This inspection took place on 26 and 28 August 2015 and was unannounced.
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.
The service provides care and support for people with learning disabilities who live in bungalows and flats on the same site. Some people are quite independent while others have significant care needs and require more support and care. The service is registered to provide care for 36 people and at the time of our inspection 33 people were resident.
The service had no registered manager in place. The last registered manager had left the service in February 2015 and the manager appointed to replace them has now also left the service without becoming registered. 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.
The service has been in breach of a number of regulations over the last three years. When we last inspected the service on 3 and10 December 2014 we found there had been six breaches of regulation. The provider had supplied us with a detailed action plan outlining how they would improve the service and meet the regulations within an agreed timescale.
We met with the provider in January 2015 and were given assurances that the required actions would be put into place. The provider stated that all required actions would be in place and they would be operating in line with the regulations by the end of July 2015. We found that this was not the case at this inspection. Extremely high numbers of staff vacancies over the last year have not been successfully addressed and we have seen an increase in safeguarding concerns and alerts from people who used the service, relatives, professionals connected with the service and members of the public over this period. Many of these related to inconsistent or short staffing and the fact that staff were not familiar with people’s needs.
Throughout this inspection we found evidence of both good and poor practice. Previous inspections had identified that certain units needed to make considerable improvements to keep people safe and meet their needs. We found that a lot of improvements had been made in these specific areas but other areas of the service now remained the focus of our concerns. Therefore, whilst we acknowledged the hard work that had gone into improving previously failing areas, we were concerned to find similar issues in other parts of the service at this inspection.
We found that the service did not always respond promptly to allegations of abuse and systems designed to protect people from financial abuse were not always adhered to.
Risk assessment was both good and poor in different parts of the service. Some risks had not been comprehensively assessed and left people at risk. We also found risks associated with the management of medicines and errors, related to the administration of medicines, were high and had not reduced significantly since our last inspection.
Staff received most of the training they needed to carry out their roles effectively but training around specific healthcare conditions was not in place for everyone. Staff understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) was not good. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s consent had not always been established in line with the MCA. The service was operating in accordance with DoLS.
There was a mixed picture with regard to supporting people with their eating and drinking with some excellent practice in some units in the service and concerns about practice in others.
Previously we had had a number of concerns about people’s access to healthcare appointments. This was much improved across the service but we were concerned about the management of some people’s epilepsy.
Most staff were caring and compassionate and supported people sensitively. Others demonstrated a less caring manner with their language and actions.
Opportunities for people to follow their own interests and hobbies had improved since our last inspection but staffing levels meant people did not have enough to do and did not go out as often as they wanted to.
Complaints were not managed well and formal complaints the service had received had not all been responded to promptly and resolved to people’s satisfaction.
Ultimately the service has not been well led over a significant period. Several changes of management and a lack of a consistent strategy to deal with the serious issues facing the service have led some people who used the service, relatives and professionals to lose confidence in the service. Very recent management changes have made significant improvements but the staffing strategy involves redeploying staff on a temporary basis which is not a long term strategy. Whilst it is the case that additional permanent staff have been recruited, a number of staff expressed to us that they were intending to leave and morale remained low with some key members of staff. Support and guidance for staff, particularly new staff, had been poor during the last few months and demonstrated the lack of oversight the provider had of the issues facing staff and of risks posed to the people who used the service.
The leadership of the temporarily redeployed regional operations manager had begun to address longstanding issues at the service and people who used the service and staff were positive about the impact this had had in a very short time. Our concern, as a regulator, is about how the provider will ensure that this is sustained.
During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.