Background to this inspection
Updated
23 February 2024
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 Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 1 inspector, 1 senior specialist for people with a learning disability and autistic people, 1 medicines inspector and an Expert by Experience. 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
Alderwood Cransley is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Alderwood Cransley is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A manager was overseeing the service at the time of the inspection, who had submitted an application to become registered manager at the service.
Notice of inspection
The inspection was unannounced on 16th October 2023; we returned announced on the 19th October 2023 to Alderwood Cransley.
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 with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
People living at Alderwood Cransley were not able to discuss the care and support they received with us. However, we observed care and support being provided to them. We spoke with 8 staff members, including the manager, regional manager, behaviour lead, team leaders and support workers. We also spoke with 8 relatives and 3 external professionals. We reviewed a range of records. This included care records of 6 people and their medicine records. We reviewed 3 staff files in relation to recruitment, 5 agency staff profiles and records related to the management of the home. During the inspection we continued to liaise with the provider to obtain additional documents which we reviewed.
Updated
23 February 2024
About the service
Alderwood Cransley is a residential care home providing personal care to up to 6 people. The service provides support to autistic people with learning disabilities. At the time of our inspection there were 6 people using the service.
People’s experience of the service and what we found:
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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Support
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. Mental capacity assessments had not been carried out robustly by the provider to ensure people were supported to have maximum control of their lives and supported in their best interest safely, the policies and systems in the service did not support this practice. The provider did not have effective processes or systems in place to safeguard people to ensure they were safe from harm. Staff did not understand when a safeguarding needed to be reported to appropriate bodies. People were not supported by staff who had been appropriately trained and were competent. People had not received their medicines safely.
Right Care
People's care plans and risk assessments did not cover their range of care and support needs. Staff were not guided to support people in line with legislation, good practice and their training. People had not been protected from harm and abuse. The provider had not always provided staff with information and guidance to support people who were expressing distress and emotionally distressed to ensure people had positive outcomes. Individual risks were not always assessed or managed well, and this placed people at risk.
Right Culture
The service was not well-led. The governance system was not effective in monitoring the quality of the service provided to people. The provider failed to recognise risks and concerns in relation to health and safety, safeguarding, completing records and medicine management. The provider did not always ensure staff deployed had the right employment checks and skills to support people safely.
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 15 February 2022.
Why we inspected
The inspection was prompted in part due to concerns received about management, safeguarding and staffing. A decision was made for us to inspect and examine those risks.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding, person centred care, good governance, staffing and dignity. 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
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 the provider has not made enough improvement within this timeframe and 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.