Archived: Garden House - Care Home Learning Disabilities

Garden House is a care home for people with learning disabilities. The service is three adjoining houses which were adapted. At the time of the inspection seven people were living at the service. The service was planning to close in March of this year. At the time of our inspection people were being supported to find alternative accommodation.

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

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 the principles of Right support, right care, right culture.

• Right support: The model of care and the setting did not maximise people's choice, control and Independence. For example, people were not supported to set goals for things they might have wanted to achieve.

• Right care: Care was not person-centred and did not always promote people's dignity, privacy and human rights. We did not see evidence that people were receiving person centred care. For example, one person was missing their hearing aids for many months and we saw no evidence of staff trying to seek a resolution.

• Right culture: The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using the service lead confident, inclusive and empowered lives. For example, we could not always see evidence of people being supported to engage in daily activities which were important to them.

Medicines were not always administered or managed in a safe way. Risk management plans were not detailed, and they were not updated when people’s needs changed. Staff told us they felt there was not always enough staff available to care for people. We made a recommendation to the provider to review staffing levels. The home was clean and tidy, but staff were not completing daily cleaning schedules, so It was not always clear how infection control practices were being reviewed.

We recommended the provider seek and implement national guidance in relation to safeguarding adults as the registered manager was not always able to evidence how safeguarding concerns had been investigated.

Care planning was not person centred and lacked information that was important to care for people.

Quality assurance processes were ineffective. Whilst there were auditing systems in place staff were not always completing the monitoring and the registered manager did not have good oversight of the day to day running of the service.

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

Rating at last inspection

The last rating for this service was good (published 11 March 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the care people were receiving. A decision was made for us to inspect and examine those risks.

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 coronavirus 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 monitor the service. 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 safe care and treatment, person centred care and good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Garden House - Care Home Learning Disabilities is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service

Staff ensured people had their medicines safely administered. Staff understood and implemented systems used in the management of medicines. We reviewed samples of medicines administration records used to record when people had this support and these were completed accurately.

There were systems in place to safeguard people from harm and abuse. Staff had developed their knowledge of abuse through the safeguarding training they attended and they knew how to report an allegation of abuse in a timely way.

There was enough staff to support people during the day, night and when people needed individual time with staff. People had enough to eat and drink to meet their nutritional needs. Meals were prepared by staff that were chosen by people which met their preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff identified potential risks associated with people’s health and well-being. Plans were developed and in place with details of actions staff would take to mitigate these risks.

People took part in a variety of social activities to meet their interests. The service had a programme of activities that took place in the service.

People and relatives were involved and contributed to their care assessments and were invited to attend a care plan review when this was due. Feedback from people was positive about the service and confirmed that staff were kind, caring and supported them in a dignified and respectful way.

People had health care support available to them when their needs changed. No one using the service required palliative care. Care records took into consideration people’s arrangements, wishes and views of the support they wanted at the end of their life.

The provider had a complaints policy and process in place. People were confident they could make a complaint about any aspect of their care.

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 requires improvement (published 9 January 2019) and we found two breaches of regulations regarding the management of medicines and quality monitoring of the service. 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 regulations. The overall rating at this inspection has now improved to good, however we made one recommendation about maintaining the decoration and furnishing of the service.

Why we inspected

This was a planned inspection based on the rating of the service at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our previous inspection of Garden House on 25 April 2018 we found several breaches of the regulations and as a result rated the service ‘Inadequate’ in Well Led and ‘Requires improvement’ overall. The provider was issued with a warning notice in relation to poor governance. You can read the report from our last inspection, by selecting the 'all reports' link for Garden House - Care Home Learning Disabilities on our website at www.cqc.org.uk.

At this inspection, we found the provider had made some improvements to the way the service operated. However, we found concerns in relation to some aspects of medicines management and quality monitoring. We rated the service 'requires improvement' overall.

Garden House is a 10-bedded care home for people with learning disabilities located in the London Borough of Southwark. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were eight people living at the service.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. “People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

A newly appointed manager had applied to become the registered manager of the service. ‘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.’

Staff were employed following an application and interview process. The provider had made efforts to update and review DBS checks for all staff members following a recommendation we made at our last inspection.

People's needs were assessed before they moved into the service and further assessments were conducted once people were living in the home and feeling settled. This information was used to develop individual support plans. People and their relatives were involved in decisions about how care and support was provided.

Staff completed a range of risk assessments in relation to skin integrity, mobility, nutrition and continence. Most risk assessments had recently been reviewed and the quality manager told us that the remaining records would be completed shortly.

Staff were not always following safe practice regarding the management of people's prescribed medicines. Staff competency in relation to safe medicines practice was not being regularly assessed.

Staff completed an induction and were required to attend training and supervision sessions throughout their employment. Sufficient numbers of staff were deployed to the service to meet people's.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe and told us they would report any concerns they may have to their manager.

Staff made appropriate referrals to health and social care professionals when needed. However, staff were not always following recommendations and guidance provided by clinicians.

People had enough to eat and drink but food supplies did not always meet people’s preferences.

The provider had policies and procedures in place that ensured staff had guidance if they needed to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation to restrict a person's liberty in their best interests.

Staff treated people with respect and were mindful of people's need for privacy.

Relatives we spoke with provided positive feedback as to the way care was delivered to their family member.

Systems were in place to improve the safety and quality of the service but there were gaps in these systems. Quality audits were not always identifying, managing and resolving issues we highlighted during this inspection.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

People and their relatives were provided with information about the service which included details of how to make a complaint.

The home was spacious and comfortable. However, staff were not always following good practice in relation to infection control.

We recommend the provider reviews its policies and procedures in relation to the above matter.

We found two breaches of the regulations in relation to safe care and treatment and governance. You can see the action we have told the registered provider to take at the end of this report.

Garden House is a 10 bedded care home for people with learning disabilities located in the London Borough of Southwark. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were nine people living at the service.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service 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.’ An interim manager was responsible for the day to day running of this service and two other services operated by the same provider.

At our previous inspection of Garden House on 28 January and 1 February 2016 we rated the service ‘good’ overall. You can read the report from our last inspection, by selecting the 'all reports' link for Garden House - Care Home Learning Disabilities on our website at www.cqc.org.uk.

At this inspection we found several breaches of the regulations and as a result rated the service ‘inadequate’ in Well Led and ‘requires improvement’ overall.

People's individual needs were not always being met by the adaptation of the premises.

Risks in relation to people’s safety were not always being addressed through the implementation of a robust risk assessment process. Risk assessments were not always being reviewed in line with the provider’s policies and procedures.

Where appropriate, people, relatives and healthcare professionals contributed to the care planning process. However, care plans were not being regularly reviewed to reflect people’s changing needs.

Staff were not always receiving appropriate support and training to enable them to carry out the duties they were employed to perform.

People using the service were not always being protected from improper treatment. Staff were not always requesting people’s consent before offering them support.

People were not always being treated with dignity and respect. Some staff members lacked the understanding required to support people in a kind and compassionate manner.

The provider had safeguarding policies and procedures in place. Staff cited physical and verbal aggression as forms of abuse. However, staff were unfamiliar with the concept of institutional abuse. Where we identified concerns in this area, staff demonstrated a lack of understanding and awareness.

Not everyone using the service knew how to make a complaint.

Staff were employed following a thorough recruitment process. However, some DBS checks dated back to 2003 and had not been renewed since.

Staff were not always supervised on a regular basis and annual appraisals were behind schedule. Training was not always effective, updated or refreshed to ensure people were receiving care and support in line with evidence-based best practice guidelines.

Audits were carried out to ensure the environment and people were safe. However, systems designed to regularly assess, monitor and improve the quality of the service were not always effective.

People were supported to have sufficient amounts of nutritious food and drink to meet their needs. Mealtimes were not always organised in a way that promoted people’s choices and preferences.

Sufficient numbers of staff were deployed to the service in order to meet people's needs.

People received their medicines safely and in line with their prescriptions.

People received access to healthcare professionals to monitor and maintain their health care needs. Staff supported people to attend medical appointments.

The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

Staff were following correct infection control procedures.

We have made two recommendations in relation to staff training and employment checks. We found breaches of regulation in relation to safe care and treatment, dignity and respect, safeguarding, person-centred care, premises and good governance. You can see what action we have told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Garden House is a residential home that provides accommodation and support to up to ten people with learning disabilities in the London Borough of Southwark. At the time of the inspection there were 10 people living at the service.

There was a registered manager in post. 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.

People received their medicines safely and in line with their prescriptions. The service demonstrated good practice with regards to the administration, recording, auditing, storage and disposal of medicines.

People’s care plans were person centred and tailored to meet their needs. Care plans were regularly reviewed to reflect people’s changing needs. People were encouraged to develop and contribute to their care plans wherever possible.

People were protected against the risk of harm and abuse. Staff were aware of the correct procedure in reporting abuse and understood their responsibilities with reporting and recognising abuse and safeguarding. Staff were able to identify the different types of abuse and their responsibilities in maintaining people’s safety. People were protected against identified risks. Comprehensive risk assessments gave staff clear guidance on how to support people when faced with known risk.

People did not have their liberty restricted unlawfully. Staff had sound knowledge of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS]. These aim to make sure that people in care homes, hospitals, and supported living services, are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive. Consent to care was sought prior to care being delivered.

The service had carried out the necessary checks on new employees to ensure they were suitable to work in the service. Staff underwent a comprehensive induction programme to ensure they gained the appropriate skills and knowledge to effectively meet people’s needs. Inductions were flexible and could be extended if staff required additional time and support to be deemed competent.

People were supported by staff that received on-going comprehensive training that gave them the skills and knowledge to meet people’s needs. Staff received ongoing guidance and support through supervisions and annual appraisals. There were sufficient numbers of staff on duty to meet people’s needs.

People were supported to have sufficient amounts of nutritious food and drink to meet their needs. Food and drinks were available to people throughout the day as and when they chose.

People received access to health care professionals to monitor and maintain their health care needs. Staff supported people to attend health care appointments in the local community.

People were treated with dignity and respect at all times. Staff supported people in a kind and compassionate manner whilst maintaining their confidentiality.

People were supported to raise their concerns and complaints. The service had pictorial posters available in the service where people could access details on how to raise a complaint. People were encouraged to share their views and these were listened to.

The registered manager operated an open door policy and was a visible presence within the service. The registered manager actively sought partnership working health and social care professionals and sought feedback on the delivery of care. Quality assurance questionnaires were sent to people, relatives and health care professionals to seek their feedback and suggest improvements to the service.

The registered manager carried out regular audits to ensure the environment and people were safe.

We answered the questions: Is the service safe?

We checked the medicine administration record (MAR) for 10 people living at the service, observed the administration of medicines and we spoke to staff.

Is the service safe?

The home was safe. Medicines were administered and handled safely. MAR were accurately completed. People medicines were stored securely. Unused medicines were returned and a record was kept for these.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe living at the service. Staffing levels were adequate and staff were trained and competent in their roles. Staff were aware of how to respond to emergencies and there was support available for people 24 hours a day.

Assessments were undertaken to identify any risks to people that used the service and actions were taken to address the identified risk. Health and safety requirements were maintained. Staff had knowledge of the signs of abuse and how to report it.

Medicines were not always handled safely or appropriately. Unused medicines were not disposed of appropriately.

Is the service effective?

People were involved in the assessment of their care needs and in developing their support plans. Their support plans were tailored to reflect their individual needs and the outcomes they wanted to achieve. Other health and social care professionals were involved where required.

Is the service caring?

People were supported by attentive staff. Staff were patient, encouraging and caring. They spoke to people with respect. We saw positive interactions taking place. Most of the people told us that staff were nice and listened to them. People commented that they liked living at Garden House Care Home and that they liked the staff. We saw that staff spent time with people and engaged them in activities.

Is the service responsive?

People were able to take part in a range of activities in and outside the service regularly. Staff understood the individual needs of the people who used the service and supported them accordingly. Care plans and risk assessments were reviewed monthly to reflect changes in people's needs.

Is the service well-led?

There was a range of quality assurance systems in place by the provider. The provider requested feedback from people who used the service about the quality of the service using surveys and monitoring visits. People knew how to make complaint.

Staff told us they were clear about their roles and responsibilities. Staff had regular supervision sessions, appraisals and team meetings to ensure they were adequately supported to do their jobs.

Staff we spoke with were happy to work for the service and told us that they 'Would recommend to others to work here', 'I'm happy here' and that 'We are a good team'. We saw evidence that the provider operated an effective recruitment process to ensure that only suitably qualified, skilled and experienced people were employed at the service.

We observed during our inspection that people were treated with respect as individuals. People had care plans which included details of how to meet their nutritional needs and they were provided with a choice of suitable and nutritious food and drink.

We found that the home was clean and hygienic and that procedures were in place to prevent the spread of any potential infections. We also found that there was a system in place to respond appropriately if people had any complaints.

People we spoke with said they talked about what they wanted to do with their support workers. We observed they were involved in making decisions about their daily lives. The provider followed appropriate procedures when an assessment was required of people's capacity to consent in relation to a specific decision.

People told us they liked living at Garden House, and one of them said 'they're like family'. People were encouraged to develop daily living skills and someone who had been living at the home for a few months said 'I'm coming to be more independent'. They had access to health services, depending on their needs. Each person had an individualised programme of activities.

There were appropriate arrangements for the management of medicines and there were checking processes to make sure the administration of medicines was safe.

The people we spoke with said they liked the staff who worked at the home. One of them said 'I have nice chats with the staff'. Support workers had access to a range of training courses and were well supported by their managers.

The records we reviewed were well ordered and up to date, and were stored appropriately.