Background to this inspection
Updated
22 April 2017
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 was an unannounced inspection which was completed on 28 February 2017. The inspection was conducted by one adult social care inspector. The last comprehensive inspection of this service was in March 2015. At the time we found one breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was followed up by a focussed inspection of the service in July 2015. At the time of the inspection, we found the service was meeting legal requirements.
We contacted five health and social care professionals to obtain their views on the service and how it was being managed. This included professionals from the local authority and the GP practice.
During the inspection we looked at three people’s records and those relating to the running of the home. This included staffing rotas, policies and procedures, quality checks that had been completed, supervision and training information for staff. We looked at a five staff files.
We spent time observing the people living at Gypsy Corner, spoke with three members of staff, the area manager, the acting manager and acting deputy manager of the service. We also spoke with relatives of two people living at Gypsy Corner. We visited the bedrooms with permission from the people living at the home. We observed staff providing care and support during the morning of the inspection.
Updated
22 April 2017
The inspection took place on 28 February 2017. This was an unannounced inspection. The last comprehensive inspection of this service was in March 2015. At the time we found one breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was followed up by a focussed inspection of the service in July 2015. At the time of the inspection, we found the service was meeting legal requirements.
Gypsy Corner is care home providing personal care for three people with autism, cerebral palsy and acquired brain injury. People who use the service may have additional needs and present behaviours which can be perceived as challenging. There were three people using the service at the time of the inspection.
There was no registered manager in post at Gypsy Corner. 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.’ When the Lifeways quality team had completed an internal audit in January 2017 a number of concerns had been identified and the registered manager had left the provider’s employment one month prior to the inspection. A manager from another Lifeways service was providing management support at Gypsy Corner. However, staff told us this was minimal and they would only have a manager on site for approximately an hour a day. Staff said they could telephone the acting manager if they required further support but felt this was not the same as having somebody present in the service. The area manager told us a new manager had been recruited and would be commencing their role the day after the inspection.
The Local Authority had completed a visit to the service and found concerns relating to people’s safety. A number of concerns had also been raised from an inspection of another Lifeways service which had been managed by the same registered manager. Our inspection highlighted shortfalls where a number of regulations were not met and improvements were required.
People did not always receive a service that was safe. Although staffing levels appeared to be safe, staff informed us there was an increased use of agency staff who did not always know the needs of people living at Gypsy Corner. Not all risk assessments were adequate or contained sufficient levels of information to enable staff to provide safe care and treatment. Medicines had not always been managed safely. There were a number of missed signatures on Medicine Administration Record (MAR) charts and two cases where medicine had been miscounted by the staff. The infection control practices in the home were not adequate. People were not always protected from hazardous substances as the laundry room had been left unlocked where several hazardous chemicals were kept. The environment was not always maintained to ensure the safety of the people living at Gypsy Corner was always maintained. Fire safety checks were not occurring regularly and people’s emergency evacuation plans (PEEPs) had not been reviewed. Staff demonstrated a good understanding of safeguarding and felt confident to report any concerns to management or external agencies. Recruitment practices at Gypsy Corner were safe and ensured suitable people were employed at the home.
People were not receiving effective care and support. Staff training had lapsed in core areas. People’s nutritional needs were not always clearly detailed in their care plans and where people needed their weight to be monitored; there were no clear guidelines around this. Health action plans had not been followed up to reflect staff had followed guidelines from health professionals. Staff supervision had not always occurred as per the provider’s policy. Where supervision had taken place, the notes from these were brief and it was difficult to understand the context of the discussion. Everyone at Gypsy Corner had an assessment of their mental capacity and Deprivation of Liberty Safeguards (DoLS) applications had been made to the relevant authority. People had been given the opportunity to personalise their living environment.
The service was not always caring. We could not be satisfied people were always treated with dignity and respect. There were no care plans referencing people’s behaviour. Despite this, behavioural charts were kept but there was no information as to details what the recordings in these charts stood for. People had end of life care plans which clearly reflected their wishes and preferences. Relatives spoke positively about the staff at the home.
The service was not always responsive. People’s care plans were not always person centred and did not provide sufficient detail to enable staff to provide safe care and treatment to people. People had sufficient activities to support them to lead an active and fulfilling life. Complaints had been dealt with in line with the provider’s policy.
The service was not well-led. There was no registered manager or team leaders at the time of the inspection. The majority of the staff we spoke with stated communication between management and the staff was poor and this had resulted in low staff morale across the majority of the staff group. Quality assurance checks and audits being were inconsistent and this had led to several shortfalls across the whole service. The confidentiality of people living at Gypsy Corner had not always been maintained. We found a number of files containing personal information being stored in an unsecured location.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
Following our inspection, the provider for this location submitted an application to cancel the registration to provide a regulated activity at Gypsy Corner. We will be following our processes to de-register the service.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.