LIGHT AND HOPE

Light and Hope is a care home providing accommodation for up to four people who require personal care some of whom may be living with a learning disability. At the time of our inspection there were two people living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

Support plans were not always kept up to date with the most recent information to support people with their care and support needs. People were not always encouraged to plan for aspirations and goals. People were not supported to have maximum choice and control of their lives and staff did not always 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. The service did not provide care and support within a homely and well-maintained environment. Parts of the home needed repair and people’s rooms and communal areas were not decorated in line with people’s preferences or to reflect their personalities. People received their medicines as prescribed, although medicines had not been managed effectively. Staff competencies to administer medicines were reviewed.

Right care

Staff acted promptly to protect people from poor care. Incidents or concerns were reported but some incidents involving people did not trigger a review of the care they received. Staff had training on how to recognise and report abuse. We have made a recommendation that the provider reviews themes and trends and takes appropriate action. People were not always supported through planned person-centred practices. Care and support plans did not contain personalised plans or outcomes for people with achievable goals. We have made a recommendation that the provider develops links for advocacy to ensure people have an independent voice. People were not always encouraged to take positive risks. Keyworker meetings did not support people in positive risk taking to achieve personal change or growth. Further development was required to manage risks in ways which improve the quality of life of the person, to promote their independence or to stop deterioration if possible.

Right culture

People did receive good quality care in their day to day care support and treatment. People could lead more inclusive and empowered lives which the provider continued to work towards. The quality assurance processes were not always effective and failed to identify and address shortfalls in a timely manner. Safe recruitment processes were followed to ensure suitable staff were employed.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 12 August 2022)

We served the provider warning notices in relation to a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served requirement actions for breaches of regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12. The provider remained in breach of regulation 9 and regulation 17 in relation to planning person centred care and effective risk management and effective governance and oversight.

This service has been in Special Measures since 11 August 2022. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service between 04 July 2022 and 12 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safety, person centred care and governance.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Light and Hope on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach in relation to governance, provider oversight and monitoring at this inspection.

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

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Light and Hope is a residential care home providing the regulated activity of accommodation for person's who require nursing or personal care for up to six people. The service does not provide nursing care. The service is registered to provide care and support for younger adults, older people and people living with mental health, dementia or physical disabilities.

The home is a modern end of terrace building that has been extended and provides accommodation over two floors. The home had limited dining and communal living space for people to spend time together. Some bedrooms had en-suite facilities, with shared bathroom and toilets also available for people. At the time of our inspection there were two people using the service.

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

The registered manager and provider had not developed a system of quality monitoring to help ensure they were managing a safe, effective and well-led service.

The provider’s fire risk assessment had not been reviewed. Fire doors were wedged open, self-closing mechanisms had been de-activated, staff fire awareness was poor and emergency evacuation risk assessments did not reflect night-time, where staff presence in the home was reduced to one.

People were supported safely with their medicines; however, medicine management processes were not always safe. Risks to people had been assessed, however assessments were not always sufficiently detailed to guide staff how to support people safely.

Staff had received training in all basic core areas prior to joining Light and Hope. The registered manager and provider had failed to assess staff understanding of their training and their competencies to help ensure people received safe and effective care and support.

Infection prevention and control practice in the home was not in line with current guidance. The registered manager was not aware of the current government guidance relating to care services.

People were not always supported to have maximum choice and control of their lives. 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 best practice. People were cared for in bed and in their rooms, not supported to go out into the wider community. We have made a recommendation for the provider to seek additional guidance and training in this area.

People were not always supported with kindness and compassion and their privacy and dignity was not always respected. People’s end of life care wishes were not recorded or explored at a time when they could voice their opinions, therefore the plans in place for any future care needs were not personalised.

People’s needs were not always met. Staff supported people with essential care needs but did not spend time chatting with them or supporting them with social interests. People received their personal care and medicines, were offered food, drinks and were kept warm. The only interaction people received was whilst staff were providing personal care. People were not supported with activities to engage them and help to avoid isolation and boredom.

People were protected from abuse. Staff and management demonstrated a good knowledge of safeguarding and how to report any concerns.

Staff felt well supported and could ask the manager for any help they needed.

People were supported to see health professionals if this support was needed.

The manager had a complaints policy in place but stated they had not received any complaints.

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 04 January 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, infection control, the use of restraint and lack of social interaction for people using the service. A decision was made for us to inspect and examine those risks.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care, personalised care and management processes.

Follow up

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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 six 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.