Poppy Cottage Limited

Poppy Cottage Limited is also a domiciliary care service. The service informed us they had provided domiciliary care to people in their own homes in the community in the past, but were not doing so at the time of our inspection.

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

People's risks were not always assessed appropriately to identify or effectively reduce risk in areas such as fire safety, health, finances and safety of chemicals. Governance systems did not manage risks to people well, or ensure records were well managed.

People's care and support was provided in a safe and clean environment. Systems were followed to ensure people were protected from abuse and poor care. The provider reviewed incidents but this did not include themes or outcomes. We have made a recommendation about this. People and relatives told us they felt the service was safe and that staffing levels had improved. Medicines systems had generally improved, however we have made a recommendation about the management of medicines records and audits. Staff recruitment checks were completed before they started supporting people. We have made a recommendation about the recruitment records.

The service did not effectively meet two people’s hydration needs to maintain their health and wellbeing. Other people received effective support to monitor their nutrition.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this this practice. We have made a recommendation about this.

People's care, treatment and support plans were holistic. However, they did not always include enough information about identified needs or how to provide support. We have made a recommendation about this.

People were supported to be independent, pursue their interests and achieve their own goals. Staff protected and respected people’s privacy and dignity. People told us they staff were caring and treated them well. We have made a recommendation about how people prefer to be addressed.

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.

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

Right support: The service supported people to have the maximum possible choice, control and independence. This was not consistently supported by recorded best interest decisions.

Right care: Staff provided person-centred care and promoted people’s dignity and privacy. This was not consistently supported by documentation, which did not always demonstrate how people’s human rights were considered and upheld.

Right culture: People were at increased risk of harm because the provider did not manage risk well to protect people. There was a transparent and open and honest culture between people, those important to them, staff and leaders.

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 inadequate (published 22 September 2021).

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 some improvements had been made. The provider remained in breach of two of the regulations and we found a new breach of regulation. It was no longer in breach of other regulations.

This service has been in Special Measures since 8 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. The service is now rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Poppy Cottage Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches of regulation in relation to risk assessment, good governance and meeting people’s hydration needs.

We issued a notice of decision to impose conditions upon the providers registration. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Poppy Cottage Limited is a supported living service. The service provides personal care to people living in five supported living settings, so that they can live as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 18 people with a learning disability and/or autism used the service.

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

People’s care and support was not always provided in a safe or clean environment.¿Systems were not always implemented to ensure people were protected¿from abuse and poor care, or the safe management of medicines. In general people and relatives told us felt the service was safe, however, they were concerned about the impact of poor staffing levels and inexperienced staff upon people’s safety and quality of life. People's risks were not always assessed regularly in a person-centred way. People were not involved with managing their own risks whenever possible. Systems to report and learn from incidents, including where restrictive practices were used were not implemented effectively.

People's care, treatment and support plans, did not fully reflect all of their sensory, cognitive and functioning needs. People did not receive care, support and treatment from trained staff and specialists able to meet their needs and wishes. People who had behaviours that could challenge themselves or others had care plans in place, however these did not always include proactive plans to reduce the need for restrictive practices. 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 best practice.

People were not always supported to be independent and identity or achieve their own goals. Where people were supported by staff who knew them well, and understood the support they required, people told us they experienced caring and positive relationships with staff. People did not always have care from staff that protected and respected their privacy and dignity.

People's communication needs were not always met, and information shared in a way that could be understood. People were not always supported to take part in meaningful activities which were part of their planned care and support. People and those important to them, were not actively involved in planning their care. Care plans were not always reviewed to ensure they were up to date and accurate.

People were not supported by staff who understood best practice in relation to learning disability and/or autism. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, were not fully involved with leaders to develop and improve 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 statutory guidance which supports CQC 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 some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and the setting did not always show how people's choice, control and independence were maximised.

Right care:

• Care was not always person-centred and did not always 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 led confident, inclusive and empowered lives.

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 3 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, medicines errors, an allegation of abuse and poor management. A decision was made for us to complete a focused inspection to review the key questions of safe and well-led. However, during the inspection we found wide-spread concerns and decided to complete a comprehensive inspection to include all key questions.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poppy Cottage Ltd on our website at www.cqc.org.uk.

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 people’s safe care and treatment, safeguarding from abuse and improper treatment, person centred care, dignity and respect, need for consent, sufficient numbers of skilled staff, fit and proper persons employed, governance systems and reporting events to CQC when required.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

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.

Poppy Cottage Limited is a 'supported living' service. The service provides 'personal care' to people living in four 'supported living' settings, so that they can live as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 16 people with a learning disability and/or autism used the service across four different settings.

We found the following examples of good practice

The service took action to manage the outbreak of Covid-19 to prevent further spread. A review was underway to see how the outbreak happened, to avoid further occurrences. The service liaised with appropriate external bodies for advice and guidance, such as Public Health England and local authority commissioners.

The service had regular contact with people’s GPs in relation to their health conditions and had identified people who were at higher risk or extremely clinically vulnerable to Covid-19.

Staff were cohorted to avoid movement between settings. Isolation procedures were followed for people who tested positive or showed symptoms. The service followed advice from Public Health England to balance people’s safety, emotional wellbeing and the limited available space at the setting we visited.

Visitors to the service were restricted due to the outbreak. Staff supported people to maintain contact with their relatives through technology. The service had previously enabled limited visits under exceptional circumstances alongside IPC safe measures.

Infection prevention and control (IPC) measures were implemented by staff, such as visitor temperature checks on arrival and enhanced cleaning schedules. Staff had received training in the use of PPE and IPC procedures. PPE supplies were accessible to staff at the premises entrance.

Further information is in the detailed findings below.

Poppy Cottage Limited is a 'supported living' service. The service provides 'personal care' to people living in four 'supported living' settings, so that they can live as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of our inspection 16 people with learning disabilities and autism who used the service received personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

There were sometimes shortfalls in the provider’s oversight of risks. The provider had not promptly reviewed fire safety emergency evacuation procedures and some medicine practices to ensure they met people’s needs. No harm had come to people, but these processes were not robust enough to always identify shortfalls in the service.

During the inspection and after, immediate action was taken to ensure these reviews took place and action was being taken to improve the monitoring systems. It was too early for us to make a judgement about whether the action taken would be effective in identifying risks to people. We have made a recommendation about quality assurance systems.

The provider’s quality monitoring processes, for monitoring other areas of the service and making improvements where needed was working well. In all other ways the service was being well managed.

All staff we spoke with felt supported and valued by the leadership team. Staff appeared highly motivated and shared the provider’s vision to achieve person-centred care. The provider worked in partnership with all stakeholders and sought feedback from people and relatives to support continuous learning and development.

Systems were in place to make sure people received their medicines as prescribed, however we found that ordering systems did not always make sure people’s medicines stock was not excessive. Systems were followed to reduce the risk of abuse to people. People’s specific needs were risk assessed effectively and staff understood safe measures to reduce the risk of hazards. People’s emergency evacuation procedures were reviewed and updated during our inspection to make sure the risk of harm from fire was reduced.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s needs were assessed and delivered in line with current guidance. Staff co-ordinated with each other or agencies to provide consistent, effective, timely care. People benefited from suitably trained staff to meet their needs.

People received care which consistently promoted their privacy, dignity or independence. People and relatives said staff treated them well with comments such as, “They’re very caring. They know me like the back of their hands. They always listen to me.” We observed staff were caring in their interactions and people appeared relaxed in staff company.

People told us the service supported them to participate in activities to meet their interests. Information contained in people’s care plans was personalised and included people’s preference and background. All staff we spoke with demonstrated a sound knowledge of people’s needs and preferences. People’s complaints were dealt with appropriately to improve the quality of care they experienced. The service explored end of life preferences with people.

The service consistently applied 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.

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 8 June 2018) and there were breaches of two regulations. 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 been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poppy Cottage Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service provides care and support to people living in four ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection 19 people with a range of physical and learning disabilities were being supported.

The service had a registered manager in post. 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.

We received positive feedback from people, their relatives and staff on how the service was led. Comments included “Brilliant management, they are all absolutely fantastic; they have really made me feel comfortable.” A relative told us “I am very grateful to [Name of registered manager] and her staff for their patience and kindness to both [Name of person] and my family.”

Providers and registered managers are required to notify us of certain incidents or events which have occurred during, or as a result of, the provision of care and support to people. One notifiable event is when abuse is suspected. The provider had notified the local authority of suspected abusive situations; however they did not notify CQC.

Providers have a requirement to be open and transparent when things go wrong. We call this duty of candour. When certain events happened there are a number of actions providers should take. This includes making an apology to the person or their legal representative. The provider was unaware of the requirements. However it responded quickly once this was discussed with them.

The provider had processes in place to undertake pre-employment checks on staff to ensure they were suitable to work with people. However some staff were working in the service without a full police clearance. The provider did not allow the staff to work unattended until a full police clearance was received. We were assured provisions were in place to protect people during this time.

Staff were supported to develop their skills and knowledge through training. However there had been a delay in some of the required training to ensure people received safe care. We have made a recommendation about this in the report.

Staff were aware of the need to report any incidents and accidents. However no analysis was carried out to identify any trends or learning to prevent a future similar event. We have made a recommendation about this in the report.

People were supported by staff that had developed a good working relationship with them. Staff were aware of people’s likes and dislikes.

People were supported to engage in meaningful activities and keep in contact with family and friends.

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. Staff

You can see what action we told the provider to take at the back of the full version of the report.