This inspection took place on 22 and 25 September 2015 and was unannounced. The home provides accommodation and personal care for up to six younger people who have learning disabilities. There were three people living at Armstrong House when we visited.
The home did not have a registered manager. 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.
At the last inspection in June 2014, we identified breaches of Regulations relating to staffing and safeguarding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We made two compliance actions. The provider sent us an action plan stating they were now meeting the requirements of the regulations.
At this inspection we found the previous concerns had not been met and also identified additional breaches of regulations. Monitoring systems were not effective in identifying areas for improvement and as a result, people’s safety and the service they received was compromised.
Emergency procedures were inadequate to ensure people’s safety. Routine checks on the home’s fire detection and management systems had not been completed. Not all staff were aware of what action they should take in the event of a fire placing them and people at risk.
There were insufficient staff employed with a high reliance on non-permanent care staff. Staff had not attended all necessary training and were not supported in their roles.
Staff did not follow legislation designed to protect people’s legal rights. Although adults people were referred to and treated as children.
Care files and individual risk assessments were chaotic and did not reflect the care and support people needed. Action to meet health needs had not always been taken. People were not supported to eat a balance healthy diet. People were not receiving adequate mental and physical stimulation.
Systems to manage medicines were inadequate and did not ensure people received all prescribed medicines safely. There were no systems to ensure people could receive ‘as required’ medicines such as paracetamol for minor illnesses or pain.
The views of people and relatives were not actively sought and people were not involved in decisions about the service.
The provider was recruiting new permanent staff and the recruitment process was safe and ensured staff were suitable for their role.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to the provider and will report on this when it is completed.
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 is made within this timeframe so that there is still 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 if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take 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.
There was a breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.