Background to this inspection
Updated
10 January 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.
Inspection team
The inspection was undertaken by two inspectors on 19 October 2022 and one inspector on 21 and 27 October 2022.
Service and Service Type
Providence House 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. Providence House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was a manager in post who had applied to be registered with us.
Notice of inspection
This inspection was unannounced on the first and third day, and announced on the second day.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 5 young people who used the service and the relatives of 2 young people. We received written feedback from 18 staff who completed questionnaires we provided. We spoke with the manager, service director, positive behavioural support lead, restraint reduction lead and clinical practitioners. We reviewed a range of records including assessments, care records, records relating to medicines, staff recruitment, training and supervision, accident and incidents and safeguarding logs and infection control policies. A variety of records relating to the management of the service, including audits and policies and procedures were also reviewed.
Updated
10 January 2023
About the service
Providence House is a residential care home providing personal and nursing care to up to 10 people. The service provides mental health support to young people aged between 13 and 18 years old. We are still looking at the registration status of this home as identified in the last inspection report (published) 7 Jul 2022.
Throughout the report we have used the term young people to represent those using the service. At the time of our inspection there were 8 young people using the service.
People's experience of using this service and what we found
Young people told us this was the best placement they had experienced. However, young people also told us they did not feel safe all the time. We found some evidence of a closed culture in relation to the practice of some staff. We define a closed culture as - a poor culture that can lead to harm, including human rights breaches such as abuse.
Young people were supported by enough staff, who had been recruited safely.
Young people were supported to consider and understand risks. The provider followed comprehensive risk assessment and management procedures. However, we found not all decisions had been recorded in sufficient detail to evidence the decisions made.
Young people had been fully involved in decisions about how they were supported and praised the quality of their care plans which were written clearly.
Legal authorisations were in place where young people had restrictions on their liberty. Young people were aware of restrictions on their liberty and their views had been considered and recorded.
Management oversight had improved, however further improvements were needed to ensure the improvements had been fully embedded. The manager in post was committed to achieving optimum oversight of the service to help ensure consistent high-quality care.
Young people praised the impact the new manager had on the service and the changes they had started to make. Young people said they felt more confident about being listened to and feeling safe.
Staff felt well supported and valued by the manager and management team. Staff were proud to work in the home and were committed to the provider's values.
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 requires improvement, (published) 7 July 2022.
Why we inspected
This inspection was prompted due to concerns we had received about; the use of restraint with young people, some staff interactions with young people, adherence to risk management plans and the availability of food and drink. A decision was made for us to inspect and examine those risks. We looked at the key questions of Safe, Effective and Well-Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Providence House on our website at www.cqc.org.uk.
The overall rating for this service has remained as requires improvement.
We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to; Safeguarding people from abuse, and Governance. We have also made a recommendation in relation to recording risk management decisions.
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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.