Archived: McLaren House

McLaren House is a care home which is registered to provide personal care for up to 9 people with mental health needs. There were 7 people being supported at the time of our inspection.

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

Although people told us they felt safe, the systems in place failed to ensure people would always be protected and safe from risk of harm and abuse. Numerous incidents including abuse and/or allegations of abuse had been overlooked. These concerns were not escalated to relevant partner agencies as required, such as the local authority and notified to CQC. This amounted to two breaches of regulations due to the provider’s failure to protect people from harm and abuse, and to always notify the Commission as required of specific incidents and events including safeguarding matters. The provider and staff failed to respond appropriately to safeguarding concerns and people remained at ongoing risk of harm and abuse as a result.

We identified a third breach of the regulations due to the poor management of people’s risks, medicines, and further significant shortfalls in the safety of the service. Incidents including where people had come to harm, were not learned from to prevent reoccurrences and to safely manage risks. Our inspection found people’s risks were not adequately assessed and known to all staff, and poor management and oversight of the premises and medicines management presented further risks to people’s safety.

We identified a fourth breach of the regulations because staff were poorly deployed. Systems were not in place to establish how many staff were needed to safely meet people’s needs at all times and to ensure staffing levels were always safe. This included the provider’s absence from the service although they were on the rota to attend on the day of our inspection. Recruitment processes were not robust. We found infection control concerns and improvements were required to health and safety checks.

Although people spoke positively about their support, our review of records found people’s needs were not adequately assessed or detailed to inform effective support at all times. Information and/or learning about incidents were not shared with staff. Staff did not have sufficient training and guidance for their roles and the service was not fully adapted and maintained to promote people’s safety as far as possible.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support consistently good practice.

People were supported by staff to access further healthcare support when needed. Most people spoke positively about the home’s food and some people prepared their own meals. Staff told us they felt supported.

We saw positive interactions from staff and most people spoke positively about staff. However, the inadequate response to safeguarding matters and incidents at the service, by staff and the provider, failed to ensure people were always well treated and supported. People were not supported to always have their views heard and acted on; and to be involved in their care as far as possible. We saw and heard examples of how people’s privacy and independence was promoted.

Care planning processes failed to capture people’s individual needs and preferences and ensure these could be met as far as possible, including people’s communication needs. Most people spoke positively about the service and told us they would recommend it. People had access to doing things they enjoyed but told us there were not enough activities led by the home. Most people told us they would feel comfortable complaining if they needed to, although we saw other concerns and issues were not always adequately responded to.

We identified a fifth breach of the regulations because the provider did not have systems and processes in place to adequately support people and staff. We found widespread and significant shortfalls in the quality and safety of the service which exposed people to ongoing risk of harm and poor care, including around medicines management, learning from incidents, risk management, the safety of the premises and ensuring staff were sufficiently skilled and suitably deployed. Despite our urgent prompts, the provider failed to act on the serious concerns we brought to their attention.

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 July 2017).

Why we inspected

The inspection was prompted in part due to concerns about the provider’s governance systems and oversight of the quality and safety of care provided, identified through our inspection activity at another service registered with the provider. We decided to inspect and examine those risks.

We identified serious concerns and breaches of the regulations at this inspection. We found evidence that people were at risk of harm as a result. Despite our urgent prompts and enforcement activity, the provider did not take enough action to mitigate those risks. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We identified five breaches of the regulations at this inspection. This was because the provider failed to protect people from abuse and ensure any allegations of abuse were immediately investigated. The provider failed to adequately assess and mitigate risks to people’s health and safety, including risks posed by their poor upkeep of the premises and poor management of medicines. We identified further safety shortfalls that the provider failed to ensure there were sufficient numbers of suitably skilled and competent persons deployed to safely meet people’s needs. The provider failed to operate effective systems and processes to assess, monitor and improve the quality and safety of the service. This included the further breach of the provider’s failure to notify CQC of all incidents that affect the health, safety and welfare of people using the service.

After our inspection, we took urgent enforcement action to require the provider to immediately address significant concerns that placed people at immediate risk of harm. We informed relevant partner agencies of our serious concerns. The provider failed to take enough action to ensure people’s safety which continued to place people at immediate risk of harm. We continued to liaise closely with the local authorities and other relevant partners. We carried out a responsive inspection of the third service registered with the provider based on the concerns we had identified.

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

During and after our inspection processes, we requested information from the provider about what action they were taking to address our serious concerns. We also worked alongside the relevant local authorities in light of the concerns we identified. We carried out urgent enforcement action in relation to this service. During our enforcement processes, we continued to monitor the service for any further concerning information to help inform our inspection activity.

Special Measures

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.

People continued to receive safe care and were supported to take their medicines as prescribed. Staff had received training and any necessary updates in how to protect people from abuse and harm. Risks to people were consistently assessed and guidance was available for staff to follow to ensure they were protected from harm.

People continued to receive effective support from staff who had the skills and knowledge to meet their specific needs. People were enabled to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. People were assisted to access appropriate healthcare support and take a nutritional diet.

The care people received was consistently provided with compassion and kindness. Encouragement for people to express their views and be involved as much as possible in making decisions about their support needs remained apparent. People’s diverse needs were recognised and staff enabled people to continue to enjoy the activities and/or hobbies they enjoyed.

The service continued to be responsive and involved people in developing their care plan so that their individual preferences and abilities were known and these were respected by staff. People were able to speak openly with staff and tell them if they were unhappy or wanted to make a complaint.

The service continued to be well-led, including ongoing checks and monitoring of the quality of the service. People and staff highly rated the leadership skills of the registered manager. Arrangements were in place to obtain people’s views about the service and some further plans to develop how feedback was sought were in place.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We observed that people were treated with dignity and respect by the care staff. We saw that people were given choice in their care and how they spent their day.

All of the people we spoke with told us that they were very happy at the home and told us that staff helped to keep them safe. One person said, 'I always feel safe here. It's my home and I have lived here for 20 years. Another person said, 'The staff are kind and make sure we are all safe here. The staff help to keep me safe when all go out anywhere as well.'

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receiving care and were able to make informed decisions. We spoke with staff and the registered manager about Deprivation of Liberty Safeguards (DoLS). This applies to all care homes. All staff spoken with told us and records sampled showed that all staff had received DoLS and Mental Capacity Act (MCA) 2005 training and which meant that they understood their responsibilities and ensured that the rights of people were protected.

The provider had policies and procedures in place to protect people from harm. Some people had complex support needs, with some behaviour that challenged. All staff spoken with understood what safeguarding people meant. All staff had up to date training on how to protect vulnerable adults and how to support a person when they displayed behaviours that may harm themselves or others. This meant that the safety of people who lived there and of others was promoted and protected.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

We saw that systems were in place to make sure that learning takes place from accidents, incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

Three people spoken with told us, and we saw records to confirm that friends and relatives could visit throughout the day. We saw that facilities were available so that people could meet in private if they wanted to.

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people could influence the care they received. One person we spoke with said, 'I choose what I want to eat each day and where I want to go. The people that help me here are kind to me.' Another person told us, 'They have helped me learn how to cook meals for myself and sometimes the others. I can travel on my own to work one day a week as well.' This meant that people were supported to develop independent living skills and engage in community involvement.

We saw that relatives were involved with people's care. A relative told us, 'They always make sure that my relative sees the doctor and dentist when they need to."

All staff spoken with were able to give us good detail about the support they provided to people. People's health and care needs were assessed and care plans told staff what people's care needs were so they could support people consistently. Referrals had been made to external professionals so that people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.

We saw that people's cultural, dietary and communication needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their support needs and understood their cultural requirements.

Records sampled showed that people were encouraged to eat a healthy and nutritious diet. We saw that they had a choice of what to eat and enjoyed the food provided. Their weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. This meant that people were supported to eat and drink sufficient amounts to meet their needs and ensure their health and wellbeing.

Is the service caring?

We saw that staff treated people with dignity and respect. We saw that were patient and caring they took their time and did not rush people. Staff were seen to be attentive and interacted well with the people they supported. We saw that people responded positively to staff and chatted with them in a friendly manner.

People, their relatives and other professionals involved with the service had completed an annual satisfaction survey. We saw that relatives had made positive comments in the surveys we looked at.

People's preferences, interest and aspirations and diverse needs had been recorded in their care records.

Is the service responsive?

We saw that people took part in a range of activities at home and in the local community either independently or with support from staff. We saw that staff responded to spontaneous requests from people to do activities, or to spend their time in a way that they preferred. People had been supported to go on holiday and we saw records to show that people who lived here chose their destination each year.

We saw that when needed staff had requested the involvement of other health professionals in people's care.

Is the service well lead?

The home had a manager who was registered with us, CQC. They were experienced and knowledgeable about the needs of the people that lived in the home.

We found that robust systems were in place to regularly assess the quality of the service that people received. Records showed that regular spot checks on staff skills and work practices were by carried out by the manager. We sampled the findings and saw that they were detailed and feedback was provided to staff following these checks. Supervision and training records showed that supervision and staff training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.

All staff that we spoke with were clear about their role and responsibilities. They had a good understanding of the ethos of the home and the systems in place to monitor quality assurance. This ensured that people received good quality of care.

At the time of our inspection the provider did not have a registered manager in post.

We observed how people using the service and staff interacted, and how the needs of each person were met. People were treated with respect and dignity and we saw that they felt comfortable and at ease with the staff, often sharing homely tasks and talking together.

A care staff told us, 'It would be good to have a few more staff available at certain times, so we can spend more time with the people living here doing fun stuff'.

We saw that people had personalised care profiles. The seven people spoken with who used the service told us that they were aware of these and had signed them. One person told us, 'I discuss what I want to do and what they want me to do and we negotiate and decide.'

The care profiles included information from other health professionals in regard to their health and well-being. This meant that people using the service were appropriately assessed. Staff had all the information they needed to support people appropriately and safely in the way they preferred

People we spoke with told us that the staff had helped them to become more independent.

We saw that people could choose what they did and how they spent their time, but two people spoken with told us, 'I used to handle my own money. I used to go to the post office, but they won't let me' another said, 'I like cleaning and polishing I did it yesterday, but I was stopped because the cleaner did it.' This meant that some people are not always assisted to be as independent as they wished.

A robust system was in place for the management of medicines, records were up to date. Staff records and care staff spoken with confirmed that all staff who handle medication are trained and are observed to ensure they are skilled to manage the medicines. One person spoke with told us they would like to manage their own medicine as they did when they were at home.

There are suitable numbers of staff on duty at all times. One person spoken with said, 'A lot of staff, and the house, I like it.'

A quality assurance system was in place to assess the service provided. We looked at records and found that these were not always kept up to date or completed properly. This meant that the provider could not demonstrate that everything in the service was running as it should have been to meet the support and safety needs of people living and working at the service.

We spent time observing how people were cared for to understand their experiences. We saw that people were treated with respect and dignity and were at ease with the staff.

We saw that people had personalised care plans. These included advice form health care professionals involved in their care and treatment. This meant that staff had all the information they needed to support people appropriately and safely in the way they preferred

People we spoke with told us that the staff had helped them to become more independent. One person told us, 'I have learned how to cook for myself its great here.'

We saw that people could choose what they did and how they spent their time. One person told us, 'We can choose what we do. We go out to the library and we go shopping when we want to.'

Systems were in place to ensure that people were safeguarded from harm.

Appropriate checks were completed before staff started working there to ensure they were 'suitable' to work with the people living there.

Staff were trained to give them the skills and knowledge to know how to meet peoples needs and ensure their wellbeing.

The people living here and their relatives were asked for their views about the home and these were listened to.