Archived: Residential Care Home

Residential Care Home is a residential care home providing accommodation and personal care to five people with a range of needs, including learning and physical disabilities, mental health and sensory needs at the time of the inspection. Residential care home accommodates up to six people in an adapted building.

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

We found the environment unsafe and parts of the building in need of refurbishment. This put the health and safety and well-being of people using the service at risk. Risk assessments lacked detail on how to mitigate the risks people faced. Staffing levels were insufficient to meet people’s needs. Therefore, we could not be assured that people’s need were always met. Recruitment practice was unsafe. This meant we could not be assured that staff employed were of good character and safe to work with people. Medicine management was unsafe. This meant we could not be assured that people received their medicines as prescribed.

There was no evidence of learning from accidents and incidents to drive changes and the provider did not identify the areas where improvements were needed to service delivery. Systems for monitoring the quality of the service were ineffective in identifying the issues found during our inspection. Audits were not routinely carried out.

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 this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The environment required modernising and did not enable people to have choice, control and independence. Care was not always provided in a dignified manner and people’s human rights were compromised. The service lacked leadership and risk management. Leaders were not aware of their role in delivering the principles of right support, right care, right culture. We received mixed feedback from relatives about whether they felt their relative was safe living at the home. This meant we could not be confident people received appropriate care and support.

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

Rating at last inspection and update

The last rating for this service was good (published 30 December 2019)

Why we inspected

This inspection was carried out to follow up on concerns raised about safety, the quality of care, safeguarding and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements.

Enforcement

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.

We have identified breaches in relation to staff recruitment, staffing levels, medicine management and management of the service.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Residential Care home is a residential care home providing personal care to six people with a learning disability at the time of the inspection. The service can support up to six people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People told us they felt safe at the service. A relative told us their family member was safe. Staff at the service knew their safeguarding responsibilities and knew how to report abuse.

People had risk assessments in place to protect them from avoidable harm yet allow them to live as freely as possible. People’s medicines were managed safely. The service was clean and free from malodour, staff followed good hygiene practices.

People were supported by staff who had been recruited in a safe way.

People received an assessment of needs before moving into the home. People told us staff were good and could support them well. Staff received regular training and supervision to ensure they had the right skills to support people.

People had enough to eat and drink. The building was accessible, and people could navigate their way around it well.

People liked the staff who supported them, and staff were observed to be kind and caring.

People’s privacy and dignity was respected. Staff were non- discriminatory and respected people as individuals.

People received person centred care and were involved in the planning and delivery of their care.

People’s communication needs were documented clearly. People were supported to do activities of their choice and to attend places of worship. Trips abroad were encouraged and supported by the service.

The service had a registered manager who was visible and involved in peoples’ care. People and staff spoke highly of the registered manager.

The registered manager regularly audited the service and sought the views of people, relatives, staff and professionals to improve the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 8 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation and support with personal care for up to six adults with learning disabilities. Six people were using the service at the time of our inspection. The service provider is a registered individual. This means there is no requirement to have a registered manager as the provider is considered a registered person. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. However, medicines were not always managed in a safe manner.

Staff received on-going training to support them in their role. People were able to make choices for themselves and the service operated within the spirit of the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. We observed staff interacting with people in a caring way. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Systems were in place to seek the views of people on the running of the service.

Residential Care home is a care home proving care to up to six people with learning disabilities. At the time of our inspection five people were living in the home. The service provider is a registered individual. This means there is no requirement to have a registered manager as the provider is considered a registered person. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Staff knew people well and described in detail how to support people and manage risks. However, risk assessments were not robust and did not describe measures used to reduce the risk of harm. Care plan documentation was not person-centred. We have made a recommendation about person-centred care plans.

The service completed quality assurance questionnaires and audits. However, the audits used were not robust and did not identify areas for improvement. We have made a recommendation about quality assurance processes.

The service recorded incidents and accidents but did not complete analysis to see if lessons could be learnt. We have made a recommendation about incident recording and analysis.

People told us they felt safe, and staff were knowledgeable about safeguarding adults from harm.

There were sufficient numbers of staff to provide people with the support they needed. Staff received the support and training they required to carry out their roles and responsibilities.

People were supported to take medicines, and this was managed in a safe way. People were supported to access healthcare services and follow medical advice.

People had consented to their care. The service was working in line with legislation and guidance regarding capacity and consent. People were involved in making decisions about their care and had regular meetings to review their care and support.

Care plans contained details of people's dietary preferences and needs. People were supported to maintain a culturally appropriate diet that met their nutrition and hydration needs.

People and staff had developed positive, caring relationships with each other. People's individual identities, cultural and spiritual backgrounds were supported. People were supported to have private time when they wanted and staff maintained people's dignity during care.

The home had a robust complaints policy and complaints were resolved in line with it.

The home had a positive culture that recognised people's individuality and preferences. People and staff spoke highly of the registered provider and the manager.

At our previous inspection we had identified concerns with staff working long hours due to absence, records not being updated and staff rotas being maintained in pencil. On this visit we reviewed rotas from September to November 2013 and found them to be written in ink and meeting the needs of the people. For, staff working over 48 hours a week, we saw a signed work directive opt out form. Care plans and risk assessments were up to date and reflected the needs of people using the service.

We found that the home was clean and well maintained. Staff were knowledgeable about infection control procedures. Equipment was clean and serviced at least once a year. Staff were aware of how to use, clean and report faulty equipment. People told us that they were comfortable. One person said, 'This has been home for almost ten years. Everything is clean and comfortable."

There were inadequate procedures in place to support staff, when shortages arose due to sickness or annual leave. We found that three staff were working six days a week in order to cover all the shifts, whilst two staff were on annual leave and one staff was off sick. Staff were qualified but had limited knowledge about the Mental Capacity Act (2005).

We found that people's records were sometimes inaccurate and needed updating. Risk assessments and care plans did not have current review dates. The staff rota was in pencil instead of ink, therefore any alterations or amendments would not be retained.

People's ethnic requirements were respected and supported. People using the service felt and were kept safe. They appeared happy and content. They took part in decision making in the service.

Medications were generally handled safely apart from a recording error.

Staff felt well managed and supported and enjoyed working in the service. Some mandatory refresher training was overdue and training in mental capacity needs to be implemented.

The provider has been responsive to feedback from a variety of sources and improved the service.

People using the service we spoke to could not think of how the service could be better when we asked them. One said 'they take good care here'.