Archived: Iverna (North) Devon

Updated 6 July 2021

The inspection

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12- safe care and treatment (Regulation description, e.g. Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection was completed by two inspectors

Service and service type

Supported Living:

This service provides care and support to people living in nine ‘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.

The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. We also needed to gain permission to visit people in their supported living homes.

Inspection activity started on 10 June 2021 and ended on 15 June 2021. We visited the office location on 10 June 2021.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection-

We spoke with the providers operations manager, two office staff, service manager, two house managers and five care staff. We also spoke with six people living at various supported living houses, one visiting parent and one visiting healthcare professional.

After the inspection –

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 6 July 2021

About the service

Iverna North is a supported living service providing personal care to people with a learning disability in shared housing. 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 the inspection nine people were receiving personal care.

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

People said they enjoyed living in their supported living accommodation. Not everyone was able to communicate their views, but our observations showed people were relaxed in the two houses we visited.

People were not supported to have maximum choice and control of their lives. This was because people had shared hours of care and it was difficult to see how those who had enhanced one to one hours, were benefitting from this arrangement. Staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was because some people’s mental capacity had not been assessed. We were also informed there were incidents of unlawful restraint which was investigated by the local authority safeguarding team.

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 guidance CQC follows 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:

Model of care and setting maximises people’s choice, control and independence. We found people’s choice was not always being considered. We heard how some people were being asked to move to different dwellings or rooms to suit the service rather than their individual needs. We heard concerns around how people’s finances were being managed, which may not allow them choice or control about how their individual monies were being spent.

People were not always supported by enough staff on duty who had been trained to do their jobs properly. People did not always receive their medicines in a safe way. People were not always protected from abuse and neglect.

People’s care plans and risk assessments were not always clear and up to date.

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights. Some practices and ways of providing personal care did not promote people’s dignity and privacy. We had concerns from a large number of anonymous staff whistle-blowing contacts that people’s human rights might not always be fully protected. In particular people’s rights as tenants and their rights to spend their personal finances how they wished. In one or two isolated incidents, items were withheld from individuals as a form of control, for example someone’s cigarettes were withheld by some staff.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. We were not confident or assured by the leadership of Iverna North. Two local management staff had left the organisation recently. A high volume of staff contacted us about their concerns in relation to the leadership style by members of the senior head office leadership team. This had been described as “bullying and unprofessional.” Several staff had also raised concerns about the lack of confidentiality from senior leaders.

There was a closed culture where incidents and concerns were kept in-house. There was little evidence to show any lessons were learnt when things went wrong. There was a constant change of leadership which left staff found difficult to manage. Complaints were not always recorded and outcomes reached.

The ethos of people leading empowered lives was not evident in the records we reviewed, the practices staff described and our findings during our visits. For example, staff going in and out of the different houses to chat to each other and asking staff from one house to come and sit with a person from another house, so staff could take other people out. This sharing of resources, which included a clinical waste bin shared across three houses, did not promote a person-centred supported living model.

The impact for people was that they were generally cared for. However, the lack of consideration for meeting the Right support, right care, right culture meant people may not always have choice, their dignity respected and their rights upheld. The high volume of concerns we received from staff led us to be concerned about the services ability to retain a workforce who knew people and could provide the right support.

We have asked the provider to send us their investigation of all the concerns raised with us and any actions they have or will put in place to mitigate any risks as an outcome. We have also shared our concerns and the whistle-blowing information with the local authority safeguarding team and the commissioning team. The service is part of an ongoing whole safeguarding process which means the local authority are co-ordinating and reviewing the safeguarding concerns raised. Judgements have not yet been made on all the concerns raised.

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

This service was registered with us on 21 November 2019 and this is the first inspection. Due to being in a national pandemic we had not being able to complete a rating inspection as early as we would have normally. However, due to the number and nature of concerns being raised, we decided we needed to inspect this service.

Why we inspected

The inspection was prompted in part due to a high volume of concerns received. These indicated the Right support, right care, right culture was not being followed. A decision was made for us to inspect and examine those risks. Initially we commenced a targeted inspection. However, during the inspection we received further concerns and whistle-blower information. Therefore, we extended the inspection to look at all the five key areas.

The themes of the concerns we received which put people at unnecessary risk included:

• Not enough staff on duty to meet people’s needs fully.

• People not receiving their contracted hours of care and support.

• Staff feeling bullied and not listened to by senior staff from head office.

• People and staff’s information not always kept confidential by staff members.

• Some people named where there were potential safeguarding issues or risks identified.

• Allegations of personal protective equipment (PPE) not being worn correctly and lockdown rules being broken.

• Some themes of best interests not being followed, so people’s rights not being protected.

• Lack of dignity and respect for some individuals.

• Institutional practices identified in some areas of the service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Following the inspection, we asked the provider to investigate several areas of concern highlighted during the inspection.

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 five breaches in relation to: poor leadership of the service; not acting in an open and transparent way; poor complaints management; reduced staffing numbers and lack of staff training, not keeping people safe from abuse and poor infection and control practice.

We also identified four recommendations to improve practice in relation to people’s risk assessments, people’s rights under the Mental Capacity Act (MCA) and following the Right support, right care and right culture.

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.

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