Background to this inspection
Updated
16 January 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 25 April 2017 and was unannounced.
The inspection was conducted by one inspector.
Before the inspection we looked at all the information we held about the provider. This included the last inspection report, the provider's action plan for meeting requirements and other evidence they had shared with us.
During the inspection we met all three people who lived at the service. They could not describe to us how they felt about living at the service. We observed how they were cared for and treated. Our observations included a Short Observational Framework Inspection (SOFI) during the morning. SOFI is a specific way of observing care to help us understand the experiences of people who could not speak with us.
We spoke with four support workers who were on duty. We also met and spoke with one visiting relative.
We looked at the records for all three people, including care plans, risk assessments and records of care provided. We looked at other records the provider used for managing the service and these included the training records for three members of staff, recruitment and support records for three members of staff, the staff communication book, the staff signing in book, the provider's policies and procedures and records of checks made by the staff on the environment. We looked at the environment and how medicines were being managed, stored and recorded.
Following the inspection visit we requested the provider sent us some records which were not available at the location. These included the staffing rotas, evidence of team meeting minutes, evidence of fire drills, evidence of the provider's insurance and evidence of further checks on the health and safety of the environment. We were sent these.
On 5 May 2017 we requested further information from the provider in the form of an action plan telling us how they would respond to risks of extreme seriousness which we identified. The provider sent us this action plan on 9 May 2017.
Updated
16 January 2018
The inspection took place on 25 April 2017 and was unannounced.
The last inspection took place on 16 January 2017, when we found breaches of six Regulations relating to notifications of incidents, person-centred care, safe care and treatment, safeguarding people, good governance and staffing. We issued a warning notice for breaches relating to the safe care and treatment of people and we made five requirements. The service was rated Requires Improvement, with the key question of Safe being rated Inadequate. The provider wrote to us to state that all the required improvements would be made by March 2017. At the inspection of 25 April 2017 we found that there had not been any improvements in some areas and not enough improvements in other areas. We could not make a judgement about notification of incidents because there had not been any such incidents since the last inspection.
New Beginnings Residential Care - 2 Dorchester Drive is a care home for up to three people. At the time of our inspection three people were living at the service. Two were adults under the age of 65 years who had learning disabilities. The third person was an older person living with the experience of dementia. People living at the service had limited communication skills because of their disability or condition. In addition one person did not speak English as their first language. The service was managed by Clover Residents Limited, a private organisation who ran two other care homes in North West London.
The registered manager left the organisation in August 2016. There was a new manager in post. They had started the process of applying to be registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.
People who lived at the service were not always safe. The provider had not ensured that all risks were appropriately assessed or that plans were in place to mitigate these risks. The arrangements relating to fire safety were not sufficient and people were at risk in the event of an emergency situation. The staff were not deployed in a safe way and worked excessively long hours without sufficient breaks, placing people at risk.
There had been improvements in the way medicines were stored although further improvements were needed for the storage of controlled drugs. People received their medicines in a safe way, although the protocols for the administration of PRN (as required) medicines were incomplete leaving the decision about whether to administer these to the judgement of staff who were not trained to make this decision.
People were being unlawfully restrained and their freedom and rights restricted without proper authorisation. For example, the staff physically restrained one person when providing personal care in order to prevent injury to the person and staff. This had not been properly assessed or planned for and incidents of restraint were not recorded or investigated. People were administered medicines covertly (without their knowledge). The provider had made this decision without proper assessment or best interest planning.
New staff were not given the information and support they needed to care for people and to keep them safe. Experienced staff told us they received training and support, however there was insufficient documented evidence of this.
People were not supported in a way which met their needs and reflected their preferences. They did not have fulfilling lives nor were they supported to try new things, access the community or achieve their potential.
The service was not well-led. The provider had failed to address and take enough action regarding the concerns we identified in January 2017. The provider's action plan following the inspection of January 2017 and evidence of their discussions with staff about the outcome of the inspection indicated they had misunderstood the seriousness of some of our findings. Records had not been completed, were not accurate or were not available at the service.
The majority of interactions we witnessed between the staff and people who they supported were not unkind, but were task based and did not take account of people's individual needs or preferences. We spoke with one relative who told us they thought the staff were kind and caring. We also received positive feedback about the staff approach from two other relatives who we spoke with in January 2017.
Following the inspection visit we asked the provider to supply us with assurances about how they would alleviate the risks we considered to be extremely serious. They sent us an action plan telling us they would address these risks by 15 May 2017.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this provider is 'Inadequate' with the key questions of safe, effective, responsive and well-led rated ‘Inadequate.' This means that the service has been placed into ‘Special Measures’ by CQC.
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. To provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.