Updated 1 October 2025
Our view of the service
We carried out this assessment from 21 October to 6 November 2025. The service is a care home providing support to people with a learning disability and autistic people. There were 6 people living in the home at the time of our assessment.
We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choice, independence, and good access to local communities which most people take for granted. We found people did not always receive care and support in accordance with the principles of this guidance.
We carried out this assessment following concerns raised about the way the service was being provided to people. We found 6 breaches of the legal regulations relating to person centred care, safe care and treatment, good governance, staffing, the environment and safeguarding people from abuse and improper treatment. The provider was previously in breach of the legal regulation in relation to good governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation.
People were not always protected from the risk of harm. Information about people’s risk assessments were not always up to date and accurate. There were not always enough qualified and skilled staff to support people effectively and safely.
The environment and infection control practices were not always safe. There was a malodour in some parts of the dining room and lounge area. The furnishings in these areas were not composed of non-permeable, wipe clean fabric. The home was not clean in some areas and the lack of facilities in the bathrooms and toilet increased the risk of the spread of infection.
There were not always enough staff to enable people to do the activities they wanted to do, to enhance their quality of life like accessing community activities. People’s care was not always personalised to reflect their needs and preferences, and people regularly participated in the same activities within the home. It was not always clear how people had been involved in making decisions about their care. This is contrary to the principles of the 'Right support, right care, right culture’ model of care.
Governance and audit systems had not identified the issues we found during this assessment. There was a lack of oversight, monitoring, and action. For example, there was no formal process to monitor the quality of care provided, including care records and daily notes. Audits of infection prevention and control had not prompted the provider to take responsive action. The provider did not have robust processes in place to identify learning and drive improvement.
However, staff were caring and attentive to people’s needs. They understood how to keep people safe and how to report concerns. Staff assessed people’s communication needs. When the service identified changes to people’s health and care needs, they worked with external health professionals and sought medical advice appropriately.
In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.