions. People’s nutritional needs were not always being met to ensure their diet was healthy and adequate to maintain good health.
People were not always supported to have maximum choice and control of their lives and supported in the least restrictive way possible. We have made a recommendation about ensuring the principles of the Mental Capacity Act 2005 are consulted.
People were supported by staff that cared for them. However, the provider had not ensured that people were supported with consistent staffing in relation to their autism. This meant that people were not always supported by staff that had the time to get to know them well and understand their care and support needs, wishes, choices and any associated risks.
People’s care needs were not regularly reviewed. Care plans were muddled and incomplete which meant staff could not always access all information about people. People did not always have opportunities to pursue their interests and hobbies.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. People using the service did not receive consistent, planned and co-ordinated person-centred support that was appropriate and inclusive for them.
The provider was actively addressing the issues that had been raised during the inspection and demonstrated a willingness to work transparently and openly with all relevant external stakeholders and agencies.
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 Outstanding (published 27 May 2017). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
Why we inspected
This was a planned inspection based on the previous rating. However, just prior to the inspection we received information of concern from anonymous sources. These included, people not being supported by sufficiently experienced staff as training had not taken place. There was also concerns expressed about unsafe medicines management
We have identified four breaches in relation to person centred care, safe care and treatment, staffing and good governance at this inspection. We have made one recommendation in relation to the Mental Capacity Act 2005.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ciderstone House on our website at www.cqc.org.uk.
Follow up:
Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded. We will work alongside the provider and 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.