This announced inspection took place on 9 November 2015.
At the time of our inspection the service supported 2 adults with learning disabilities.
The service had 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 2008 and associated Regulations about how the service is run.
There was a registered manager in post; however, they had not ensured that there was an adequate infra-structure to ensure there were sufficient systems and procedures to adhere to the regulations.
The provider had not ensured there were effective processes in place to monitor, assess and evaluate the service. This had led to failings in areas such as safeguarding, recruitment and staff training. There were no systems in place to ensure that policies and procedures to guide staff were reviewed and updated.
People were not always protected from the risk of poor practice or potential abuse, staff had not received training in safeguarding in the last two years and there were no up to date guidelines or policy to provide instruction for staff to follow to contact relevant external agencies.
Recruitment systems were not effective, the provider did not have a clear record of staff employment records and none of the staff had undergone recent disclosure and barring checks that related to their employment at the service.
Although staff received informal training from staff that had in-depth knowledge of the people that used the service, staff had not received formal training in areas such as fire awareness, first aid, manual handling, food safety, infection control, and health and safety. People had health conditions which required specific knowledge and skills, but the staff had not received training in how to manage these conditions. Staff administered medicines in accordance with people’s prescriptions, but staff had not received training in medicines management.
People’s risk assessments had not been regularly reviewed and not all risk assessments in place were relevant as people’s needs had changed. Care plans did not always reflect the care that people received. People
The provider had not ensured that decisions about people’s care was provided following assessment of their mental capacity, best interest meetings or by making an application to the court of protection. Staff did not understand their role in acting in accordance with the Mental Capacity Act 2005 (MCA 2005).
The manager and staff knew the people well and had a good knowledge of people’s individual personal care needs that helped them to manage people’s complex behaviours. People had been with the service for many years, and relatives were happy with the environment and with the staff providing their care.
People’s routines were maintained which had a positive effect on their well-being. They had their own bedrooms and living spaces which reflected their own personalities. People were encouraged to take responsibilities and they were supported to maintain their relationships with their families. People received regular meals and were encouraged to maintain a healthy diet and staff involved them in choosing their menus and shopping.
There were enough staff allocated to provide care on all shifts, and staff were flexible in providing time to take people out. People received care from staff that had undergone a period of induction and staff received regular supervision with the manager and staff told us they felt supported.
Staff enabled people to attend their healthcare appointments by helping people to prepare for their appointments.
No complaints had been made by people who used the service or their relatives.
We identified that the provider was in breach of five of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.
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.