10 September 2020
During an inspection looking at part of the service
Keepence Homes is a care home providing accommodation and personal care for up to four people that may have a learning disability or an autistic spectrum disorder. Four people were living in the home at the time of this inspection.
People’s experience of using this service and what we found
The service didn’t always consistently apply 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, because people’s capacity had not been assessed appropriately in line with the Mental Capacity Act. Some choices around accessing the community, visiting relatives and access to pain relief were at times restricted.
People were not always supported to have maximum choice and control of their lives. Mental capacity assessments were not in place or reviewed in order to ensure that staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.
Risk assessments were not in place for people at risk of self-harm. Important information was not recorded on people’s hospital transfer documents. Actions and investigations from incidents were not recorded to ensure lessons were learnt and actions could be reviewed. Medicine management still needed improvement to be safe. The service was not following department of health guidelines for working safely in care homes during the coronavirus pandemic. This was a continued breach of Regulation 12 Safe care and treatment.
Recruitment checks were still not always thoroughly completed before staff started working for the service.
Staffing levels continued to negatively impact on people's involvement in external activities and support. This was a continued breach of Regulation 18 Staffing.
The service was not always working within the principles of the Mental Capacity Act and assessments had
not always been completed. This was a continued breach of Regulation 11 Consent.
The provider had failed to implement a robust system to action and drive improvement within the service. There was a lack of oversight and good governance to ensure people received a safe and well managed service that was committed to making the necessary changes. This was a continued breach of Regulation 17 Good Governance.
The provider had failed to submit seven notifications without delay. This was a continued breach of Regulation 18 Notifications of other incidents.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update:
The last rating for this service was Requires Improvement (published 29 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made or sustained and the provider continued to be in breach of regulations.
Why we inspected
We undertook this targeted inspection to check if the breaches of Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
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 continue to speak with this provider to discuss our proposed actions. 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.