Background to this inspection
Updated
22 November 2023
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 Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of 3 inspectors. Two inspectors attended both dates of the inspection visit.
Service and service type
Zeno Ltd is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Zeno Ltd is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us.
Inspection activity started on 25 July 2023 and ended on 4 August 2023. We visited the home on 26 July 2023 and 1 August 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
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.
During the inspection
During the inspection, we spoke with the registered manager the deputy manager and 6 staff members. We spoke with 1 person living at the home and 2 relatives. We also spoke with health professionals of people living at the home.
We reviewed 3 care records and associated care plans and assessments. We reviewed 5 staff recruitment records and several, induction, training and supervision records. We looked at the providers policies as well as governance processes.
Updated
22 November 2023
About the service
Zeno Limited is a residential care home providing accommodation for persons who require personal or nursing care for up to 7 people. The service provides support to children aged 13 – 18 years, younger adults and people with learning disabilities or living with autistic spectrum disorder. At the time of our inspection there were 3 people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: The model of care did not always maximise people’s choice, control and independence. Restrictions within the home did not always consider people’s individual needs and were not reviewed in line with current best practice.
The provider had not always considered best practice and guidance for the design of the home.
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 were not always supported to receive a healthy and nutritious diet. There was a lack of meal planning, to ensure people’s dietary needs were addressed and improved.
Staff used pictorial images and social stories to support communication between themselves and people living at the service.
Right Care: Proactive strategies to reduce the risk of people exhibiting behaviours were in place. However, the provider had not agreed the most appropriate strategies for using physical intervention in care records. Assessments had not fully considered holistic person–centred care and did not describe how people should be supported to reach identified goals.
Relatives felt their relation was safe while living at the home. Staffing levels were satisfactory.
People were supported by a range of health and social care professionals. Health actions plans were in place but lacked guidance for how staff should support people to stay healthy.
We observed kind and caring interactions from staff when supporting people. People were relaxed in staff’s presence.
People were supported to attend activities at and away from the home with staff.
Right Culture: The provider had not ensured staff were always recruited safely. The provider had not identified gaps in recording within incident records. The provider was not completing spot checks and fire drills during evenings and weekends to assure themselves the service was operating effectively in their absence.
Incidents of self-injurious behaviour, which required hospital treatment, were not always reported to the local authority or the Care Quality Commission. Commissioning social workers were informed of incidents.
Staff received training to support their job role. Training to support people with learning disabilities and autism was provided.
Staff and relatives felt confident to raise any concerns they had and felt they would be listened to.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection for this service was good (published 24 December 2019).
Why we inspected
The inspection was prompted, in part, due to concerns received about alleged abuse and staffing arrangements. A decision was made for us to inspect and examine those risks.
We found some of the information received about the service had been incorrectly linked to this location and was connected a separate location of the providers. We have now ensured the information had been aligned with the correct location.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Zeno Limited on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to person–centred care, safeguarding service users from abuse and improper and good governance at this inspection.
We have made a recommendation the provider consults with a pharmacist to obtain the correct administration process for administering medicines in people's food.
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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.