31 March 2021
During an inspection looking at part of the service
The House of St Martin is a residential care home, part of The Langley House Trust, a Christian based organisation. It provides accommodation with personal care for up to 31 men. The focus of the service is to support ex-offenders or those at risk of offending with physical and mental health needs, dementia, substance misuse as well as people with learning disabilities and autism. 26 people lived there when we visited.
The home is a three - storey wheelchair accessible building with single room accommodation, some of which are en-suite. There is a large communal lounge/dining area, a smaller sitting room and inner courtyard area. It is set within a six-acre site.
People’s experience of using this service and what we found
Most people we spoke with said they enjoyed living at the House of St Martin, but their experiences varied. One person said, “It's really good living here. I have made friends. I like listening to music, looking at the birds and watching the weather.” A professional said, “Overall, the people that I see seemed to love it there.”
Several people said there wasn’t enough to occupy them. One said, “I'm a bit bored during lockdown, there's not much to do.” Since we last visited the service in April 2019, the service employed an activity co-ordinator, who was organising group activities such as art and crafts and gardening. Wheelchair accessible transport was provided so people could go out for trips and drives, although trips into the community were restricted by lockdown when we visited.
People did not always have their needs met because of staffing and skill shortages. There was a high turnover of staff with heavy reliance on agency to safely run the service. Where staff were unfamiliar with people' needs, this had a negative impact on their experience of care. Staff did not have all the skills, training and support they needed to provide safe and effective care and treatment.
People were not prevented from receiving unsafe care and treatment as assessments, care plans and staff handover information did not include all the information staff needed to minimise risks to people's health, safety and welfare.
The incident reporting system was unclear. We were not confident all incidents were reported or followed up, so the provider could not rely on this information to manage known risks.
Quality monitoring systems were not effective. Three breaches of regulations were identified at the inspection in relation to safe care and treatment, good governance, staff and staffing skills.
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.
This 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 used at House of St Martin’s did not fully maximise choice, control and independence for people with a learning disability. The National Institute for Health and Care Excellence recommends residential care ‘should usually be provided in small, local community-based units (of no more than six people)’. The environment of care with 31 people living in one house with large noisy shared communal facilities were not ideally suited to the needs of people with learning disabilities, autism and mental health conditions. Some outbuildings which were being refurbished to provide additional space for people. This included plans to provide a small kitchen so people would have facilities to learn to cook and a new laundry, so people could do their own laundry.
Right care:
The care and support provided, did not always meet the needs of people with learning disabilities. Staff did not receive the training they needed, so they did not develop the skills to provide appropriate support. This was made worse because of high staff turnover and heavy reliance on agency staff, so people did not always receive care from staff they knew and trusted. People’s care wasn’t person centred. Care plans were not focused on people’s strengths, abilities and individual goals.
Right culture:
The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people with learning disabilities led confident, inclusive and empowered lives. This was because the provider was trying to meet the complex needs of a wide range of people. Staff lacked the skills needed and the environment was not ideally suited to supporting needs of people with learning disabilities.
We discussed our concerns about how the House of St Martin supported people with a learning disability and/or autism with the manager, the Director of Operations and the Director of Quality and Compliance. We requested they review their Statement of Purpose about who the service is for and what they are trying to achieve. We will arrange a meeting with them to follow this up further.
Most people said they felt safe living at the service. Staff had a good understanding of signs of abuse and felt confident any safeguarding concerns reported were listened to and responded to.
Staff had received infection control training and followed up to date infection prevention and control guidance to help people stay safe. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.
People, staff and professionals spoke positively about the new manager who was making improvements.
People did not always to have as much choice and control of their lives as they wanted. Staff supported people in the least restrictive way possible and in their best interests; but documentation of best interest decisions needed improvement.
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. (Report published May 2019). The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
Why we inspected
We undertook this inspection to follow up concerns raised with us about staffing levels and skills and poor standards of care. Also, safeguarding concerns about bullying and intimidation by some people towards other more vulnerable people and by some staff. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well led.
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.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report. We have identified three breaches of regulations in relation to Safe care and treatment, Staffing and staff skills and in Good governance. The provider has agreed to mitigate immediate risks by a voluntary undertaking not to admit any more people to House of St Martin until further improvements have been made.
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 House of St Martin on our website at www.cqc.org.uk.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.