Background to this inspection
Updated
13 November 2021
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 Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a residential care home. It provides accommodation and personal care to people living at the service.
The service did not have a manager registered with the Care Quality Commission. It is a requirement of the providers registration to have a manager who would be legally responsible for running the service and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
People living at the home had complex needs, so we spoke briefly to four of the five people living at the home and two relatives about their experience of the care provided. We spoke with four staff members, including the provider, senior support worker and two care workers. We reviewed a range of records. We reviewed medicine administration records for three people. We looked at staff files in relation to recruitment. We looked at records related to building safety, including gas safety checks and emergency lighting and health and safety audits.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, two care plans and associated risk assessments. We spoke with the local authority commissioning and safeguarding team. We spoke with a care worker and two relatives. We reviewed recruitment records for three staff members and documents related to the running of the service, including policies and procedures.
Updated
13 November 2021
About the service
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.