Background to this inspection
Updated
11 January 2020
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
The inspection was carried out by one inspector.
Service and service type
Cana Gardens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as one single package under one contractual agreement. CQC regulates bot the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. The provider took on the dual role of the registered manager and the nominated individual. This means they are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission packages of care with the service. We used this information to plan our inspection.
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
We met and spoke with one person who used the service. However, they were unable to fully comment upon their care at Cana Gardens. We met and spoke with two family members of one person, using the service. We spoke briefly with the registered manager by telephone. We spoke with the care manager and consultant manager at the service, and two members of the care staff team.
We reviewed a range of records. This included two people’s care and medication records. We looked at a variety of records relating to the management of the service, which included, audits, policies and procedures, and minutes of staff meetings.
After the inspection
We spoke with a professional involved in the commissioning of a person’s care.
Updated
11 January 2020
About the service
Cana Gardens is a care home providing personal care for up to eight people with a learning disability and/or autistic spectrum disorder. At the time of the inspection there were two people using the service.
Why we inspected
This was a planned inspection based on the previous rating. We have used the previous ratings to inform our planning and decisions about the rating of this inspection.
People’s experience of using this service and what we found
We found insufficient improvement had been made to move the service out of special measures.
The provider continued to have ineffective systems to ensure people consistently received good quality outcomes. The management team appointed to oversee the day to day management of the service did not have the resources or authority to bring about improvement. This meant there were no plans to improve the environment, nor was there a planned programme to develop, support and manage care staff through on-going training and assessment of their competence.
People had their medicines safely when they needed them, however staff had not updated their training in medicine management. People’s safety was promoted, staff were aware of how to minimise risk to people’s by following their individual risk assessments and care plans. People were supported by sufficient numbers of staff.
Staff had a system of cleaning in place, using products which were stored securely. However, a malodour remained in a specific area of the service, which could only be addressed through maintenance and refurbishment, there were no plans at the time of the inspection to make the necessary improvement.
Improvement was needed to ensure referrals were made to appropriate services, where people required support with individual needs, which affected their day to day lives. Staff did refer people to health care services, where they had concerns for their physical health and well-being.
Opportunities were available for people to take part in grocery shopping, and their nutritional and dietary needs were met. However, the outcomes for people did not fully reflect the principles and values of Registering the Right Support for people for the following reasons, people’s goals and aspirations were not sought, and therefore plans to support people to achieve and develop new skills within the service were not in place.
People’s capacity to make informed decisions was assessed, and people were supported in the least restrictive way possible, which was reflected in people’s records and kept under review by independent organisations.
People were supported by staff who knew them well, and people and family members we spoke with were positive about the staff and the care and support provided.
Rating at last inspection
The last rating for this service was requires improvement (published 29 April 2019), where two breaches of the regulations were found. The service remains in special measures, as the rating of the key question is the service well-led, continues to be rated as inadequate.
Services in special measure 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 and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to be 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.
For adult social care services, the maximum time for being in special measures will usually be more that 12 months. If the service has demonstrated improvements when we inspect, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Enforcement
We have identified breaches in relation to the provider’s oversight and governance of the service, and the environmental maintenance of some areas within Cana Gardens Residential Home.
Please see the action we have told the provider to take at the end of this report.