Background to this inspection
Updated
3 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 inspectors, a member of the CQC medicines team, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
HF Trust - St Teath Site is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. HF Trust - St Teath Site is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been in post for 6 weeks, they told us they intended to submit an application to register.
Notice of inspection
The inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We met with all the people who lived at St Teath. We spoke with 12 agency staff, 1 member of relief staff, 2 permanent staff and the manager, deputy manager, the residential operations manager and HF Trusts’ Head of Care and Support - West. We reviewed 4 people’s care plans, medicine records for 4 people, people’s daily notes, rotas, training records and a range of records relating to the management of the service such as policies and procedures. We spoke with 6 relatives and received feedback from 4 health and social care professionals with experience of the service.
Updated
3 June 2023
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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
About the service
HF Trust – St Teath Site is a residential care home for up to 10 people with a learning disability and/or autistic people. The site consists of two separate houses, Rendle House and Valley View. Each can accommodate up to 5 people. At the time of the inspection 9 people were living at the service.
People’s experience of using this service and what we found
Right Support
Staff had identified goals for people and these had been included in care plans. However, there had been little progress in moving towards achieving these goals. Information on how to support people with appropriate skills was not available.
Daily logs were not consistently used to record what had worked well for people and what had not gone as well. There was limited information about people’s quality of life outcomes. This meant opportunities to learn from people’s experiences might be missed.
People’s individual interests were known and, when possible, staff supported them to do the things they enjoyed. However, opportunities were sometimes impacted by staffing arrangements.
People had a choice about their living environment and were able to personalise their rooms. Improvements were being made to the environment at Valley View and more were planned.
Staff enabled people to access specialist health care support in the community.
Staff supported people with their medicines in a way that promoted their independence. However, there had been a series of medicine errors.
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. The provider was investing in technology to enable restrictions in place to be reduced.
Right Care
Staff did not consistently respect people’s privacy and dignity.
There were not enough contracted staff to meet people’s needs and keep them safe. To mitigate this the provider had invested in regular use of agency staff. Although some agency staff were ‘block booked’ and worked at the service regularly, others were at St Teath less frequently. This did not ensure people received consistent care from staff who knew them well and who had built trusting relationships with them.
People’s communication preferences were known by staff. However, tools to support communication were not always in place.
People’s care, treatment and support plans had been updated to better reflect their range of needs.
The service worked with other agencies to protect people from potential abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
Right Culture
There was a new manager at the service. They were receiving daily support from the local residential operations manager and further support from HF Trusts divisional Head of Care and Support - West.
Additional support from external agencies and professionals had been sought to try and drive improvements in the service.
Training in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have was being rolled out to contracted staff and regular agency staff.
The high dependence on agency staff had impacted on many aspects of the service. Challenges for the service meant managers had to prioritise where they focused their efforts, often having to spend their time on rota management. This impacted on their opportunities to monitor the service.
Feedback from professionals and relatives was that, although improvements had been made there were still areas where work needed to be done.
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 22 February 2023).
At our previous inspection we identified breaches in relation to person centred care, implementation of the Mental Capacity Act, safe care and treatment including in relation to the administration of medicines, risk management and safety checks at the service, oversight and management of the service, staffing levels, a failure to follow Duty of Candour policy and a failure to notify CQC of events as required by law.
We issued 2 warning notices in relation to the breaches of person centred care and management of the service. At this inspection we found the warning notices had been partly met although we still had concerns. We met with the provider who agreed to provide monthly action plans and reports to demonstrate how they were working to address the concerns.
We also made a recommendation about the environment. At this inspection we found improvements to the environment had been made and more were planned.
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We have identified breaches in relation to safe care and treatment, person-centred care, staffing and management of the service.
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 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.