Background to this inspection
Updated
25 October 2019
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of two inspectors.
Service and service type:
Quest Haven – 31 High Street is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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
The inspection was unannounced.
What we did before the inspection
Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at our inspection
During the inspection
We spoke briefly with two people who lived at the service due to their cognitive impairment and observed interactions staff interactions with people. We also spoke with two staff members including the registered manager who is also the provider of the service. We reviewed a range of documents including two care plans, four staff recruitment files, medication administration records, accident and incidents records, policies and procedures and internal audits that had been completed.
After the inspection
Following the inspection, we spoke with two relatives, one staff member and a staff member from the local day centre by telephone.
Updated
25 October 2019
About the service:
Quest Haven – 31 High Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Quest Haven – 31 High Street provides residential care for five people with learning disabilities. At the time of our inspection there were three people living at the service who had a range of needs such as mental health diagnoses and learning disabilities. During the inspection, the registered manager informed us that one person would be moving to another service. The person has now left the service at the time of publication of this report.
People’s experience of using this service:
At our previous inspection in April 2019 we identified breaches of regulations of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the service had not made improvements in all areas identified within our last inspection. This demonstrated the provider had not ensured all required improvements were actioned in a timely manner.
The service did not apply the full range of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support due to lack of choice and control and limited inclusion.
Relatives did not always feel their family members were safe, and risks to people were not being appropriately managed or recorded. Medicine administration and recording procedures were not safe, and staffing levels did not meet the requirements set out in people’s care plans.
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. Relatives and health professionals had not been involved in best interest decisions for people. Staff were not up to date with training, and supervisions were ineffective. The environment was dirty and unclean. People were not supported to maintain a healthy nutritious diet and advice from health professionals was not always followed which impacted on their health.
There was a lack of interaction between staff and people at the service, and people were not always involved in the decisions around their care. People were not treated with dignity and respect and were supported to build relationships with visitors to the service. There was an inconsistent approach to supporting people to take part in meaningful activities and holidays. Staff did not know people’s backgrounds, needs and medical history.
Despite the registered manager feeling they had made improvements, we identified continued issues that required addressing. There was a lack of management oversight as the registered manager was only at the service one day a week. Staff did not feel supported by the registered manager. Internal and external quality audits were not effective in their use as they did not identify the issues we found on the day, and any issues that had been identified had not been rectified. People, relatives and staff were not engaged with the running of the service.
The appropriate recruitment checks had been carried out for any new members of staff. Relatives had been asked to support with completing end of life care plans, but none had been finished on the day of our inspection.
Rating at last inspection: At our last inspection we rated this service inadequate (report published on 3 September 2019).
Why we inspected: We inspected this service in line with our inspection scheduling based on the service’s previous rating.
Enforcement:
We identified eight breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded. We have made a recommendation about the use of pictorial menus for people.
Follow up:
The overall rating for this service is ‘Inadequate’ and the service remains 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.