Archived: Leopold Muller Home

Updated 20 October 2022

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

This inspection was carried out by two inspectors and an internal specialist advisor for people who are Deaf who is a British Sign Language user on site. An Expert by Experience telephoned relatives; an Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The internal specialist advisor was consulted throughout the inspection when not on site.

Service and service type

Leopold Muller Home 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. Leopold Muller Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the home changed provider and 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.

During the inspection

We spoke with four people using British Sign Language (BSL) or deafblind signing. We were unable to speak with other people who used the service because of their limited verbal communication. We completed a wide range of observations including using 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.

We spoke with two relatives on site and four relatives on the telephone about their experience of the care provided. We also spoke with 10 members of staff including the provider’s representative, the registered manager, deputy manager, nurses and care staff. We reviewed a range of records. This included seven people’s care records and a range of medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, action plans, quality assurance records, policies and other information the provider shared.

Updated 20 October 2022

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.

About the service

Leopold Muller Home is a residential care home providing personal and nursing care for up to 22 people who are Deaf or deafblind. People often have a range of other complex needs including dementia, mental health, a learning disability and/or autism. At the time of the inspection up to 15 people were living at the home. One person was at the home on respite.

The home is over three floors and has lounges with kitchenettes on the first two floors. There was an activity space on the first floor and a dining room on the ground floor. Individual bedrooms were on each floor.

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

People who were not autistic and/or had a learning disability were not kept safe or had their needs met at this home. Medicines were not always managed safely and risks were not always considered or mitigated. There were not enough staff supporting people with adequate communication skills.

People were able to access other professionals when their health declined. However, this was not always in a timely manner. Systems were not in place to help people make choices who lacked capacity. The provider and management systems were not identifying concerns found during the inspection. Neither were they ensuring people’s care was in line with current legislation, guidance and laws.

Right Support:

People were not 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 this practice. The model of care was not in line with current best practice. There was a focus from staff on encouraging people to eat at the same time in a dining room. Kitchen staff prepared the meals and there were limited opportunities for people to work towards independence, such as cooking for themselves.

People were not supported by enough staff who had adequate training to communicate effectively with them. The provider had not put systems in place to mitigate this risk and impact was identified to some people as a result. The environment was dated and in places damaged which the provider had plans to rectify.

Right Care:

People were not always treated with dignity and respect by staff. Occasions were witnessed throughout the inspection which illustrated this. Staff tried to interact with people in a caring way and there were key staff who promoted this. However, many times through the inspection undignified care was witnessed often due to a lack of understanding of people’s needs. Examples seen was staff shouting down the corridor at each other about people’s intimate care. Also, leaving doors open when delivering intimate care.

The activity coordinator did their best to involve people in games and group sessions. However, these were limited due to their availability and lacked support from staff with communication skills to assist. No people actively took part in their local community and no one was seen leaving the home during the inspection.

Right Culture:

People were not leading confident, inclusive and empowered lives at the home. Many people sat in rooms with little to no interaction between tasks that were required. Little respect was shown for people being part of the Deaf and deafblind communities. There was a lack of cultural opportunities for them.

The management at the home did their best to lead by example and we received positive feedback about them. However, they were unable to complete many of their management tasks due to supporting a large unstable staff team. The new provider had not updated their governance systems to take on a nursing home or services for people that were Deaf and deafblind.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 30 June 2021 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 5 December 2018.

Why we inspected

The inspection was prompted in part due to concerns received due to a change in provider and concerns around leadership, people’s cultural needs being met and staffing. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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.

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 keeping people safe including from risks of harm and potential abuse. Breaches have been found related to staffing and staff training, people’s dignity and culture, infection control, medicine management, personalised care and governance of the home at this inspection.

Following the inspection, the provider informed us they were going to slowly close the home making sure people’s needs and preferences were considered at all stages.

Follow up

We will meet with the provider and request an action plan of how they will keep people safe following this report being published to discuss how they will be proceeding with the closure of the home. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service until it is closed.

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 the provider has not closed the home, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement or closed the home 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.