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We are carrying out a review of quality at Treehaven Rants. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 1 October 2021

About the service

Treehaven Rants is a residential care home providing support to autistic people and people with a mental health, and or learning disability. The main house is divided into two areas referred to as “Rants” and “Boomer”. The service is registered for up to twelve people, however, because of the adaptations to create more space for people the service chooses to accommodate ten people and eight people lived there at the time of our inspection.

People’s experience of using this service and what we found

Inspectors found the standards of care had significantly reduced since the last inspection.

The support and care people received was based on the availability of staff and routines were staff led and not around the needs and interests of people using the service. People did not have consistent care and regular routines which were identified as very important to them.

The attitudes and behaviours of staff did not ensure people received safe care. There was a culture of underreporting which meant people were not protected from possible abuse. People were exposed to unnecessary risk and were living in an environment which did not promote their wellbeing or keep them safe.

At the last inspection although rated good, concerns were raised about the condition of the environment and external grounds. Despite assurances being provided by the registered manager at the time that these issues were being addressed we found at this inspection widespread neglect of the care environment. The environment was no longer fit for purpose, neither was it hygienically clean. We found multiple issues with the environment which posed some immediate risks and had resulted in one person being temporarily removed from their flat without consultation with family or other health care agencies to ensure it was in their best interest. We sought immediate assurance and clarification of urgent works and went back on site a week later to check remedials works had been completed.

We asked for assurances from the registered manager of the cleanliness of the service as we found no evidence that staff were routinely cleaning the service or that enhanced cleaning schedules had been put in place since COVID-19. The building was visibly dirty throughout. A deep clean was authorised by the provider and took place. When we returned a week later, we noted some improvement but were concerned about the continued lack of regular cleaning of the premises.

During the restrictions imposed on the country as a result of COVID-19 we found that people had not been appropriately supported or adequately protected from contracting the virus.

A high number of incidents of behaviour had occurred which could be attributed to a change in people’s routines and restrictions on their day to day lives. Incidents were not managed well or appropriately escalated. There was poor incident analysis, and adequate steps were not taken to reduce the likelihood and, or severity of incidents reoccurring. Several incidents such as trips and falls could have been avoided if appropriate, timely actions had been taken by staff.

The service was poorly managed, and governance and oversight were weak. A new registered manager had come into post in August 2020. They had not been appropriately supported and had been unable to effect positive change within the service because they told us they were constantly, ‘Firefighting.’ A poor staff culture meant staff were not working together in a cohesive way to make lives for people living at the service better.

People were not supported to have maximum choice and control of their lives and staff did not 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. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People did not have a voice and were not able to influence the service they received. Staff did not maximise people’s independence or enable people to retain or develop new skills.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published 22/03/2019).

Why we inspected

The inspection was prompted in part due to concerns received about the service in relation to a number of safeguarding incidents and concerns about other locations under the same care provider.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During the first day of our inspection we identified serious concerns. We sought immediate assurances from the provider about actions we wished them to take and asked the provider to confirm in writing the actions they had taken. We went back to the service to check they had made some immediate improvements requested. We found the provider had taken some initial remedial actions, but there continued to be significant risks and concerns present 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 improvement. Please see the key questions of safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Treehaven Rants on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care which included: infection control, safe care and treatment and the management of medicines. Safeguarding people from harm and risk. staffing levels, staff training and competencies. We also found breaches in relation to consent, dignity and respect as well as with the condition of the care environment. Management and governance, and registration requirements both notifications and adhering to conditions of registration were also areas where we found breaches.

Since the last inspection we recognised that the provider had failed to act within its own registration conditions. This was a breach of regulation. Full information about CQC’s regulatory response to this 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 now placed 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.

Inspection areas

Safe

Inadequate

Updated 1 October 2021

The service was not safe.

Details are in our safe findings below.

Effective

Inadequate

Updated 1 October 2021

The service was not effective.

Details are in our effective findings below.

Caring

Inadequate

Updated 1 October 2021

The service was not caring.

The Details are in our caring findings below.

Responsive

Inadequate

Updated 1 October 2021

The service was not responsive.

The Details are in our responsive findings below.

Well-led

Inadequate

Updated 1 October 2021

The service was not well led

The Details are in our well led findings below.