Archived: New Beginnings Residential Care - 2 Dorchester Drive

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.

The last inspection took place on 25 April 2017 when we rated the service Inadequate in the key questions of Safe, Effective, Responsive and Well-Led. We rated the key question of Caring as Requires Improvement. We rated the service Inadequate overall and placed them in Special Measures. We found breaches of eight Regulations. Full information about the Care Quality Commissions' regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. The appeals process had not concluded at the time of the inspection of September 2017.

At this inspection we found some improvements had been made, but there were continued breaches of regulation. We found that breaches relating to safeguarding people from abuse and improper treatment, meeting nutritional needs and premises and equipment were met. We found that breaches relating to person centred care, privacy and dignity, safe care and treatment, good governance and staffing were not fully met.

New Beginnings Residential Care - 2 Dorchester Drive is a care home for up to three people. At the time of our inspection one person with a learning disability was living at the service. The person had complex needs and was not able to share their experiences of using the service with us. In addition they 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.

There was a manager in post who had worked at the service since September 2016. They had applied 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.

Some of the practices of the staff meant that people were placed at risk. In particular, medicines were not always managed in a safe way.

The staff sometimes worked long hours alone without sufficient breaks. This put the safety and wellbeing of the person who they were supporting at risk because they may become tired and unfocussed. Although, this practice had improved since the last inspection, this issue has not been fully rectified.

The staff did not always receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties they were employed to perform.

The staff did not always treat the person with dignity and respect.

The person was not always supported in a way which met their needs and reflected their preferences.

The provider did not always ensure that the quality and safety of the service were assessed and monitored.

The person living at the service appeared happy and comfortable. They had unrestricted access to the environment.

The provider had made improvements in some areas. These improvements included meeting three of the breaches we found at the last inspection. The safety of the environment, in particular fire safety, had improved.

The person's health needs were being met. They were able to make choices about the food they ate and their nutritional needs were being met.

The provider was acting within the principles of the Mental Capacity Act 2005.

The person had some opportunities to access the community and try new activities. However, the provider needed to consistently provide support with these in order to meet the person's needs.

The provider had improved record keeping and the way in which records were organised.

We found breaches of five 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 will be added to reports after any representations and appeals have been concluded.

At the inspection of 25 April 2017 CQC placed the service in 'Special Measures.' The service remains 'Inadequate' and therefore remains 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. 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.

The last inspection took place on 14 January 2015, when we found no breaches of Regulation.

Clover Residents - 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 but they had not applied to be registered with the Care Quality Commission 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 and associated Regulations about how the service is run.

People were not always cared for in a safe way. For example, the staff used restraint on one person. This had not been appropriately planned for and the person had been injured during some incidents of restraint. The manager and staff were not aware that these incidents were reportable under safeguarding procedures and had not recorded any incidents of restraint or why they had happened. Therefore these had not been appropriately investigated.

People were placed at risk because the staff worked long hours without sufficient breaks and time off work.

The risk assessments and care plan for one person were not up to date and information about how to support the person was not always clearly recorded. Therefore their current needs were not clear and they were at risk of receiving inappropriate care and treatment. The information for other people was up to date, but was not always recorded in a clear way. In addition information from other professionals had not been incorporated into the support plan for one person.

The provider had not always acted in accordance with the requirements of the Mental Capacity Act 2005. In particular people's freedom was restricted without proper authorisation.

People were not always being supported in a way which met their needs and reflected their preferences. For example, they did not have opportunities to access the community, for social and leisure engagement or to meet their sensory needs.

There was not a positive or open culture at the service.

The provider had not operated effective systems to provide a quality service because they had failed to identify and mitigate risks to the health and wellbeing of people who lived at the service.

The provider had not notified the Care Quality Commission of significant events as required by Regulation.

We found 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.

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.

People were cared for by kind, polite and considerate staff. They had good relationships with the staff and relatives gave positive feedback about this aspect of the service.

People were offered enough to eat and were able to make choices about what they ate. All food was freshly prepared and reflected their individual tastes and preferences.

People's health needs were monitored and they had access to healthcare professionals when they needed this.

The relatives of people told us they knew how to make a complaint and felt able to do this.

We carried out this inspection to monitor progress made by the provider to improve the quality of care and supported received by people using the service. We were not able to get the views of people using the service due to their complex needs. However, we saw both people took part in appropriate activities and observed good interaction between staff and both people.

We found improvements had been made in the ways staff communicated with people using the service. Alternative methods of communication were used consistently to enable people to express preferences and make choices.

The daily activities people took part in were recorded and showed that each person had access to a variety of age-appropriate activities in the home and the local community.

Safeguarding concerns regarding one person's medicines had been addressed.

The provider's training records showed staff had completed most of the training the needed to support people using the service. Positive Behaviour Support training had been provided for all staff by a national organisation supporting people with a learning disability.

The provider had introduced and recorded regular monitoring visits to the home. Actions identified during the monitoring visits had been addressed by the provider and manager.

Due to our concerns we served warning notices on the Provider telling them they had to make improvements by the 2 September 2013. We received an action plan from the Provider on the 26 July 2013 detailing the improvements that would be made. These included ensuring people were treated in a dignified and valued manner, ensuring people would be involved in their care, care plans and risk assessments would be updated to reflect professional guidance and a robust monitoring system would be implemented.

We carried out visits to the service on the 5 and 18 September and 11 October to ensure improvements were made. We found the expected improvements were not made.

We were unable to gain the views of people during our visit due to their complex needs so the inspection team consisted of a professional advisor who was a Consultant Psychologist who specialises in Learning Disabilities, and an expert by experience (a person who has experience of learning disability services).

We observed how people were cared for in both the home and also in the community and found people were not treated with dignity and respect and were not supported to communicate their choices effectively.

We also found people were cared for by staff who have not had further training in the field of learning disability to develop their knowledge and skills to ensure people who use the service were cared for appropriately.

We looked at care planning and risk management and found people were not cared for in accordance with their assessed needs.

We looked at the systems in place for ensuring people's safety and welfare and also the systems for monitoring the quality of the service. People were not protected from the risks of abuse because care plans and risk assessments were not in place to protect people from harm.

Whilst the leadership and management of the home had had training in the management of care services, they have not had an on-going personal development in the area of learning disability so they were fully aware of development in this area. The provider had an audit tool as part of the quality management system but at times they had not acted promptly in circumstances where improvements needed to be made to the service.

We met with the Provider on the 20 September 2013 to express our serious concerns to the lack of improvements made. The Provider told us they were going to recruit a new manager for the service and would employ a skilled professional to support them to improve. We informed the Provider that failing to make immediate improvements would lead to further enforcement action.

We received information on the 7 October 2013 where the Provider told us they had engaged a consultant from the British Institute of Learning Disabilities to review the service provision. We also received an immediate plan of improvement.

We visited on the 11 October 2013 to ensure improvements were being made, and found that progress had been made in relation to promoting the dignity and values of people and the care and support they were receiving. We also noted that the Provider had sought professional guidance and expertise in communicating with people. Care plans and risk assessments had started to include information and recommendations from health professionals and improvements had started in relation to staff's training and development.

Although there are concerns relating to the management of the service we found the improvements which have been made since the 11 October showed that the Provider had started to take action to reduce the risks of people receiving inappropriate and unsafe care and support.

We spoke with two people during the visit due to their complex needs they were unable to tell us their experiences. We used a range of methods to help us understand people's experiences such as taking a professional advisor on our visit, talking with two members of staff which included the manager and also a consultant the service had employed following our previous visit. We also observed people receiving care and the interactions between staff and people who used the service.

At a previous visit on 16 January 2013 we found that people were not adequately involved in the planning of their care and were not treated in a dignified and respectful way. We carried out our recent visit to ensure improvements had been made. We found that the service was still not meeting people's needs. The physical environment and the activities which people participated in did not demonstrate that people were cared for in a dignified and caring manner. We also found that people were not supported to communicate in an effective way. We were concerned that staff did not acknowledge our concerns and demonstrated a lack of insight about the impact the current care arrangements were having on people using the service.

We found at our visit on 16 January 2013 that standards relating to care planning were not being met and the provider did not have effective quality monitoring systems in place. During this inspection we found that care plans and risk assessments still did not provide sufficient information to enable staff to care for people safely and effectively. For example care plans did not take into account the advice given by health care professionals and therefore care was not planned in line with their recommendations.

We also found that the provider did not have effective quality monitoring systems in place. The service did not take into account published guidance and research into how such a service for people with a learning disability should operate.

We saw some positive interactions between staff and the people using the service, however, we also saw inappropriate interactions that were not respectful. People's needs were assessed but not all identified needs were included in people's care plans and therefore staff did not always have appropriate guidance about how to meet people's needs effectively. People's healthcare needs were being met and people were being supported to attend appointments.

Staff received safeguarding training and were able to demonstrate that they knew what action to take if they were concerned about someone's safety. Staff told us that they received support from the manager of the home but staff were not receiving regular formal supervision and had not had an annual appraisal.

There were no systems in place to assess and monitor the quality of the service and therefore people were not protected from unsafe or unsuitable care.