Archived: 121 High Street

Although this is the first comprehensive inspection of this location the service was previously registered at a different location where it was rated as requires improvement. The provider was in breach of their registration with us as they had not informed us of their change of address. We also found concerns with how complaints were managed and the systems in place to manage quality needed improving. The same manager was in post at this inspection and the provider remains the same.

There is no registered manager in post; however the manager is in the process of completing their registration with us. 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 this inspection people are not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Individual risks to people were not considered or managed in a safe way and when needed action was not always taken to ensure people were safe. When incidents occurred there were no systems in place to respond to these and action was not taken to minimise the risk of reoccurrence. The systems in place to manage medicines were not always appropriate to ensure medicines were managed safely. When people had as required medicines there was no guidance in place for staff to follow to ensure people receive their medicines as prescribed.

Although people and relatives did not raise concerns about calls time, we found that people did not always receive their allocated call times. And these were not monitored by the provider. There were no systems in place to ensure staffing levels were sufficient to meet people’s needs. The provider’s recruitment process did not always ensure staffs suitability to work within people’s homes. Staff received training and induction however the provider did not check staff knowledge following this or check the competencies of staff in areas such as the administration of medicines. Staff demonstrated an understanding of safeguarding however we could not be sure all incidents had been reported in line with these to protect people from potential harm.

There were no systems in place to assess and monitor the quality of the service so this information could not be used to drive improvements. We could not be assured that all guidance staff needed to keep people safe was available and this demonstrated a lack of leadership within the service. We could not be assured we received all notifications required and the provider understood their responsibility around registration with us.

As guidance for staff to follow was not available people did not receive support that was individualised. People’s support needs were not understood and people’s cultural needs had not been considered. Information was not made available to people in a format they could always understand. There was no procedure in place for managing complaints.

People were happy with the staff that supported them. When people required support with meals they were offered a choice and people were referred to health professionals accordingly. The provider shared information with other organisations. There were infection control procedures in place and people’s privacy and dignity were maintained. Staff felt listened to and supported by the manager and provider.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.