15 January 2018
During a routine inspection
Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key question safe to at least good. At this inspection we checked to see whether improvements had been made and found the registered provider was not meeting the regulatory requirements relating to consent, safe care and treatment, building safety, good governance and staff training and recruitment.
Park Cottages is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Park Cottages provides accommodation for twelve people with learning disabilities. Park Cottages is in a residential area close to Barnsley and is close to a bus stop and some local amenities. The cottages comprise of one separate unit for three people and two units combined in one building where nine people live.
At the time of our inspection 11 people were using the service on the 15 January 2018 and 12 people were using the service on 19 January 2018
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen; however we found these requirements were not all being met.
A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We found people were not protected from unsafe or unsuitable premises. For example; we found fungi had grown around the carpet under one person’s sink due to a water leak. We also found water dripping through the light in the ceiling of the corridor on one unit from a poorly maintained roof. These and other examples of inadequate maintenance presented a risk of harm to people. No action had been recorded to rectify these significant concerns and keep people safe from harm.
Effective systems were not in place to manage and reduce risks to people from inadequate building maintenance, legionella infection and scalding.
Fire, doors were wedged open and the emergency door closers were not operative on the first day of our inspection. This meant people were not protected in the event of a fire.
People were not protected from the risk of infection because an effective system was not in place to maintain the cleanliness of the home.
Staff told us about occasional incidents between people and two of the care plans we viewed described people’s behaviour that may challenge others. No incidents or accidents had been recorded at the service and this made it difficult to demonstrate any learning from these incidents.
Safe recruitment and selection processes were not in place because gaps in employment had not been explored for three staff members and risks related to unsuitable staffing had not been assessed.
We reviewed the systems for the management of medicines and found people received their medicines safely.
Brief risk assessments were in place for people to minimise risks associated with care delivery, some risk assessments lacked detail.
Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse, however no recorded action had been taken by staff to safeguard people from the risks of harm presented by inadequate building safety measures. Sufficient staff were on duty to meet people’s assessed needs.
Staff told us they received an induction when they commenced employment with the home, although there was no evidence of this. Staff had received basic training, although no role specific training was evidenced in areas such as learning disability awareness, epilepsy or de-escalation techniques where behaviour may challenge others. Staff competence was not checked. This meant staff may not have the knowledge and skills to support the people who lived at the home.
Staff told us they felt supported and received management supervision in line with the registered provider’s policy of twice a year.
We could not be sure people were supported to eat a balanced diet as meals were not recorded and no menu was available. A record of menus was reinstated on the first day of our inspection. Some people told us they did not get a choice of meals but the food was alright.
People were supported to maintain good health and had access to healthcare professionals and services. They were supported and encouraged to have regular health checks and were accompanied by staff to health appointments. The unit manager worked in partnership with community professionals and responded positively to their intervention and advice.
We saw people were offered choice; however, the care plans we looked at did not contain decision specific mental capacity assessments and consent to care was not recorded.
Positive relationships between staff and people who lived at Park Cottages were evident. Staff were caring and supported people in a way that maintained their dignity and privacy, although people’s dignity, privacy and equality was not supported by good standards of building maintenance. People were supported to be as independent as possible throughout their daily lives.
Care plans were in place to provide guidance to staff. People engaged in some social and leisure activities in line with their tastes and interests.
No complaints had been recorded at the home. People told us they had complained about repairs not being completed, but there was no record to confirm this or the action taken in response.
The registered manager was not visible in the service and there was no evidence of oversight or audit by the registered manager. There was no evidence the registered manager had visited the service in 2017.
The registered provider and registered manager had not taken action following our last inspection to improve the safety or governance of the service.
Accurate records were not kept and the building audits completed by the unit manager were ineffective and did not identify or address the significant safety issues we found.
The registered provider had not recorded any checks on the quality and safety of the care provided.
Staff told us they felt supported by the unit manager although the registered manager did not visit the location. The unit manager told us they liaised with the registered manager verbally and we saw occasional supervision was provided by the registered manager at a different location, although no concerns about the quality and safety of the service were recorded by either party.
People who used the service and their representatives were not always asked for their views about the service.
We found breaches in Regulations 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Information about CQC regulatory response is added after any appeals have been completed.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.