Church Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Church Lane provides accommodation and personal care for up to twenty adults who have learning difficulties and may also have physical disabilities. The upstairs of the service is called Inglewood, and this provides accommodation and personal care for 10 people who have learning disabilities. The ground floor of the service is referred to as Church Lane. The ground floor provides accommodation and support for 10 people who have learning and physical disabilities. Some people had sensory impairments, epilepsy, limited mobility and difficulties communicating.
The provider has registered the whole service with the Care Quality Commission (CQC) under the name Church Lane. The service has one registered manager and overseen by the same senior management team. The provider employs two deputy manager one who works upstairs at the service and one who works downstairs.
The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. There was a risk that the size of the service had a negative impact on people.
The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, independence and inclusion. The outcomes for people at Church Lane did not reflect the principles and values of Registering the Right Support. 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 interest. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. People with learning disabilities and Autism living at Church Lane were not supported to live as ordinary a life as any citizen.
People's experience of using this service
The management and staff had not supported an empowering, inclusive culture.
People were not treated with dignity and respect. The language and actions of some staff was disrespectful and at times abusive. The local authority safe guarding team were investigating, and the investigations have not yet been concluded. People were not being supported to be as independent as they could be with their daily activities.
People were not always safeguarded from abuse and improper treatment. The registered persons failed to consistently ensure people were protected from avoidable and intentional harm. Some incidents had not been reported to local authority safeguarding team when they should have been. Individual risks to people had not been fully identified and mitigated. Some environmental safety checks had not been undertaken at the required intervals.
There was lack of choice and people were controlled by staff. People were told what they could do and when they could do it. The kitchen door was locked so people could not freely help themselves to drinks and snacks. People said if they wanted drinks or snacks outside meal and drink times they had to ask permissions from the staff. People were told when to get up and when to go to bed. People were given drinks at certain times of the day, not when they wanted them. People were not supported to choose what they wanted to eat and were not able to choose the activities they wanted to do. These decisions were made by staff.
People’s health needs, such as constipation and epilepsy, were not always being met effectively. When people’s fluid intake was monitored this was not accurately recorded to make sure they were drinking enough. People did not always receive personalised care. Some people’s communication needs were not met in a personalised way.
Since living at the service some people had become de-skilled. One person told they used to cook but since coming to the service they were not allowed to do this.
Medicines were not managed as safely as they should be. Medicines had gone missing. Some people were prescribed medicines ‘as and when’ for behaviours and medical conditions. Some people were receiving these ‘as and when’ medicines for behaviours regularly. There was no guidance for staff for when these medicines should be given. There was a risk that medicines were given inconsistently.
Some of the staff working with people did not have suitable skills, understanding and values to work with people. These concerns had been identified at staff meetings, but no action was taken by the registered persons. Staff continued to work with people in a controlling, disrespectful and restrictive way.
On Inglewood there was conflict and tensions within the staff group. This had been reported to the registered manager, but no action had been taken. Staff were not regularly supervised and monitored, therefore there was no resolution and no improvements made.
People told us that they had made complaints about the way they were being treated but their concerns had not been taken seriously and no action had been taken. People were not listened to.
Action was not taken to learn lessons and improve the service people received when things went wrong.
Staff including the registered manager had not always received training to help them understand and meet people’s care needs. This included training in areas the provider considered mandatory such as infection control, emergency first aid, manual handling and safeguarding people, as well as areas specific to individuals such as the administration of special medicines that people required when they were experiencing seizures and conflict management.
People were not involved in planning their care and support in the way they would have preferred. Consent to care and treatment was not always sought in line with legislation.
Although people received support to go out and about and to undertake activities at the service this was not consistently provided in the way the people preferred. One person should be going out in a car regularly. This was not happening; from 22 June 2019 they had only been out once prior to our inspection. Staff decided what activities people would do. We found that people had been cajoled into doing activities they had not chosen and had no interest in.
The governance arrangements including the checks and audits had not picked up the range of issues found at the inspection. The culture of staff being in control had not been identified and addressed, so it continued.
There was a lack of oversight and scrutiny by the registered persons. This had led to unsafe risks and care for the people living at Church Lane. Systems for checking and improving the quality of care and support people received did not identify concerns and affect change. Concerns relating to keeping people safe, protecting them from abuse, minimising restrictions upon people, the staff culture and oversight of the care and support people received to stay safe, had not been recognised, identified and improvements had not been made.
There was no-one receiving end of life care at the time of the inspection. A visiting professional told us that when people were at the end of their lives they were well cared for. Staff ensured they comfortable and pain free.
The service was clean, and measures were in place to prevent the spread of infection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Church lane on our website at www.cqc.org.uk.
The last rating for this service was Good (The last inspection report was published on 07 December 2018).
Why we inspected
The inspection was prompted due to whistle blowing concerns received about the restrictive and controlling culture of the staff. A decision was made for us to inspect and examine those risks.
The provider has taken action to mitigate the risks and we are monitoring the service to ensure the action the provider is taking is effective.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to failing to protect people from avoidable harm, failing to effectively risk assess, failing effectively monitor the service, failing to safeguard people, failing to provide person-centred care, failing to ensure competent and trained staff were deployed at this inspection, failure to supervise and monitor staff and failing to submit statutory notifications to CQC.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore 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 registr