Archived: Flint Cottage

Updated 17 January 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

Service and service type

Flint Cottage 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. Flint Cottage 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. The provider told us a manager had been appointed and was undergoing recruitment checks. The previous registered manager continued to be employed within the organisation and was available to support the team during this transition.

Notice of inspection

This 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 and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed people’s care and spoke with 3 relatives about their experience of the care and support provided at Flint Cottage. We spoke with 7 members of staff including the previous registered manager, regional manager and positive behaviour support practitioner.

We reviewed a range of records. This included 3 people’s care records and 2 people’s medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 17 January 2023

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.

About the service

Flint Cottage is a residential care home providing personal to 4 people at the time of the inspection. The service can support up to 4 people.

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

Right Support:

Assessments of people’s needs did not always consider known risks and guidance for staff was limited. Support plans and risk assessments were not always detailed although for some people who had lived at Flint Cottage for many years more extensive information was available. Safeguarding concerns were not consistently reported to the local authority or to CQC. At times these concerns had significantly impacted on people’s lives and well-being. The provider had begun an investigation into the reasons these concerns had not been shared as required.

People were not always 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. Capacity assessments and best interest decisions had not always been completed in relation to restrictions in place. This meant there was a risk people’s legal rights were not being met.

People were supported to access healthcare when required and staff were vigilant at identifying health concerns. People’s medicines were reviewed regularly and reduced where possible. Records of medicines administration were being reviewed as the way medicines were signed for was not in line with best practice.

People had choices regarding their food and staff were aware of people’s preferences and dietary needs. People were able to choose where they spent their time when at home and staff were respectful of their decisions. Adaptations had been made such as placing a gazebo in the garden and fitting a swing to support people’s sensory needs.

Right Care:

Different opportunities for people were not fully explored to take account of people’s interests. Care plans did not contain goals and plans to develop people’s day to day lives. However, people did have the opportunity to take part in activities they had enjoyed for many years such as horse and cart riding and bowling.

There were sufficient staff available to support people. Staff received training in relation to people’s needs. Staff had requested training in supporting people with specific mental health support needs and the provider was in the process of arranging this.

People were supported with kindness and staff showed genuine affection in their approach. Day to day choices were offered to people and staff demonstrated a good understanding of people’s communication styles. People were encouraged to take an active role in their home with tasks such as making drinks and doing laundry.

Right Culture:

Effective quality assurance systems were not in place to monitor the service people received and to ensure continuous learning and development. This meant shortfalls in the service people received were not always identified and acted upon. Records were not always consistently maintained which had led to concerns not being reviewed promptly. The provider had employed a quality assurance manager to monitor systems and audit processes going forward.

Staff told us they worked well together as a team and felt supported in their roles. The provider held a number of different staff forums to enable staff to raise concerns and share good practice. Staff received an induction when starting their employment and on-going supervision.

Staff knew people well and had formed positive relationships with people and their loved ones. Relative’s told us they were kept informed of any significant events. Staff accompanied people to see their relatives where this was their wish.

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 outstanding (published 17 September 2019).

Why we inspected

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.

The inspection was prompted in part due to concerns received about risks to people’s safety and how people’s mental health support needs were being met. A decision was made for us to inspect and examine those risks. During our inspection we found improvements were needed in the way risks to people’s safety and well-being were managed, how assessments were completed and how people’s goals and opportunities were explored. In addition, we found improvement were required in the management oversight of the service to ensure concerns were identified and acted upon promptly.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

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 risk management, person-centred care, need for consent and good governance. Please see the action we have told the provider to take at the end of this report.

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.