Archived: West Drive

Updated 3 September 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. 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.

Inspection team:

This inspection was carried out by two inspectors.

Service and service type:

West drive 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. The registered manager was not present during our inspection. The registered manager left the service with immediate effect during our inspection. The service was receiving management support from the operations manager and a service improvements manager during our inspection.

Notice of inspection:

This inspection was unannounced on 23 and 24 July 2019. Two inspectors visited the service on these dates. One inspector visited the service on 30 July 2019 and we gave the service 24 hours’ notice of this visit.

What we did before the 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 within the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection:

We spoke with one person who used the service and one relative about their experience of the care provided. We observed other people being supported by the staff team. We spoke with three support workers, a senior support worker, the service improvement manager, the operations manager, two members of the quality support team, a registered manager who was supporting from another service, the director of quality and the chief operating officer. .

We reviewed a range of records. This included five people’s care records which included all aspects of care and risk including medication records. We looked at three staff files in relation to recruitment and staff supervision. We reviewed information around people’s DoLS and restrictions. We looked at staff training. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We attended a conference call and had a meeting with the provider, the local authority and the CCG on 25 and 26 July to discuss the findings of the inspection so far and to inform the provider of actions we would be taking.

After the inspection:

We stayed in contact with the provider to collect evidence about improvements being made at the service. We looked at information around complaints and compliments and quality assurance records.

Updated 3 September 2019

About the service:

West drive is a residential care home providing personal care to nine young adults who may be living with a learning disability or autistic spectrum disorder. The service can support up to 10 people. West drive consists of an adapted building which can accommodate eight people and a bungalow which can accommodate two people. Seven people were living in the adapted building and two people were living in the bungalow. People have their own bedrooms with en-suite toilet facilities and share communal areas such as the kitchen, dining room and garden.

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. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Nine people were using the service. This is larger than current best practice guidance. The size of the service had some negative impact on people using the service. People had complex support needs and required high levels of staff support. The service was very busy and noisy. This was identified as something that made people anxious or upset. Restrictions necessary for some people were having a negative impact on other people being able to access areas of the service such as the kitchen.

People’s experience of using this service and what we found:

People were not kept safe from potential harm and abuse because known risk to people were not effectively being monitored by the management and staff team. People were required to have food, fluid or behaviours monitored to keep them safe and this was not happening. People’s risk assessments identified physical restraint to support people where people had not been assessed for these techniques to see if they were safe for the person.

Some staff members were not trained in working with people with complex needs including communication and were unable to support people safely. Staff members had not been given the opportunity to get to know people before supporting them which led to people feeling upset and anxious. The service was using a high proportion of agency staff who did not have training or an effective induction to support people safely.

The service was very dirty and in need of cleaning. This meant that people were at risk of infection. The premises needed some work to make it safe for people to use. The service was not always suitable for the needs of the people living at the service. People needed a high number of staff to support them which made the service very busy. People found this difficult to manage as busy environments were identified as reasons for their anxiety.

People were not being supported to eat a balanced diet and there was a lack of choice with regards to food that people could eat. People were supported to see health professionals when they needed this support although this was not always promptly sought.

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. Restrictions on people were not always put in place using the correct legal procedures. Capacity assessments and decisions in people’s best interests were not always completed.

The service rarely applied 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 as people had a lack of choice and control and limited independence. For example, people were restricted from areas of the service based on other people’s needs. Menus were developed by staff with no input from people who lived at the service. People were not supported in their preferred communication methods meaning they could not make choices about their support.

People were not always supported with kindness, respect and compassion. Staff did always respect people’s choices and dignity. People were not supported in a person-centred way that met their needs and preferences. Staff did not always understand peoples preferred communication methods and did not understand the reasons for people’s behaviour support plans.

The provider had not promoted a positive person-centred culture which promoted good outcomes for people. Audits and checks at the service were not effective in identifying where improvements could be made. Feedback was not being collected from people and their relatives to inform and possibly improve the service.

Following our inspection, the provider took immediate action to start making improvements and give people a better experience of the people using the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (report published 14 March 2017). At this inspection the service has deteriorated to inadequate.

Why we inspected:

The inspection was prompted in part due to concerns received about alleged unlawful restraint and the premises not being suitable to support people with complex needs. A decision was made for us to complete a comprehensive inspection to examine these risks.

We have found evidence that the provider needs to make improvements. Please see information in the report.

You can see what action we have asked the provider to take at the end of this full report. The provider has acted to mitigate these risks following the inspection and these have been effective.

Enforcement:

We have identified breaches in relation to safe care and treatment, staffing, premises, safeguarding service users from abuse, consent to care and treatment, person centred care and good governance.

We took urgent action to prevent the provider from admitting people in to the respite room at the service. We also required the provider to send us monthly reports detailing the actions they were taking to monitor the service in relation to our findings.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 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.