Archived: Quest Haven Limited - 31 High Street

Quest Haven – 31 High Street 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. Quest Haven – 31 High Street provides residential care for five people with learning disabilities. At the time of our inspection there were three people living at the service who had a range of needs such as mental health diagnoses and learning disabilities. During the inspection, the registered manager informed us that one person would be moving to another service. The person has now left the service at the time of publication of this report.

People’s experience of using this service:

At our previous inspection in April 2019 we identified breaches of regulations of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the service had not made improvements in all areas identified within our last inspection. This demonstrated the provider had not ensured all required improvements were actioned in a timely manner.

The service did not apply the full range of 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 did not fully reflect the principles and values of Registering the Right Support due to lack of choice and control and limited inclusion.

Relatives did not always feel their family members were safe, and risks to people were not being appropriately managed or recorded. Medicine administration and recording procedures were not safe, and staffing levels did not meet the requirements set out in people’s care plans.

People were not supported to have maximum choice and control of their lives and 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 this practice. Relatives and health professionals had not been involved in best interest decisions for people. Staff were not up to date with training, and supervisions were ineffective. The environment was dirty and unclean. People were not supported to maintain a healthy nutritious diet and advice from health professionals was not always followed which impacted on their health.

There was a lack of interaction between staff and people at the service, and people were not always involved in the decisions around their care. People were not treated with dignity and respect and were supported to build relationships with visitors to the service. There was an inconsistent approach to supporting people to take part in meaningful activities and holidays. Staff did not know people’s backgrounds, needs and medical history.

Despite the registered manager feeling they had made improvements, we identified continued issues that required addressing. There was a lack of management oversight as the registered manager was only at the service one day a week. Staff did not feel supported by the registered manager. Internal and external quality audits were not effective in their use as they did not identify the issues we found on the day, and any issues that had been identified had not been rectified. People, relatives and staff were not engaged with the running of the service.

The appropriate recruitment checks had been carried out for any new members of staff. Relatives had been asked to support with completing end of life care plans, but none had been finished on the day of our inspection.

Rating at last inspection: At our last inspection we rated this service inadequate (report published on 3 September 2019).

Why we inspected: We inspected this service in line with our inspection scheduling based on the service’s previous rating.

Enforcement:

We identified eight breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded. We have made a recommendation about the use of pictorial menus for people.

Follow up:

The overall rating for this service is ‘Inadequate’ and the service remains 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 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.

The care service has not 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’s experience of using this service:

At our previous inspection in January 2019 we identified breaches of regulations of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the service had not made improvements in all areas identified within our last inspection and people were still not receiving safe and effective care. This demonstrated the provider had not ensured all required improvements were actioned in a timely manner.

Relatives told us they felt their loved ones were safe at Quest Haven, but staff felt people were being put at risk due to there not being sufficient staffing levels to meet people’s needs. Although staff were aware of their responsibility to safeguard people from abuse, safeguarding concerns were not always reported to the local authority or investigated internally. Risks assessments were either not correct or guidance not followed by staff. The appropriate recruitment checks had been carried out for any new members of staff.

People’s rights were not protected in line with the principles of the Mental Capacity Act 2005. The majority of staff were not up to date with mandatory training but received supervision on a regular basis. The service was not decorated in a homely manner and was sparse. Staff felt that the communication within the service was effective. Referrals to healthcare professionals were not always made when required.

Feedback from relatives and staff were that the service was kind and caring. However, we observed a lack of interaction between staff and people at the service. There was a lack of recording to demonstrate that people were involved in the decisions around their care. People were not treated with dignity and respect which effected their wellbeing. People were encouraged to be independent where possible.

Staffing levels affected people being able to go to activities that were important to them, and there was a lack of stimulating indoor activities within the service. The service had not received any complaints from relatives, but concerns raised by people were not taken seriously or acted upon. People’s end of life wishes had not been discussed with people.

Staff felt supported by various levels of management within the service. Quality audits by the owner of the service were not robust and did not identify the issues we found on the day of the inspection. Records showed there was a lack of engagement from people and staff in the running of the service. Despite concerns raised in our previous inspection, there had been little improvements made by the registered manager and owner.

Rating at last inspection: At our last inspection we rated this service inadequate (report published on 16 February 2019).

Why we inspected: We brought forward this inspection due to ongoing concerns around safe care and treatment, record keeping and staffing.

Enforcement: We identified seven breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of The Health and Social Care Act 2008 (Registrations) Regulations 2009. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded. We have made a recommendation about the use of pictorial menus for people.

Follow up:

The overall rating for this service is ‘Inadequate’ and the service remains 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.

The care 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

The inspection took place on 4 January 2019 and was announced.

The service had 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.

Risks to people were not always being managed appropriately and staff did not follow the guidance in people’s risk assessments. There was no monitoring or analysis of accidents and incidents that had taken place to identify trends and reduce further risk. There was not a sufficient number of staff to meet people’s needs. Some staff did not receive adequate breaks between shifts. Recruitment practices were not robust. Safeguarding procedures were not always followed and appropriate referrals were not made to local authority. People’s concerns were not being investigated and therefore leaving people at risk of abuse.

There was not a sufficient number of staff to meet people’s needs. Some staff did not receive adequate breaks between shifts.

Safeguarding procedures were not always followed and appropriate referrals were not made to local authority. People’s concerns were not being investigated and therefore leaving people at risk of abuse.

People had access to a wide range of healthcare professionals, such as GPs, dentists and opticians. The recording of healthcare appointments was not always accurate.

Medicines were appropriately stored and managed. There were no gaps in Medicine Administration Records (MARS) and protocols were in place for ‘as and when’ medication. People were being cared for by staff who were aware of and carried out safe infection control processes.

Staff were not up to date with their mandatory training, and records of training did not reflect the information staff gave us around their training. We did not see evidence that staff were receiving supervision and appraisals. People’s rights were not protected. The service did not follow the Mental Capacity Act principles and correct legal authorisation had not been sought to deprive people of their liberty. The adaptation of the premises was suitable to meet people’s needs effectively. However, the environment could be made to feel homelier.

People’s rights were not protected. The service did not follow the Mental Capacity Act principles and correct legal authorisation had not been sought to deprive people of their liberty.

People had a choice of foods, and their weight was monitored regularly. However, people did not have free access to food and drink when they wished it. People and their relatives were involved in the review of their care. However, this was not recorded in people’s care files. People were not always treated with kindness, respect or dignity. However, relatives were very complimentary of staff.

Care plans were not person-centred and did not include any detail around people’s end of life wishes or health diagnosis. Because of this, staff were unaware of people’s medical conditions. Complaints were not responded to in line with the providers policy. However, relatives felt that they have received a satisfactory outcome.

The service did not have robust quality assurance systems in place. Internal audits that had taken place had not identified the issues that we had during our inspection. The service had not notified the Commission of all reportable incidents. This included incidents where people living at the service had had physical altercations.

Staff and relatives felt that the registered manager and deputy manager were approachable. Staff felt valued. There was partnership working with a local day centre. However, more could be done in relation to activities that took place inside the service and meaningful activities. Plans were in place to expand the service. However, issues we found during our inspection should be resolved first. We did not observe any pre-assessments as people at the service had been living there for many years.

During this inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

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.

Quest Haven 31 High Street is registered to provide accommodation with personal care for up to three people. At the time of our inspection there were three people living at the service all of whom had a Learning Disability. People required minimal support with staff encouragement and prompting as they were able to attend to most of their own personal care needs.

A registered manager was 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 told us that staff were kind and they felt safe living at the service. Staff had received training in relation to safeguarding. Staff were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training and supervisions that helped them to perform their duties. New staff received a full induction to the service which included training.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People were positive about the care provided and their consent was sought. People told us that staff treated them with respect and any help with personal care was done in private.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when they required.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a choice of meals and people were able to choose a meal that was different to the menu choices. People told us they liked the food and that they cooked meals with the help from staff.

Documentation that enabled staff to support people, and to record the care and treatment they had received, was up to date and regularly reviewed. People had signed their care plans and were involved in writing and reviewing their plans of care. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Relatives and friends were encouraged to visit and there were no restrictions to when people could visit.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms.

There were enough staff to ensure that people could undertake their activities and to meet the assessed needs of people. Staff encouraged people to be independent and to do things for themselves, such as cooking and cleaning.

People told us they were able to have talks with staff. People told us they were able to raise concerns and make complaints if they needed to.

Staff at the service worked in line with the provider’s values that ensured people received effective care. Staff were also aware of the whistle blowing procedures and would not hesitate to report bad practice.

Quality assurance processes were in place to monitor and improve the service.

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, and the 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 are treated with respect and dignity by the staff. People told us that they felt safe living at the service.

Systems were in place to make sure that people received their medicines safely, that the registered manager and staff learn from events such as accidents and incidents, complaints, concerns and investigations.

The registered manager sets the staff rotas to show they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people's needs are always met.

We noted that the environment was in need of attention to the d'cor and the carpets were badly stained. This did not ensure that people lived in an environment that is suitably designed and adequately maintained.

Is the service effective?

People's health and care needs were assessed and they and their relatives were involved in annual reviews of care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when they supported people. People told us, 'Staff always help me, they are here all the time.' People told us that the staff were very good.

The registered manager and staff told us that people who use the service, their relatives and associated professionals completed annual satisfaction surveys. One person who used the service told us they had completed a questionnaire.

People's preferences, interests, aspiration and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People said they could make choices about the activities they wanted to do. Records showed that people had access to all the healthcare professionals as and when required.

Is the service well-led?

The service has a system in place to monitor the quality of the service provided. We saw that the service maintained records of accidents and incidents. We saw that the registered manager had a book to record complaints received at the service. We saw that no complaints had been received.

People who live at the service told us that 'It's nice here. I like to go out every day to get my paper, and staff help me do this.' They also told us they were able to go out and do the things they like.

People told us that they felt respected by staff, and were able to take part in decisions about their care. People we spoke with told us that they had meetings to talk about how the house was managed.

We saw that people's individual needs had been assessed and 'care protocols' put into place. People told us they received the support they needed.

We saw that rooms were clean. People we spoke with were happy with the standard of cleanliness in the house. We saw that people were encouraged to help with keeping the house clean.

The provider had systems in place to manage the maintenance and safety of the premises.

We saw that the provider carried out checks on staff before they started working at the service. This was to ensure they were of good character and had the skills and experience to meet people's needs.

We saw that people had the opportunity to express their views about the service, and that action had been taken where needed.

People we spoke with told us that they were asked for their consent before treatment or medication was given. We saw evidence that family members had been involved for people who may not have understood complex decisions, such as dental treatment.

We saw that people's individual needs had been assessed and 'care protocols' put into place. These detailed the supported people needed in their daily lives. People told us they received the support they needed.

The people we spoke with told us they felt safe living here and staff supported them. We saw procedures were in place which gave guidance to staff on safeguarding vulnerable adults. Staff were able to describe what action they would take if they suspected abuse was taking place.

We looked at records of training and spoke with staff and saw the training was appropriate to meet the needs of the people living there.

We saw that people had the opportunity to express their views about the service, and that action had been taken where needed.

Where fire safety system faults had been identified by staff the provider had not assessed and managed the risks to health and safety of the people living or working at Quest Haven.