Archived: Holt Road

We inspected Holt Road on 22 December 2014. This was an unannounced inspection. Holt Road provides accommodation, personal care and support for five people with autistic spectrum disorders, learning disabilities and complex needs. The people who use the service require one to one or two to one support from staff due to the assessed risks to themselves and others due to exhibiting behaviours that challenged the service. There were five people living at the home when we visited.

At our last inspection in November 2013 the service was meeting the regulations we inspected. There was not a registered manager at the time of our 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 last registered manager left in November 2013. Two further managers were appointed but both left before they were registered. At the time of our inspection the provider’s area manager was acting as manager of the service pending appointment of a permanent manager.

People were not protected against risks to their safety in the premises. There were poor arrangements for the management of medicines that put people at risk of harm. There were no measures to address the risks from open flames on the cooker or the handling sharp knives. The area manager had started to manage the home a few days before the inspection. Records about the management of the service were not available during the inspection. The area manager was not able to show how they monitored the quality of care provided. Staff told us that they knew how to support each person effectively and to address any behaviour that challenged the service with positive reinforcement. However, there were no records to show that staff had regular supervision of their work and the training records were not available. We have made a recommendation about this.

We observed some examples of staff interacting with people in a positive way, but we also observed other examples of negative interactions that did not support people to manage their behaviour. For example, we observed a member of staff using abrupt language and another example of staff not telling the person what they were doing. We found that there could be developments in providing space for privacy within the home and we have made recommendations about these matters.

The service did not respond to people’s individual needs effectively. Care plans contained information on people’s needs, but were not detailed. In particular, care plans did not address each person’s individual preferences for activities in the service and in the community. The activity records that we saw showed that similar activities took place for people on a daily basis, and many of the activities involved a drive or a shopping trip. A staff member told us, “People go out in the minibus and then split up and do other activities when we are out.” However, these individual activities were not recorded. We have made a recommendation about supporting people with autistic spectrum disorder to take part in their choice of activities.

The provider did not fully follow the Code of Practice of the Mental Capacity Act 2005 (MCA). People did not have assessments of their mental capacity to make decisions for themselves, and for others to make decisions in their best interests if required. CQC is required by law to monitor the operation of the MCA Deprivation of Liberty Safeguards (DOLS) for care homes, and to report on what we find. Where there is a deprivation of a person’s liberty DOLS requires the provider of the care home to submit an application to a ‘Supervisory Body’ for authority to do so. Risk assessments showed that people were at risk outside the home if unaccompanied. However, only one person at the home was subject to a DoLS. We have made a recommendation about following the MCA Code of Practice.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and corresponding regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to medicines management, risk assessments and records. You can see what action we told the provider to take at the back of the full version of the report.