Background to this inspection
Updated
9 April 2021
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 Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Garden House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. 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.
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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with two people who used the service. We spoke with six members of staff including the deputy manager, team leader and three staff and domestic staff. We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at two 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 data regarding staffing and quality assurance records. We contacted five healthcare professionals, but we received no feedback. We spoke to two staff members and four relatives.
Updated
9 April 2021
About the service
Garden House is a care home for people with learning disabilities. The service is three adjoining houses which were adapted. At the time of the inspection seven people were living at the service. The service was planning to close in March of this year. At the time of our inspection people were being supported to find alternative accommodation.
People’s experience of using this service and what we found
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 guidance CQC follows 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 principles of Right support, right care, right culture.
• Right support: The model of care and the setting did not maximise people's choice, control and Independence. For example, people were not supported to set goals for things they might have wanted to achieve.
• Right care: Care was not person-centred and did not always promote people's dignity, privacy and human rights. We did not see evidence that people were receiving person centred care. For example, one person was missing their hearing aids for many months and we saw no evidence of staff trying to seek a resolution.
• Right culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using the service lead confident, inclusive and empowered lives. For example, we could not always see evidence of people being supported to engage in daily activities which were important to them.
Medicines were not always administered or managed in a safe way. Risk management plans were not detailed, and they were not updated when people’s needs changed. Staff told us they felt there was not always enough staff available to care for people. We made a recommendation to the provider to review staffing levels. The home was clean and tidy, but staff were not completing daily cleaning schedules, so It was not always clear how infection control practices were being reviewed.
We recommended the provider seek and implement national guidance in relation to safeguarding adults as the registered manager was not always able to evidence how safeguarding concerns had been investigated.
Care planning was not person centred and lacked information that was important to care for people.
Quality assurance processes were ineffective. Whilst there were auditing systems in place staff were not always completing the monitoring and the registered manager did not have good oversight of the day to day running of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.
Rating at last inspection
The last rating for this service was good (published 11 March 2020).
Why we inspected
The inspection was prompted in part due to concerns received about the care people were receiving. A decision was made for us to inspect and examine those risks.
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 coronavirus and other infection outbreaks effectively.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
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. 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 and treatment, person centred care and 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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.