Archived: Eastry Villa's

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

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; the policies and systems in the service did not support this practice.

People had been unlawfully restrained by staff and were at risk of harm. There had been numerous incidents which were not reported to the relevant professional stakeholders. Staff did not have the skills or competencies to support people when they were distressed or to support them proactively to manage their behaviours. People’s human rights were not upheld. People were told to ‘be good’ and punished for behaviour staff did not agree with. People had been unnecessarily restricted and were not supported to be independent or make their own choices. The registered manager and provider had poor oversight of incidents and had allowed people to be harmed by staff. The registered manager was involved in incidents of unlawful restraint. The provider had failed to introduce measures to reduce repeated incidents or learn lessons.

Medicines were not managed safely or in line with best practice guidance. There were not sufficient numbers of suitably qualified staff to meet people’s needs. We were not assured that the provider was protecting people from the risk of infection.

There was a closed culture in the service which was not person centred. There was a lack of oversight and leadership at the service. Staff did not understand their responsibilities, as a result people were harmed. The provider did not learn lessons or implement improvements leaving people at risk. Staff, the registered manager and provider were not open, honest or transparent

when things went wrong. The registered manager and nominated individual failed to meet their regulatory requirements. People told us they were not asked for their views or supported to make decisions about the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not maximise people's choice, control and Independence.

Right care:

• Care was not person-centred and did not promote people's dignity, privacy and human Rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services could lead confident, inclusive and empowered lives.

This meant people were placed at harm; had unnecessary restrictions placed on them and did not receive person centred care. The provider had not acted or taken any measures to mitigate the risk of harm to people or support people to live with choice or independence.

Immediately following this inspection, the nominated individual of this service changed.

Following this inspection, we worked closely with local authorities to ensure people were safeguarded from ongoing harm. Eight people were supported to move out of Eastry Villas, there is currently nobody living at Eastry Villas.

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 27 December 2018).

Why we inspected

We received concerns in relation to incidents and allegations of abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eastry Villas on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, good governance, and notifications of other incidents at this inspection.

Following the inspection, we took immediate action to restrict admissions to Eastry Villa's. We took action against the provider and cancelled their registration at Eastry Villa's. Everyone moved out of the service and Eastry Villa's is now closed.

Eastry Villa’s is a ‘care home’ for up to 11 people with learning disabilities. People in care homes receive accommodation and 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. At the time of the inspection, there were three people living at the service. The service was going through a transition where a number of people had moved out of the service, and people with different needs were being supported to transition into this service.

The accommodation was set out across a main house, a self contained flat and a separate bungalow. All bedrooms baring one had en-suite facilities. There was a communal lounge, dinning area and kitchen in the main house. There was access to a garden at the back of the house.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The service ethos is to enable people with learning disabilities and autism to live as ordinary a life as any citizen.

At our last inspection on 31 March 2017, we rated the service Good. We re-inspected this service earlier than planned due to concerns that had been raised about people’s safety. At this inspection we found that the evidence continued to support the rating of Good.

At this inspection we found the service remained ‘Good’

The service did not have a registered manager in post. The last registered manager left the service in July 2018, a new manager was appointed in September 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. During this period of time the service has not been consistently well led. Staff told us there was a lack of support and guidance for them when supporting people to move into the service.

People continued to be safeguarded from potential harm and abuse. Staff knew about abuse, and how to report any concerns they had. Risks to people had been assessed and minimised where possible, with detailed guidance in place for staff to follow. Accidents and incidents had been recorded and used to improve the service. Medicines were stored and administered safely. Risks to the environment had been assessed and well managed. The service was clean and well maintained, and had been adapted to meet the needs of the people living there.

There were sufficient staff to meet people’s needs. There were staffing vacancies which were being covered by consistent regular agency staffing. People had been recruited following safe recruitment processes. There continued to be an effective induction system in place, followed by regular training which staff informed us supported them to complete their roles.

People’s needs were assessed before they moved into the service and in line with good practice. People were supported to eat and drink sufficient amounts to maintain a balanced diet. People with specific diet related healthcare conditions had been supported to manage these well, and maintain good health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness, compassion and respect. Positive relationships had formed with staff and people. Staff were aware of how to adapt their communication styles to meet people’s needs. People’s privacy and dignity was maintained by staff.

People were supported in a person centred way. People had individual care plans, and had been supported to follow personal interests. Stakeholders knew how to raise concerns and complaints about the service.

The leadership of the service had changed since the last inspection. Staff told us morale had improved and staff felt opportunities to express their views had improved. Staff told us they felt valued and listened to. Healthcare professionals and relatives had been involved in giving feedback about the service. Improvements had been implemented because of lessons learnt within the service. Regulatory requirements had been met; we had been informed of important events at the service, and the provider had displayed their rating at the service, and on the provider’s website.

Further information is in the detailed findings below.

The service is in the village of Eastry near to the main towns of Sandwich, Deal and Ramsgate. There were nine people living at Eastry Villa’s and each person had their own bedroom. All bedrooms, apart from one have en-suite facilities. There are communal rooms which are open plan in style with access to the garden at the back of the house. There is a main house, a separate bungalow for one person and a separate flat for one person that all make up Eastry Villa’s.

There was a registered manager at the service who was present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in January 2016, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The registered manager sent us an action plan outlining how they would rectify those breaches. The registered manager and team had worked hard to update policies, care planning, staff training and recruitment and develop communication support and person centred care. At this inspection all the regulations were met and improvements had been made, although there were some areas that still required improvement.

There were some different areas of improvement identified at this inspection that the registered manager agreed to address. There was a lack of communication to visitors to make sure that they did not inadvertently trigger people having anxious and emotional behaviours. One person needed emergency medicine to be administered if they became unwell and because not all the staff were trained they had been limited in how often they had been able to go out. Sometimes staff had limited people’s opportunities to go out if they had behaviour that challenged earlier in the day and this had not always been addressed by the registered manager. The registered manager agreed that these were areas for improvement and said they would address them.

There was a clear complaints process but there was a lack of clarity about what should be considered a complaint. A recent concern raised by a relative had been missed, not resolved and had happened again because the issue had only been written in the team’s communication book and not acted on as a complaint. We brought this to the registered manager’s attention who agreed to respond to it.

Staff we spoke with knew about different types of abuse and had attended training in safeguarding people from harm and abuse. Recruitment checks on staff were thorough. References were requested and any issues were followed up. Health declarations had been completed and prospective staff had provided proof of their qualifications.

There were enough staff on duty to meet peoples’ assessed needs and it was clear who was receiving one to one support and how these hours were allocated. People were participating in a variety of activities both in and outside their home. There were planned activities that people could choose from and the right number of staff to support them. If people changed their minds about activities this was respected and alternatives were offered or the activities were offered at a different time.

There was a good range of training that staff had attended to make sure they had the skills to support people. Staff had regular team meetings and one to one meetings with the registered manager or senior members of the staff team and said they felt well supported and were able to air their views. The deputy manager worked alongside staff to provide additional guidance and support the change of culture from doing for people to supporting people to develop their lifestyles.

Staff respected peoples’ privacy and dignity and offered people choices in the way they could understand and respond to.

The registered manager understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were subject to constant supervision by staff and there were some restrictions to their liberty but these had been assessed to make sure they were the least restrictive. For example, people were able to freely access the kitchen and only sharp knives and other assessed items were kept out of harm’s way. All DoLS authorisations had been agreed and were up to date or had been sent to the local authority for review.

Each person had a health action plan that gave staff details about the person’s health needs. The staff worked closely with health professionals to maintain peoples’ health and followed their advice. Medicines were stored safely and managed safely by the staff. Prescribed medicines had been reviewed and there were regular audits of stocks and administration. Assessments had been carried out to see how much people were able to do for themselves and make sure they had the right support.

People looked like they enjoyed the food and usually chose to eat together in the dining area. People were offered choices and there was a picture menu where everyone could see it. People helped in the kitchen and were involved in mealtime tasks. The house was clean and spacious and there were various features to make it more homely.

People’s communication was supported and they were able to express what they wanted using gestures, objects, pictures and photos and had the support of community professionals to develop these. Noticeboards and planners were used to assist people to plan activities and events.

Each person had a care plan detailing their needs with guidelines for staff support which had been reviewed and were up to date. These included plans to help people achieve their goals to help them develop their independence and increase their experiences. People were developing skills like making drinks and helping with meal preparation. Risks had been assessed and reviewed.

There was a clear complaints procedure and opportunities for people to share their views and experiences of the service in a way they could understand. An easy read version had been designed and was available to people.

Regular checks of the environment had been carried out and there were clear records of checks of the care plans, staff files, medication records and other records. Peoples’ and stakeholders, including staff, views had been gathered, analysed and acted on. Incidents and accidents had been analysed to look for any common patterns and trends to reduce further incidents. The registered manager had notified the CQC of events that affected people or affected the smooth running of the service. The office was well organised and records were accessible and up to date.

The service is in the village of Eastry near to the main towns of Sandwich, Dover and Ramsgate. There were nine people living at Eastry Villa’s and each person had their own bedroom, all bedrooms, apart from one have en suite facilities. There are communal rooms which are open plan in style with access to the garden at the back of the house. There is a main house, a separate bungalow for one person and a separate flat for one person that all make up Eastry Villa’s.

There was a registered manager at the service who supported both days of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager started working at the service recently in August 2015. He had identified lots of areas where improvements were needed and had written an action plan. The registered manager had lots of ideas to improve the service and was working through the action plan, which meant that some of his ideas had not yet been implemented. The registered manager said that there was ‘a lot to do’ and ‘it was a work in progress’.

Staff we spoke with knew about different types of abuse but not all of the staff had attended training in safeguarding people from harm and abuse. Recruitment checks on staff were not as thorough as they should be. Unsatisfactory references had not been questioned and followed up and some staff had no written references on file. Some staff had not declared that they were healthy and fit for the role and provided proof of their qualifications.

Some people needed additional one to one and two to one support hours that had been assessed and funded for. People were not all directly receiving these additional support hours and the use of these hours was not recorded. When people were at home, activities were limited leading to low levels of engagement and participation in everyday activities, including cooking and cleaning, as well as educational and learning activities. Some people, but not all, had an individual activity plan but these activities did not always happen, leaving people at home with not much to do.

Staff attended basic training courses; however, subjects related to peoples’ needs were limited. Staff had not had training in person centred planning, learning disability awareness, positive behaviour support and active support. Staff had not had the opportunity for regular one to one meetings and staff meetings were not held regularly. The registered manager said that he planned to hold more regular staff meetings and one to one meetings with staff. The registered manager agreed that the training for staff could be improved and he would talk to the provider about this. Staff respected peoples’ privacy and dignity and, on the whole, were kind and caring.

The registered manager understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were subject to constant supervision by staff and restrictions to their liberty, for example, some external doors were locked and access to the kitchen was restricted. These restrictions must be agreed by the person’s local authority who agree a DoLS authorisation. Seven people were currently being restricted unlawfully as their DoLS authorisations expired in October 2015. Restrictions had not been reviewed to ensure that they were the least restrictive option. Following the inspection the provider told us that the applications have been made and are in the process of being authorised by their funding authorities. We will check this at the next inspection.

Each person had a health action plan that gave staff details about the person’s health needs. The staff worked closely with health professionals to maintain peoples’ health and followed their advice. Medicines were stored safely and managed safely by the staff. The potential for people to take some control of their medicines had not been assessed and regular checks of medicines had not been carried out.

People looked like they enjoyed the food and usually chose to eat together in the dining area. Peoples’ involvement in cooking and baking was limited and there were no plans to increase peoples’ cooking skills. The house was generally clean and spacious but did not feel homely. It was cold, as the boiler was not working, and did not support communication that would give people some control. For example, there was nothing to show who was on duty that day, what the activity options were, what the meal choices were and what other opportunities were on offer.

Each person had a care plan detailing their needs. Personal goals and aspirations had not been recorded so there were no plans to help people achieve their goals. There were no plans to support people to learn new skills and to develop existing skills like, learning more about money, cooking or how to do laundry. The registered manager was aware of this and wanted to improve this. Some care plans had not been reviewed so it was not clear if the support being given was effective. Risks had been assessed but not always regularly reviewed to check if the risk was still apparent and if the risk was being reduced by staff or not.

The registered manager was planning to create a separate office that he could work from. The ground floor office space, he felt, was limited. There were records and paperwork that was awaiting filing. Not all records were up to date including the training matrix.

There was a complaints procedure but it was not displayed. There were plans for an easy read format of the complaints procedure but this was not yet in place. Staff were unsure where complaints should be recorded but said they would pass any complaints to the registered manager.

There was a lack of records relating to checks and audits. Regular checks of the environment had not been carried out and there were no records of checks of the care plans, staff files, medication records and other records. The provider had organised checks by external auditors but no records of any outcomes of these audits were available. An external audit was being carried out on one of the days of our inspection. Peoples’ and stakeholders, including staff, views had not been gathered, analysed and acted on. Incidents and accidents had not been analysed to look for any common patterns and trends to reduce further incidents. The registered manager agreed that this was an area for improvement.

The registered manager had notified the CQC of most events that affected people or affected the smooth running of the service, apart from the boiler break down that affected the heating in some parts of the house. He agreed to do this retrospectively and had several portable electric heaters sited around the service to heat up the house.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see details of the breaches and the action we have taken at the back of this report.

One person who used the service was able to tell us of their experiences of receiving care. They said they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. They said 'staff are very good they help me with many things. They help me to lead the life I want to lead'.

Through direct observation, discussions with staff and records we, viewed we saw that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. Daily reports were written showing things such as, what a person had done that day, what support they had and what they had eaten.

People received support to maintain a healthy, active lifestyle. They were supported to attend health care checks and community health professionals were involved to provide advice and support when needed. A healthy balanced diet was offered to people who were able to choose the food they ate from photos if they did not understand the menu. People were supported to develop their independence skills, including making snacks and drinks.

People were supported to express their views and make important decisions because the staff supported them with their communication and spent time with them.

There were a clear recruitment process and staff said they received the training they needed and were well supported when starting work in the service.