The Big House

About the service

The Big House is a residential care home providing personal care to one person at the time of the inspection. The service can support up to three people.

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

Right Support

Staff supported the person to have the maximum possible choice, control and independence and they had control over their own lives. Staff communicated with the person in ways that met their needs. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

Staff focused on the person’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

The service gave the person care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. The person was able to personalise their room and benefitted from the interactive and stimulating environment.

Staff supported the person with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff supported the person to play an active role in maintaining their own health and wellbeing.

Right Care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well.

The service had enough skilled staff to meet the person’s needs and keep them safe. The manager assured us staff training was being monitored to ensure all staff had completed the essential training needed to provide good quality care and meet people’s needs and wishes.

People’s care and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Risks to the person had been assessed and staff followed the support plan guidance to protect the person from avoidable harm. Staff encouraged and enabled the person to take positive risks.

People had individual ways of communicating; using body language, sounds, pictures and symbols so they could interact comfortably with staff and others involved in their care and support. Staff had the necessary skills to understand them.

Right culture

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.

Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Leicester, Leicestershire and Rutland. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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

Why we inspected

We undertook this inspection to assess whether sufficient improvements had been made to meet the regulations and check the service is applying the principles of Right support Right care Right culture.

Follow up

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.

The service provides day care services to people. CQC does not regulate the day care provision.

We found the following examples of good practice.

Information produced in easy read format about COVID-19 and infection prevention and control practices was displayed throughout the home. This included the use of personal protective equipment (PPE) and hand washing guidance.

Visiting procedures were in place to reduce risk of COVID-19. All visitors were required to show a negative COVID-19 test and had their temperature checked before entering.

Safe admission processes were in place to support people being admitted to the service. Risks to people had been assessed which considered the impact of COVID-19. People were risk assessed regarding the testing and vaccinations, and best interest procedures were followed. People continued to receive one-to-one hours of support from staff as per their package of care.

The provider had systems in place to manage an outbreak of COVID-19. Staff were trained and followed safe infection prevention and control procedures, including the safe wearing and disposal of PPE and regularly sanitising their hands. There were sufficient stocks of PPE available to staff. PPE stations were placed outside rooms where people were isolating.

The service was clean. Staff regularly cleaned the high touch areas. Immediate action was taken when we identified issues infection control risks.

Staff were kept up to date with specific government guidance in the management of COVID-19. Staff engaged in a programme of regular COVID-19 testing.

The Big House is a respite service, providing personal care and support from the age of 13 into adulthood for up to 3 young people with a learning disability and autism. The accommodation is provided over two floors, access to the first floor is via a stairwell. There are two bedrooms on the first floor, and one on the ground floor. Communal facilities include a lounge. The dining room, kitchen and courtyard are shared with people who attend a day care service. CQC does not regulate the day care provision.

Not everyone who used the service received personal care. CQC only inspects where people received personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider, and wider social care provided. At the time of the inspection the service had two people in residence, of which one person was receiving support with personal care.

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

People’s safety, health and welfare was placed at risk. Documents detailing people’s care and how to minimise potential risk were not signed, dated or reviewed. In some instances, contained inaccurate information. Potential safeguarding concerns had not been shared consistent with local safeguarding protocols. The medication policy was not implemented. Medication administration records were not signed and information to support why medication, which was prescribed to be given as and when required, was not documented. Infection prevention control procedures were not consistently followed in line with government guidance for COVID-19.

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 fully demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. Care records detailing people’s care needs were not always written in everyday language, or in a respectful way with consideration to people’s dignity. Records written by staff about the care and support they provided did not always reflect that they had understood or followed the person’s care plan, which meant people may not have received person centred care.

We have recommended that the provider reviews best practice guidance for supporting people with distressed behaviours.

People were supported to have maximum choice and control of their lives, as people’s independence to make day to day decisions were supported. However, staff did not always support them in the least restrictive way possible or in their best interests; as an application to deprive people of their liberty known as a Deprivation of Liberty Safeguard had not been applied for. The policies and systems in the service had not been implemented to support this practice.

A lack of governance and oversight by the provider and registered manager had meant some policies and procedures had not been followed. This had put people’s safety and care at risk, with opportunities to improve and develop the service being missed. Audits which had been undertaken were not always effective, as areas where improvement was required had not been identified. The oversight of staff training was ineffective as the staff training matrix showed not all staff had undertaken training to enable them to meet people’s needs and keep them safe.

The service provided respite care, which meant personalisation of bedrooms in terms of décor and furnishing was limited. People if they wished brought with them small items to personalise their room. The service supported up to 3 people and was set amongst similar residential properties in the area.

People were encouraged to use local community activities, and to maintain contact with family and friends. There were sufficient staff to support people within the service and the community. People shared the dining room, kitchen and courtyard with people who used the day care facility.

People’s views and that of family members and staff employed had been sought through a questionnaire. All questionnaires indicated people were happy with the service provided. Staff told us they felt supported by the registered manager.

The registered manager worked with local commissioners, and other organisations involved in people’s care, to share information for the benefit of those using the service.

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

Rating at last inspection

This service was registered with us on 23/02/2020 and this is the first inspection.

Why we inspected

This was a scheduled inspection following the services registration.

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.

You can see what action we have asked the provider to take at the end of this full report.

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 promoting people’s safety as potential risks were not accurately assessed or kept under review, and local safeguarding protocols were not followed. Medication systems and practices were unsafe, and improvements were needed to promote consistent infection prevention measures. Governance and oversight of the service was not effective, policies and procedures were not followed, and a lack of auditing and analysing of accidents and incidents meant opportunities to develop and improve the service were missed.

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

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.