Background to this inspection
Updated
27 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 27 January and was unannounced. The inspection team consisted of an inspector and a specialist advisor for people who have learning disabilities and autistic spectrum disorder.
We looked at notifications we had received with regard to the service prior to the visit. We looked at three people’s care files and medicine administration records. We looked at nine staff recruitment files. We looked the systems and policies used by the service. People living at the service were not able to answer complex questions as such we observed care in communal areas across the home, mealtimes and some daily activities. Following the inspection we spoke with commissioners from three authorities.
Updated
27 April 2016
The unannounced inspection took place on the 27 January 2016.
We found nine breaches of legal requirements, which put people using the service at significant risk of receiving inappropriate or unsafe care. You can read the report of this inspection, by selecting the 'all reports' link for this service on our website at www.cqc.org.uk.
We took urgent enforcement action against the registered provider and imposed the condition that they must not admit service users, either new to the service or returning without the prior written agreement of the CQC for a period of three months.
The service opened in May 2015 and this was the first inspection since the service opened. The service was registered to provide accommodation for persons who require personal care. The service’s registration stated a maximum of five people who are younger adults and have learning disabilities or autistic spectrum disorder. The service is a three storey house with an enclosed garden situated on a residential road. At the time of inspection four people lived at the service although one person was not present on the day of inspection.
There was no 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.
We found some staff had not received safeguarding adults training. Staff were able to tell us how they would report a safeguarding concern. However the service had not reported safeguarding incidents to the appropriate authorities this failed to ensure people were protected from abuse.
We found on the day of inspection there was enough staff on duty to manage the needs of the people using the service. However we found omissions in the staffing recruitment process, this meant the provider could not be certain staff were properly vetted and safe to work with people.
Some people living at the service had complex behavioural support needs and required staff expertise to keep them safe from physical harm. However many staff had not received training to keep people safe. We found that four of the staff on duty had not received training in managing behaviour that challenged the service. This put people and the staff at high risk of injury and distress.
People had individual risk assessments. Some risk assessments did not contain sufficient detail and we found some historical risks were missing in the current risk assessment. This meant staff did not have guidelines should these risks arise and new staff or agency staff may not be aware of the range of risks surrounding an individual they are required to support.
Staff referred people for health professional support where needed. Medicines were stored appropriately and there were systems in place to ensure the safe administration of medicine.
People required support with physical and mental health conditions however we found most staff had not received appropriate training in essential areas such as autism to meet people’s support needs. Some people used Makaton, a language programme using signs and symbols, but staff had not received training to use this form of communication. In addition the service had not created visual aids to support people to know what was planned for the day and who would be working with them. Staff did not use visual prompts such as easy read posters or symbol labels or photo activity plans to keep people informed. This failed to support people to receive care and support that enabled their involvement and met their needs.
Staff spoke about people in a positive way and we witnessed some staff speaking to people in a gentle and affirming manner. One staff was able to converse in a person’s family language and the person responded well to this. However we also observed staff did not always promote people’s dignity. Staff used their mobiles and had conversations when supporting people, which meant people were always not the focus of their attention and was disrespectful.
People did not have enough activities to engage them in a meaningful manner. We observed that staff did not have activities planned and there was a lack of leisure equipment, games, sensory objects and items of interest for people. Staff did not work with people to explore ideas about what they might like to do other than basic activities such as going for a walk or watching TV.
The service did not provide guidance to tell people how to complain and complaints were not recorded and analysed.
Although some auditing had taken place it was inconsistent and had not addressed all the issues identified. Therefore the service had poor systems of accountability and this had left the service unsafe.
We found overall nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider. We will report further on this when it is completed.
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 further action taken if needed. 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.