Background to this inspection
Updated
16 December 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
Two inspectors and a medicines team inspector carried out the inspection.
Service and service type
Agate House Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. Agate House Care Home with Nursing Physical Disabilities is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a manager in post who had started the process of registering with the CQC.
Notice of inspection
This inspection was unannounced
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke and communicated with 14 people who used the service and 11 relatives about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating such as using their body language. We spent lots of time observing how staff interacted with people using the service.
We spoke with 21 members of staff including support workers, activity support workers, domestic care staff, team leaders, cooks, the maintenance team, deputy managers, the manager, members of the quality management team and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records and multiple medication records and monitoring charts. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
16 December 2022
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Agate House Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 32 people, some who may be autistic or living with a learning disability or a physical disability, at the time of the inspection. The service can support up to 36 people.
Agate House Care Home with Nursing Physical Disabilities provides all accommodation, communal areas and therapy support on one ground floor level. The building is split into four separate wings, each of which has adapted facilities. People share communal areas such as kitchens, lounges and bathrooms and have their own bedrooms.
People’s experience of using this service and what we found
Right Support:
¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support. Staff did not always communicate with people using their identified and preferred methods.
¿ People did not always benefit from an interactive or stimulating home environment and sometimes felt isolated or bored.
¿ Staff had started to support people to be independent if this was their choice. The management team were continuing to support staff to improve in this area.
¿ People were being supported to pursue their interests and achieve their aspirations and goals.
¿ People were supported to follow social interests and past times.
¿ The service gave people care and support in a clean environment which met their physical needs and people were able to personalise their bedrooms.
¿ The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
¿ Staff supported people safely with their medicines.
¿ People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service mostly supported this practice.
Right Care:
¿ People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.
¿ Staff did not always have the training or knowledge to support people effectively. The management team were still improving the way staff knowledge and competency was bring checked.
¿ People’s support plans did not always fully reflect their range of needs and promote their wellbeing and enjoyment of life.
¿ Staff supported people to assess any risks they might face in a safe way and supported people to take positive risks.
¿ Staff promoted people’s equality and diversity and knew them well as individuals for the most part.
¿ People received kind and compassionate care which fully promoted their privacy and dignity.
¿ Staff were prompting people to try new things which may enhance their wellbeing and enjoyment of life.
¿ Staff members mostly knew people well and communicated with them in a kind and compassionate manner.
Right Culture:
¿ Audits completed at the service by management had not always picked up on areas that could have been improved to help support a more positive culture.
¿ People and those important to them, felt they were not always involved in planning their support.
¿ Staff turnover was very high meaning people did not always receive consistent support from a staff team who knew them well.
¿ There were still some occasions where people were left without engagement from the staff team for extended periods of time.
¿ People received good quality care and support and were supported to lead inclusive and empowered lives for the most part.
¿ Staff were responsive to people’s needs and worked well together to achieve good outcomes for people. Feedback from people and relatives was that there had been improvements at the service.
¿ The new manager, staff and management team were passionate about continually improving the service and supporting people to achieve their goals and aspirations.
¿ Staff worked hard to achieve good quality care and good outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 19 July 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of all the regulations in breach at the last inspection. However, the service was still in breach of one regulation.
This service has been in Special Measures since 15 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
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.
The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified a continued breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.