The Elms @ Kimblesworth

The Elms @ Kimblesworth is a care home which provides accommodation for people who require nursing and personal care. The service can provide care for up to 19 people. At the time of our inspection 14 people with mental health needs and learning disabilities were using the service. People with learning disabilities were therefore living in a home larger than current best practice guidance recommends.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values ensure 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 did not 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

People’s safety had been compromised. Three safeguarding concerns raised by professionals with the local authority had been investigated and substantiated. These concerns had included the safe use of medicines. Further concerns re the use of medicines were found during this inspection. People’s personal risks required updating to include more person-centred information. Accidents and incidents had not been reviewed in a timely manner. The manager was continuing to learn lessons and had shared some lessons learnt with staff in a staff meeting.

The provider did not have a suitable system in place to measure people’s dependency needs and enable them to decide how many staff should be on duty.

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 this practice.

Staff training and support were not effective. Staff were carrying out physical health checks on people without having had appropriate training.

Staff had worked with other professionals to support people’s care needs. However, we found some opportunities had been missed where the involvement of other professionals may have benefitted people. Action had been taken when this had been pointed out to the manager.

Updated care plans required further improvement to enable staff to have sufficient information to meet people’s care needs. The service did not have in place accessible information for people.

End of life care was provided in accordance with people’s wishes. Where people had not wished to discuss their end of life care, staff had documented this. Staff were respectful and kind towards people. They respected people’s privacy and dignity. Their ability to provide appropriate care for people was reduced by not being suitably supported by the area manager and the provider.

Care in the home was not informed by national best practice guidance. There were three people who used the service with diagnosed learning disabilities. The service didn't apply 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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not always have the appropriate support to give them choice and control. People’s independence was not always promoted. We made a recommendation about this.

Governance arrangements in the service was poor. Audits carried out in the service did not identify the deficits we found. Arrangements to support the manager develop in their role were not in place.

People and staff were not fully engaged in the service. We made a recommendation about this.

Joint working with other professionals had been undermined in some circumstances where staff had not seen the opportunity to seek advice or share information.

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 requires improvement (published 9 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when they would improve. At this inspection sufficient improvement had not been made and the provider was still in breach of regulations. The service had deteriorated to inadequate.

Why we inspected

The inspection was prompted in part by safeguarding concerns and a notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incidents indicated concerns about the management of unsafe medicines practices and falls.

Enforcement

We have identified breaches in relation to people receiving inappropriate care to keep them safe, medicines, staff implementing the Mental Capacity Act, staff training and good governance at this inspection.

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

Follow up

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.

People’s experience of using this service: The outcomes for people with learning disabilities did not fully reflect the principles and values of Registering the Right Support for the following reasons: lack of choice and control, limited independence and limited inclusion. Practices in the home were under developed to consider risks and support people to reach any personal goals in line with best practice guidelines.

Pre-employment checks were carried out to ensure staff were suitable to work in the home. Insufficient staff were employed in the service to support people to leave the home and engage in community activities. Consequently, people spent their days within the confines of the perimeter of the home. A staff training matrix showed staff had received training in a variety of topics. Not all staff had received training in autism.

New nursing staff had been recruited to the service to provide people with consistent nursing care. However, agency nurses had been employed in the service and the provider had failed to carry out checks on them before they began working in the service.

People’s oral medicines were administered in a safe manner. There were deficits in the administration of topical medicines. There were also some gaps in the guidance given to staff for medicines required on an ‘as and when’ basis.

People were protected by staff who had received training in safeguarding and understood how to raise concerns with their manager.

People’s diets were compromised through a lack of choice; kitchen staff were not always aware of people’s dietary needs. Advice from professionals was not documented within a care plan. Food and fluid charts were not completed.

Staff engaged people in making decisions about their care during the day. Systems were in place to obtain people’s consent. When the Mental Capacity Act principles and code of practice had been applied, and people were found not to have capacity to make decisions, these did not result in best interests’ decisions.

The provider had a procedure for complaints. Information was not on display in an easy read format to help people with additional learning needs.

People confirmed that staff treated them with kindness and respected their wishes. Opportunities for people to influence their service were limited. Resident’s meetings were infrequent.

A new manager began working in the service the day before our inspection began. Governance improvements were required in the service to ensure audits were effective, records were up to date and accurate, and people’s voice about their experiences using the service were heard.

Rating at last inspection: This service was registered with CQC in November 2018 as the provider D3 Care Limited. Before that the provider was known as Jigsaw Care Limited. There have been no changes in the directors or the name of the service, but the name of the company providing the service has changed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: We inspected this service as concerns had been raised with us by the local authority.

Improvement Action:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good. We have rated the effective key question inadequate. This means we will inspect the service within the next six months.