Archived: Moseley Gardens

Moseley Gardens provides accommodation and personal care for up to eight people who require specialist support relating to their learning disabilities and/or mental health needs. At the time of our inspection, there were six people living at the home. At the last inspection that service was rated as requires improvement; sufficient improvements had not been made and a further deterioration was noted.

The provider was required to deploy a Registered Manager to manage the service as part of the conditions of their registration. There had not been a registered manager in post since August 2017. The provider had appointed a new manager who had been managing the day to day running of the service since October 2017 and they were applying for 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.

The service was not always safe because the provider had not always ensured that there were sufficient numbers of staff available to meet peoples’ needs in a safe way both in and outside of the home. Staff were not always aware of people’s personal histories and therefore were not aware of some of the risks associated with their support needs. This meant that people, staff, visitors and the general public were put at risk of actual or potential avoidable harm. The home environment did not always promote comfort or safety; it was not always clean or well-maintained. The provider’s quality monitoring systems and processes had been ineffective in identifying some of the shortfalls found during the inspection. Where quality assurance processes had identified areas in need of improvement, the provider had not always responded efficiently to ensure the safety and quality of the service was maintained in a timely manner.

Staff received training relevant to their role but it was not always evident how they transferred their learning in to practice. People were not always cared for in the least restrictive ways possible and the provider was not always responsive to their feedback. This meant that people’s views and opinions were not always listened to or valued and people were not consistently treated with dignity and respect.

The provider did not use communication aids to enable people to fully engage within the planning or review of their care or to influence the development of the service. People were supported to engage in some activities of interest but there were missed opportunities by staff to interact with people in a meaningful way. This meant that care was not always provided in keeping with quality standards set for services that support people with learning disabilities.

People were supported to maintain good health because the provider worked collaboratively with other agencies. However, this was not always by way of a proactive approach. People were encouraged to develop and maintain their independence as far as reasonably possible and were supported to sustain relationships with people that were important to them. Visitors were welcome at any time.

This meant we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; regulation 12 associated with safe care and treatment and regulation 17 concerning the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

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 has been made within this timeframe and we continue to find 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 of our return visit if they do not improve. After which, this service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will then be conducted within a further six months, and if there is still not enough improvement and an on-going rating of inadequate is awarded for any key question or overall, we will take further 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.

Moseley Gardens provides accommodation and personal care for up to eight people who require specialist support relating to their learning disabilities and/or mental health needs. At the time of our inspection, there were five people living at the home. At the last inspection in November 2017 the service was rated as Inadequate in four out of the five areas we looked at. At that time, we found that sufficient improvements had not been made since our previous inspection in January 2017 and a further deterioration was noted. The provider was found to be in breach of the conditions of their registration because they had failed to ensure a registered manager was in post. They were also in breach of regulations 11, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to consent, safe care and treatment and good governance, respectively. We imposed urgent conditions upon the provider’s registration at this location requiring them to take immediate action to safeguard people against the poor quality and potentially unsafe care that they were receiving at this service. We also proposed to cancel the provider’s registration at this location if sufficient improvements were not made. We received representations from the provider against this action alongside an action plan assuring us that improvements had been made since our inspection in November 2017. We carried out this inspection on 28 March 2018 to check whether improvements had been made and to inform our decisions about whether or not to continue with our proposal to cancel the provider’s registration at this location.

We found sufficient improvements had not been made a further deterioration was noted; this was namely due to the provider’s failing to learn lessons in order to promote and maintain the safety and comfort of people living at the home. We found sufficient evidence to demonstrate a continued breach of regulations 12 and 17 of the Health and Social Care Act Regulated Activities) Regulations 2014 concerning the safety and governance of the service. We also found breaches of regulations 10, 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to dignity and respect, safeguarding and staffing. You can see what action we have taken at the bottom of this report.

The provider was required to deploy a Registered Manager to manage the service as part of the conditions of their registration. 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. There had not been a registered manager in post since August 2017. The provider had appointed a new manager who had been managing the day to day running of the service since October 2017 but they withdrew their application to register with us and left the service in January 2018. A further manager had since been deployed to the service and had been in post since February 2018. They had initiated their application to register with us but this had not yet been completed. This meant that the service remained without a registered manager and the provider continued to be in breach of the conditions of their registration. We are in the process of deciding what action we shall take regarding this offence.

The service was not always safe because staff did not know people well enough to recognise or did not always recognise the potential or actual signs of abuse. The provider had not always followed robust recruitment practices to ensure only staff with the sufficient level of skills and experience had been deployed to support people within the home. The provider had also failed to ensure that fire safety practices and the home environment had been maintained to promote peoples safety, privacy, dignity and comfort. The provider had not consistently implemented effective quality monitoring systems and processes which meant they had failed to proactively and independently identify the shortfalls we found during the inspection.

The provider had undertaken a full staff reform, which meant that only three members of staff were still employed by the provider, two of these were night staff. The remaining staff were deployed from an agency. The provider had recently initiated a new staff development programme, but this was still in its infancy and the provider was unable to assure us that staff deployed had the knowledge, skills, training and experience to support people safely and effectively. People were not always cared for in the least restrictive ways possible and the provider had not always treated people with dignity or respect because their privacy was not always maintained and the home environment continued to require improvement.

People were supported to maintain good health because the provider worked collaboratively with other agencies. However, due to the inconsistent staffing team, recommendations made to support people’s care and support needs were not always implemented.

The provider had increased the staffing levels within the home which meant people were supported to engage in more activities of interest both in and outside of the home. Staff were seen to engage and interact well with people and people appeared comfortable in the presence of staff. People were encouraged to develop and maintain their independence as far as reasonably possible and were supported to sustain relationships with people that were important to them. Visitors were welcome at any time.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains 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 has been made within this timeframe and we continue to find 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 of our return visit if they do not improve. After which, this service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will then be conducted within a further six months, and if there is still not enough improvement and an on-going rating of inadequate is awarded for any key question or overall, we will take further 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.

Moseley Gardens provides accommodation and care for up to eight people with a learning disability. At the time of our inspection there were seven people living at the service.

There was a registered manager at the service when we inspected. 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.

There were systems and processes in place to assess and monitor the quality and safety of the service. However, further improvements were needed to ensure that these were effective in identifying shortfalls within the service.

People’s requests to take part in community activities could not always be met because the numbers of staff and their deployment was not always well managed.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision and staff training was monitored by the provider. Staff were recruited in a safe way and employment checks were completed before they started to work at the service.

People had been involved in decisions about their care and received support in line with their care plan. The provider had made appropriate applications so that people’s rights could be protected. However, not all staff were aware of what restrictions were in place for people to keep them safe.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and supervision and staff training was monitored by the provider.

People were supported to maintain good health and had regular access to healthcare professionals. People received their medicines as prescribed. Arrangements were in place to ensure that people made choices about the food they ate and specialised meals were provided when needed.

People were supported to take part in interests and hobbies that they enjoyed. People who could tell us told us they could speak to staff if they needed to, and the provider had a system for listening and responding to complaints.

We spoke with two staff members, the registered manager and the new acting manager. We also spoke with a relative and we contacted five health care professionals to ask them their views about the home. At the time of writing the report three health care professionals had responded to our request for information.

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All the staff we spoke with told us that they felt that the people who used the service were well cared for, their needs were met and that people were safe.

Staff told us about the on call procedures that were in place to provide advice and support to staff when needed, so that they felt supported and safe in their role.

We observed that there were enough staff available to care for the people that lived there and keep them safe.

The care records looked at needed some additional information so that staff had all the information they needed to ensure people's wellbeing and safety.

All of the staff that we spoke with had a basic knowledge of Deprivation of Liberty Safeguards (DoLS) process. DoLS is a legal framework that may need to be applied to people who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. The registered manager told us that to date there had been no application made to the local authority regarding a DoLS issue. However, they were going to review each person's care and if needed an application would be made. This meant that the registered manager had taken appropriate steps to ensure the service operated within the legal framework.

Overall, we found that some improvements were needed to meet the requirements of the law to ensure the service was safe.

Is the service effective?

We observed that people looked comfortable and relaxed in their home.

All of the staff we spoke with told us they felt people's needs were met and that people were well cared for.

Staff had received the training and support needed to carry out their role and meet people's needs. This included training specific to the needs of the people that lived there. For example, autism and training to support people who had behaviour that challenged the service.

People had their needs assessed and care records showed how they wanted to be supported.

Arrangements were in place to ensure that people had been supported to meet their health and medical needs. Systems were in place to identify changes in people's needs so that people continued to receive the care they needed.

We found that auditing and monitoring systems had been improved since our last inspection.

Overall, we found that adequate processes and systems were in place to meet the requirements of the law to ensure the service was effective.

Is the service caring?

A relative told us that the staff were, 'friendly and helpful'.

A professional told us, " I have never had any issues at all with this provider, just the upmost high quality of care'.

We observed interactions between staff and the people who lived there. We saw that staff showed patience and spent time sitting, talking and listening to people. People were happy and relaxed around staff members.

Staff that we spoke with knew the care and support needs of people well enough to ensure personal care was provided adequately.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.

Is the service responsive?

We found that people had been asked their views. A person had requested that their bedroom was painted a particular colour and this had been responded to. This showed that the provider was willing to listen to the views of the people that used the service to improve the overall provision.

People that lived there had been supported to take part in a range of recreational activities in the home and in the community which was organised in line with their preferences. This included walks to the local shops and park and attending a day centre and the mosque.

When people had become unwell or their care needs had changed staff had noticed this and taken action, for example medical input had been sought when needed.

We found that the provider had taken note of the findings from our previous inspection and had taken some action to address issues to improve, for example, improving monitoring systems and ensuring staff received the training they needed.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was responsive.

Is the service well led?

There was a registered manager in place who was aware of their legal responsibilities. Changes within the management team were being well managed to ensured continuity for the people that lived there.

All the staff we spoke with told us that they could raise any concerns about risks or poor practice to the registered manager and that they felt confident they would be listened to.

A relative told us that they knew who the registered manager was and they could speak to them if they had any concerns about the home.

A health care professional told us the registered manager and staff were open and receptive to advice that they gave.

Some systems were in place to monitor the quality of the service and make improvements.

Overall, we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was well lead.

Three people lived at the home on the day of our inspection. One of those people was there for a short stay only. We met with all three people. However, some people were unable to tell us their experiences of living there due to their communication needs. Consequently we spent time observing how staff interacted with and supported them. One person told us that the home and staff were, 'Nice'.

We spoke with four staff members and the registered manager. We looked at care records relating to three people.

We saw that staff treated people with respect and found that people's dignity was protected.

Care planning and support pathways related to physical care did not evidence that people's needs were met, or that all risks were considered and managed. This meant that people could be placed at risk of ill health because their needs were not addressed or met.

Systems were in place to ensure that people were safeguarded from harm. We saw that people were comfortable in the company of staff. All staff told us that no abuse occurred at the home and that people were safe. One staff member said, 'There are no concerns here'.

We found that staffing levels met people's needs and kept them safe. We identified however, that some staff training had expired which meant that staff may not have up to date knowledge to equip them to appropriately look after the people that lived there.

Processes to ensure that the people that lived there and their relatives were asked for their views about the service were not robust. We found that quality monitoring systems and processes were weak which did not give the people that lived there assurance that the service was being run in their best interests.