Background to this inspection
Updated
10 August 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 15 and 16 February 2017 and was unannounced. This meant the provider did not know we would be visiting.
The inspection was carried out by two adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience of services for people with long term mental health needs
The last full inspection of the service was carried out in June 2015. At that time we did not have any concerns and rated the service overall as ‘Good’. As a result of concerns shared with us and, the provider being placed in ‘organisational safeguarding’ by the local authority, we carried out a focussed inspection of the service on 29 September 2016. At that time we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and rated the service as ‘Inadequate’ in the three key question areas we looked at.
Prior to this inspection we looked at the information we had about the service. This included information of concern shared with us by health and social care professionals. We also reviewed the statutory notifications that the provider had sent to CQC. A notification is information about important events which the service is required to send us by law.
Due to the number of individual safeguarding concerns raised regarding the provider’s services. This location (along with two others managed by the provider) had been under a process of ‘organisational safeguarding’. This is a process initiated by the local authority as a result of the number and/or severity of concerns raised with them. CQC had attended several meetings prior to this inspection. This meant CQC had been closely involved with a number of health and social care professionals, social workers and commissioners regarding the service. We have referred to the intelligence reports we have received from those that visit the service and from multi-agency meetings we have attended.
During the inspection we spoke with each person people living at Bedrock Mews. We also spoke with a total of five staff. This included; the acting manager, members of the ‘turnaround team’ and support workers.
We looked at the care records of four people living at the service, staff personnel files, training records for all staff, staff duty rotas and other records relating to the management of the service.
Updated
10 August 2017
Bedrock Mews provides accommodation and personal care for up to six people aged 18 years and over. At the time of our inspection five people were using the service.
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 Lodge, Bedrock Mews and Bedrock Court. The reports of all three inspections can be viewed on our website. The provider’s main offices are at Bedrock Lodge. We found many aspects of the service provided at the locations to be similar. This is because the policies, 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 contains some information that is similar.
Our last comprehensive inspection of this service was carried out in June 2015. At that time we rated the service overall as ‘Good’.
As a result of concerns shared with us, we carried out a focussed inspection of Bedrock Mews in September 2016. At that time we rated the service as ‘Inadequate’ under the three key questions 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 that they were going to employ a registered manager the provider had failed to register a manager with the CQC. The provider had taken responsibility for managing Bedrock Mews. The provider who took the lead in matters concerning the care and support provided was not available when we visited.
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 and people not being required to attend another of the provider’s locations for day care.
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.
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 11 new individual safeguarding concerns raised with the local authority relating to people living at Bedrock Mews 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.
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 gave the impression of feeling 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.
Although staff were making efforts to provide activities that were person centred and supported choice and personal preferences, their attempts were compromised by the provider, and this reinforced our previous concerns around the control they exercised.
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 drank 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.