CareTech Community Services Limited - 34 Porthill Bank

Updated 10 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. This inspection was planned to check 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.

The service did not have a manager who was registered with the Care Quality Commission. This means that the registered provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Inspection team

This inspection was conducted by one inspector and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service 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.

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

During the inspection, we spoke with two people who used the service. We spoke with three people who lived at the service and three relatives, we asked them about their experience of the care provided. We spoke with the manager, the deputy manager, locality manager, and four members of staff.

We looked at three people’s care records including accident and incident records. We looked at three staff files in relation to recruitment and to review staff supervision records. Multiple records relating to the management of the service and a variety of policies and procedures developed and implemented by the provider were reviewed during and after the inspection. We walked around the building to make sure it was a clean and safe environment for people to live in.

After the inspection

We continued to seek clarification from the provider to corroborate evidence found. We looked at training data and quality assurance records. We also spoke with staff and relatives via telephone to seek their views about the care.

Updated 10 September 2019

About the service

CareTech Community Services Limited - 34 Porthill Bank is a care home which provides care and accommodation for up to 6 people with a learning disability or autistic spectrum disorder. At the time of inspection five people lived at the home.

While the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, the practices in the service were not always meeting the principles. Registering the Right Support principles 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. In the majority of the cases people using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

We received mixed feedback from visiting relatives regarding their family member’s safety. One relative spoke positively and expressed that their relative was safe and received excellent care. However, two other relatives said they did not feel their relatives were safe due to incidents that had occurred in the home. Staff deployment and arrangements for one to one observation for people were not always robust to ensure one to one support for each individual was maintained. The provider had no arrangements to protect staff from risks of being bitten. We received mixed feedback regarding the staffing levels in the home and the level of oversight provided to care staff by management.

While staff had continued to receive a range of training and supervision, the providers' systems and processes for supporting staff to gain relevant competences for their role were not robust. Not all staff had received induction and training in a timely manner. The manager had assessed people’s needs and provided staff with guidance on how these needs were to be met. However, staff had not always consistently followed the plans to prevent incidents between people. There was no registered manager. A new manager had been employed and they were also managing two other services. People’s relatives raised concerns regarding the management support at the home. People and their relatives had not been supported to share their end of life care preferences. We made a recommendation about end of life care.

Staff considered positive risk-taking approaches to enhance people’s independence and well-being and new how to report safeguarding concerns. People were supported with the safe use of medicines. Staff had received training in safe medicines management and had access to national guidance and best practice. Staff had been safely recruited and employment checks carried out.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. They sought consent before delivering care. Some improvements were required to ensure documentation was kept on how the use of restraint was in the best interest of people where it was required to keep people safe. We made a recommendation about mental capacity assessment and best interest records for the use of restraint.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. While people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent, this was not always consistently meet.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met. Staff consulted with specialist professionals and reviewed people’s needs regularly. There were arrangements to maintain regular communication between relatives and staff. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident their complaint would be listened to and acted upon quickly.

The manager and the deputy manager showed they were committed to improving the service. They displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (published 05 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report. We have identified breaches in relation to staff training. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.