Archived: Nutbush Cottage

Nutbush Cottage provides accommodation and personal care for up to 4 people who have a learning disability and/or autistic people. At the time of our inspection, there were 4 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.

Right Support: People were not supported to develop ways to reduce their anxiety and distress in situations they found difficult. Robust safeguarding processes were not followed which meant people were not fully protected from the risk of potential abuse. Risks to people’s safety and well-being were not always recognised or acted upon.

People had limited opportunities to do things they enjoyed or develop interests and did not benefit from an interactive, stimulating environment. People spent long periods of time in their rooms, walking around the house, watching films or listening to music. Staff had not explored people’s communication needs or developed plans to support people in being more involved in their own care and support.

Improvements had been made in the way medicines were managed and safe systems were now in place. People were generally supported by sufficient staff who were recruited safely. The building of an office in the grounds of the home had led to a decrease in one person’s anxiety. People lived in a clean and comfortable environment.

Right Care: People were not always treated with dignity and their privacy was not always protected although some individual interactions with staff were kind. Staff did not demonstrate an understanding that Nutbush Cottage was people’s home and did not always treat people as equals. People were not involved in the running of their home in a meaningful way and choices in respect of meals and how to spend their time were limited. People were not always supported to develop skills and independence.

Although improvements had been made to the monitoring of healthcare appointments, advice provided from healthcare professionals was not always followed and staff were not fully aware of people’s healthcare needs.

Right Culture: The ethos, values, attitudes and behaviours of leaders did not support people to lead confident, inclusive and empowered lives. The provider had failed to develop a skilled staff team who understood how to support people in a person-centred way. The principles of the Right Support, Right Care, Right culture guidance was not embedded into the culture of the service and audit systems were not in place to monitor this.

A task based approach had developed which did not focus on supporting people to live fulfilled lives. This has not been identified by the manager, as there was a lack of provider oversight and support for the manager.

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 (6 July 2023) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence 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.

The overall rating for the service has remained inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to people not being protected from abuse; people not always receiving safe care and treatment and staff not having the appropriate training to meet people’s needs effectively. We also identified breaches in relation to the staff not always being caring and respectful, people not being supported to do things they enjoyed, people not receiving personalised care and a lack of robust management and provider oversight.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Nutbush Cottage provides accommodation and personal care for up to 4 people who have a learning disability and/or autistic people. At the time of our inspection, there were 4 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.

Right Support: People were not always given the opportunity to go out and do things they enjoyed. People’s wishes and needs were not put at the centre of the service and their aspirations were not identified and supported. 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. People were not always protected from the use of unlawful restraint and the lack of robust auditing meant that people were not always protected from the risk of financial abuse.

People’s anxiety and distress was not responded to in a consistent way and additional support from professionals was not always sought in a timely way. People’s communication needs were not known to staff, and professional guidance was not followed. This meant people had limited choices and opportunities to express their views.

Medicines were not managed safely which meant people were at risk of not receiving their medicines in line with their prescriptions. The hours staff worked were not effectively monitored which resulted in people being supported by staff who had worked day and night shifts without sleep or breaks away from the service.

Right Care: People’s dignity and privacy were not always respected. Staff stood over people and did not always communicate in a caring way. There was no lock on the main bathroom door and one person had been without curtains or window coverings in their bedroom for several months.

People’s health needs were not always monitored and there were delays in health referrals being made for some people. People were not supported to develop their independence. With the exception of one person, people were not encouraged to be fully involved with maintaining their home, preparing food or doing their own personal shopping.

Right Culture: The culture at Nutbush Cottage did not support people living fulfilled and empowered lives. Staff were unable to demonstrate their understanding of ‘Right support, right care, right culture’ guidance and how this should influence the support people received. The views of people and staff were not sought to ensure they could contribute to the running of the service.

There was a lack of management oversight which had led to concerns not being identified and acted upon. Audits and reviews were not effective in identifying shortfalls in the care and support people received. People’s quality of life was not central to audits and action plans. The provider had not ensured additional support was in place given the previous manager was new to their role and was not registered with the Care Quality Commission. Systems in place did not drive high standards and ensure continuous development.

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

Rating at last inspection

The last rating for this service was good (published 21 November 2019)

Why we inspected

The inspection was prompted due to concerns received about people not being protected from the risk of abuse, concerns around safe staff levels and lack of robust management oversight. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to people being at risk of abuse, safe care and treatment and staff deployment and skills. We have also found people’s care was not person-centred, people were not always treated in a caring way, people were not supported to do things they enjoyed and there was a lack of management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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 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.

Nutbush Cottage provides care and accommodation for up to four people with learning disabilities, autistic spectrum disorder and behaviour which may challenge others. People had a range of communication needs and abilities, which included body language and gesture. At the time of our inspection there were four people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

We spent time with people during our visits and observed their interaction with staff. People’s relatives said that the service was of a high standard. Feedback from a relative included, ‘I do hope that Nutbush Cottage receives the recognition they deserve.’ Staff demonstrated a depth of compassion and empathy and genuinely cared for people they supported. Staff told us, ‘At Nutbush Cottage we pride ourselves in maintaining a high standard of care.’ Without exception all the feedback received was positive.

The culture at the service was warm and relaxed, we saw a caring relationship between people and staff. Staff were highly skilled and had extensive training. They had the skills, knowledge and confidence to effectively support people with a high level of needs.

People were enabled to exercise choice and control over their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were safe There were systems and processes to maintain their safety. There was a stable staff team with a high level of staff retention.

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service was well led. The manager's values and vision were embedded into the service, staff and culture. The provider and registered manager were passionate and committed to developing a service where people received genuinely person-centred care. This was evident throughout our visit. A relative told us that they, “Recommend Nutbush Cottage as a great place for vulnerable clients.”

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

Rating at last inspection:

At our last inspection in September 2016 we rated the service good. The last inspection report was published 14 November 2016. At the inspection we found areas that required improvement. The provider had not maintained appropriate procedures in relation to people’s personal finances. A condition was imposed on the provider’s registration to protect people's finances and personal possessions. .

Why we inspected:

We completed a planned inspection based on the previous rating of Good.

Follow up:

We will review the service in line with our methodology for 'Good' services.

This inspection took place on 13 September 2016 and was unannounced.

The home was run by 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 and associated Regulations about how the service is run. The registered manager was on annual leave on the day of our inspection.

The provider did not have a robust process that had ensured people finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy.

People said that they felt safe and they appeared happy and at ease in the presence of staff. One person said; “The staff help me. I feel safe.” We saw staff had written information about risks to people and how to manage these in order to keep people safe.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People who may harm themselves or displayed behaviour that challenged others were supported by staff who knew how to calm situations.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals

People said that they consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People said that they were involved in making decisions about their care as much as they wanted to be.

People were cared for by staff that had the specialist training they needed in order to meet people’s needs.

People were supported to have a meal of their choice. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People received care and support from staff who had got to know them well. The relationships between staff and people receiving support demonstrated dignity and respect at all times. Staff knew, understand and respond to each person’s diverse cultural, gender and spiritual needs in a caring and compassionate way.

Staff were proactive and made sure that people were able to maintain relationships that matter to them. People took part in community activities on a daily basis; for example regular clubs. The choice of activities had been in place for a number of years. The deputy manager discussed ways of improving this. We have made a recommendation regarding people’s social activities.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. Staff knew how to respond to a complaint should one be received.

The provider had quality assurance systems in place, including regular audits on health and safety, medicines and support plans. The registered manager met CQC registration requirements by sending in notifications when appropriate. We have made a recommendation about this. We found both care and staff records were stored securely and confidentially.

The people who used the service were assessed fully and a detailed person centered care plan was developed for staff to follow when providing support.

We spoke to staff, who were aware of safeguarding procedures, and all had training or refreshers in this area. Staff were aware of other connected policies, such as their responsibility for reporting abuse and whistle blowing, and deprivation of liberty safeguards when it is in the best interest of the person who uses the service.

The staff told us that the manager held regular one-to-one supervisions. We were told that the supervisions were done in private and that they could talk over issues or areas of concern. One member of staff continued to tell us that during the supervisions seasons they were encouraged to discuss further training needs or any other area that the service could offer them.

We were told that the people who used the service have limited verbal communication but they can indicate that they are happy or not. The family members of the people who used the service told us they were asked for their views about the care and treatment provided to their family members at the service. One person "felt that the manager listened to their feedback and acted appropriately".