Archived: Bedrock Court - New Road

This inspection was unannounced and took place on 15 and 16 February 2017.

We carried out inspections of three of the provider’s locations from 13 to 17 February 2017. These locations are; Bedrock Court, Bedrock Mews and Bedrock Lodge. The reports of all three inspections can be viewed on our website. The provider’s main offices are at Bedrock Lodge. As a result we spent time there gathering information relating to each separate location. We found many aspects of the service provided at the locations to be similar. This is because the policies and procedures, systems and processes used by the provider were consistent across all three locations. In addition, a number of staff worked across all three locations and, until recently the service users from each location attended Bedrock lodge during the day. As a result, each of the three reports contain some information that is similar.

Our last comprehensive inspection of this service was carried out in December 2015. At that time we rated the service overall as ‘requires improvement’ As a result of concerns shared with us we carried out a focussed inspection of Bedrock Court in September 2016. At that time we rated the service as ‘Inadequate’ under the three key questions areas we looked at. These were; is it safe, is it effective and is it well-led. We were unable to change the overall rating for the service following that inspection because it was not a full comprehensive inspection and, was carried out more than six months after our previous inspection.

There was no registered manager in post. 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. The previous registered manager resigned from the provider’s employment over 18 months ago. Despite assurances from the provider they were going to employ a registered manager the provider had failed to register a manager with CQC. The provider had taken responsibility for the day to day management of Bedrock Court.

Following our previous inspection the provider had made arrangements for a ‘turnaround team’ to oversee the management of the service. This had involved the provider commissioning experienced health and social care staff to be available on a day-to-day basis and co-ordinate the management of the service. At the time of our inspection the provider’s three services were managed by an independent project manager, they oversaw the senior person from the ‘turnaround team’ and an acting manager directly employed by the provider, who managed an assistant manager, senior care staff and support workers.

After the inspection in September 2016 some improvements had been made to ensure that people’s immediate safety was considered and action taken. Immediate actions included, investigating the possibilities of finding alternative placements for people whose needs were not being met, people not being required to attend another of the provider’s locations for day care and staffing levels increased during the day and at night.

During this inspection improvements were identified and are referred to throughout this report. However we were concerned the improvements we saw would not be sustained following any withdrawal of the ‘turnaround team’. Staff employed directly by the provider and, members of the ‘turnaround team’ themselves were unclear how much longer this arrangement would be in place. We wrote to the provider and told them to provide us with further information detailing their plans for any withdrawal of this additional input. The answers we were given were vague and they told us a date for withdrawal had not been identified and that plans were yet to be agreed. This raises concerns and, we could not be satisfied, that the improvements we found would be sustained and that subsequent improvements required would be achieved. The inspection history of the service shows repeated concerns regarding the leadership and management of the service.

Staff told us they were concerned any improvements would be reversed when the ‘turnaround team’ were no longer in charge and the provider took control. Some senior staff told us they felt they were able to withstand attempts to do this; others felt it unlikely they would be able to do so.

Since the inspection in September 2016, there had been nine new individual safeguarding concerns raised with the local authority relating to people living at Bedrock Court and 35 in total across all three of the provider’s locations. The concerns about the service were still considered a risk by the local authority and other agencies, and the service continues to be placed in an organisational safeguarding process.

The environment at Bedrock Court was not designed to effectively meet people’s needs. The home was poorly maintained and did not allow for the safe management of infection control.

Staff still lacked the skills and abilities to provide effective care and support. Staff did not always have a good understanding of the principles of the Mental Capacity Act (MCA) 2005 or best interest decision making. However, people told us they were now able to make more day-to-day choices and decisions. Relevant health and social care professionals were now more involved in ensuring people’s needs were met.

At the inspection in September 2016 we found the provider and staff had failed to recognise where certain practices compromised people’s dignity and respect. We also reported that the service was, in many ways, demeaning to people and did not contribute towards them being viewed as valued individuals. The improvements made had been led by the ‘turnaround team’. People told us they felt they were better cared for and more able to exercise their independence. However further progress will be required to take this forward as the structure and delivery of the service is still more likely to foster dependence than independence, because of the way the service has been previously led and managed.

People still told us they felt they were required to fit into the service rather than the service being designed and delivered around their needs. In addition, the service had failed to continually assess and support people in ensuring the service was still a suitable place for people to live. The provider had failed in their responsibility to engage with commissioners who funded people’s placements to ensure that placements were still appropriate. The impact on people due to the lack of support and planning to ensure smooth transitions was unsatisfactory. The attitude of staff to other professionals was not always positive. They did not see the professionals’ support as helpful and in people’s best interests. Although the ‘turnaround team’ had tried to change this attitude, it was still evident with some staff.

Since the ‘turnaround team’ commenced in November 2016 they had needed to prioritise the most urgent areas for improvement in order to keep people safe. Some of the actions they had taken had improved the quality of service people received. This was particularly around improving their day to day lifestyle. People were making far more choices about everyday matters, for example, what time they got up, when they went to bed, what they did during the day, what they ate and drink and when they received meals. They had worked extensively with permanent staff members on role modelling, coaching and introducing best practice.

People told us they felt safer. Staff had a better understanding of how to recognise the possibility of abuse and report concerns appropriately. Staffing levels had increased. The management of medicines had improved and people benefitted from revised individual protocols for the administration of these. Staff had received some additional training to meet people’s needs. We saw staff treating people in a more caring manner. People’s care records were written in a more objective and positive manner. The turnaround team had tried to build better working relationships with other agencies and to educate staff on the importance of this in order to enhance people’s health and well-being.

Following this comprehensive inspection, the overall rating for this provider is ‘Inadequate’. This means it has been placed in ‘special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Full information about CQC's regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

We found and, have reported on, breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in our report.

This inspection was unannounced and took place on 27, 28 and 29 September 2016.

People living at Bedrock Court attended another location (Bedrock Lodge) which is also a location registered with the CQC. The provider used this location for their day service. We visited that location on 27 and 28 September 2016. We visited Bedrock Court on 29 September 2016. In this report we have described the care received by people living at Bedrock Court. However, because of the arrangements for day care support and the fact that the staff worked across the providers locations it is inevitable that there will be some cross over of information. Therefore, our report of this inspection should be read in conjunction with the report for that location. You can read the reports from each of the provider’s locations on our website at www.cqc.org.uk.

Our last full comprehensive of the service was on 22 and 23 December 2015. At that time we rated the service overall as ‘Requires improvement’. This inspection was focussed and carried out in response to concerns shared with us. As this inspection was a focussed inspection and took place more than six months after the last comprehensive inspection, we were unable to alter the overall rating of the service.

There was no registered manager in post. 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. The previous registered manager resigned from the provider’s employment just over 12 months ago. An acting manager was in post and had submitted an application to register as manager with CQC.

We identified serious concerns during this inspection. We wrote to the provider outlining the most urgent of these and told them to provide us with a report of actions they would take to address these.

The provider and senior staff had failed to recognise where certain practices compromised people’s dignity and respect. We found some of the terminology written in a people’s care records was subjective in nature and reflected the personal opinion of staff. The tone of the accounts did not reflect a sense of compassion or sympathy and evidenced a lack of knowledge and understanding of people’s needs. The service was, in many ways, demeaning to people and did not contribute towards them being viewed as valued individuals.

People did not receive a service that was safe. Risk assessments had not resulted in sufficiently detailed plans to keep people staff. Staff did not always know about the different types of abuse to look for and what action to take when abuse was suspected. Night time staffing levels had not been assessed by the provider to determine if people would be kept safe. Records regarding the administration of medicines were not maintained correctly.

The service did not provide effective care and support. Staff had not received the training required to effectively meet people’s needs. The provider and staff did not have a good understanding of the Mental Capacity Act 2005 (MCA). People were not encouraged to make choices and decisions. The involvement of other health and social care professionals was not sought and, as a consequence people’s needs were not always met. The service was not built around people's needs. People were not involved in the planning of their care and support. People did not have access to hot drinks or snacks from the kitchen when they wanted them.

The service was not well-led. The culture of the service was not empowering and person centred. The service provided was institutional, dictated by routine, with a rigid hierarchy. People were expected to conform to the ‘house rules’. Quality systems were not operated effectively. People’s views were not used to make improvements. The provider and senior staff had not worked positively with other health and social care professionals. Records of the care and support provided and other records regarding the management of the service were not well maintained.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 22 and 23 December 2015 and was unannounced.

There was no registered manager in place at the time of the inspection. 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. The previous registered manager had left their position on 2 July 2015. CQC had been notified of the resignation of the registered manager by the provider. The service was being managed by an assistant manager reporting directly to the registered provider when we visited.

People did not always receive a service that was safe. The day before our visit a person had received the wrong medicines. Staff had not sought medical advice immediately following this to ensure the person was safe.

There were enough staff to meet people’s needs. Checks were carried out to assess the suitability of staff before they started work. People were supported to take appropriate risks. Risks were assessed and individual plans put in place to protect people.

The service provided people with effective care and support. Staff had received the training required to meet people’s needs. They were regularly supervised by a senior member of staff. People’s capacity to make choices and decisions was assessed. Where people were assessed as not having the capacity to make choices and decisions and, there were restrictions upon their freedom, the provider had sought authorisation from the appropriate authorities. People told us they had enough to eat and drink and liked the food. Arrangements were in place for people to see their GP and other healthcare professionals when they needed.

People received a service that was caring. People living at the service and staff had positive and caring relationships. People were treated with dignity and respect. People were supported to maintain their independence.

People were actively involved in a range of activities. People were encouraged to make their views known and the service responded by making changes. People received care and support based on their individual needs and likes and dislikes.

The service had been without a registered manager since July 2015. The provider had notified CQC of the absence of a registered manager and put in place an assistant manager to oversee the service. The registered provider must ensure a registered manager is in place to provide good leadership and management of the service. Quality monitoring systems were in place and used to further improve the service provided.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment.

You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection we found that although there were measures in place to help prevent abuse from occurring, the provider had not responded appropriately to all allegations of abuse. The manager had not reported incidents that may have harmed people to the local authority safeguarding team and to the Care Quality Commission (CQC). At this visit we found that people were now better protected through incidents being reported appropriately. Regular monitoring and auditing of aggressive incidents between people had taken place to ensure all allegations of abuse were followed up.

People were supported safely by staff who had been trained in administering medicines. Information had been well documented about the sort of medicines people took, and the times they were given had been recorded.

Menus showed that people were offered a choice of varied and sufficient food and drink that was monitored individually. Other records had been maintained and kept up to date including those associated with all aspects of people's care and their health and safety.

Although not all the people wanted to comment on their care, we observed that staff supported them in a respectful way. Staff spoken with demonstrated how well they knew people's needs and preferences.

We looked at the care plans, daily records, and incident reports for five people. People had been asked for their consent before they received care or treatment.

Although there were measures in place to help prevent abuse from occurring, the provider had not always responded appropriately to all incidents of aggression between people living at the home. They had not always been referred to the local authority safeguarding team and we had not always been notified.

Systems in place to assess and monitor aspects of the quality of service that people received had not always been effective. Although people's views about their care had been sought the outcome had not been fed back or the issues raised, followed up.

People knew how and to whom they could complain and complaints were investigated appropriately.