Prior to the inspection we had received a number of whistle-blowing concerns and concerns from other regulatory bodies and linked organisations, about the safety and welfare of the people who used the service. We took the decision to bring forward the date of the scheduled inspection. We considered the findings of our inspection to answer questions we always ask:
Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
This is a summary of what we found:
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Safeguarding procedures were in place and some staff understood how to safeguard the people they supported. Other staff told us that they had not had training or did not feel they had had enough training to enable them to confidently safeguard people. Staff also told us that they were unsure of what their responsibilities were in relation to safeguarding people who used the service.
The practices in the home did not protect the people who used the service or staff from the risk of harm. Some incidents had resulted in verbal and physical abuse between people who used the service. There had been a sexual assault on a member of staff by a person who used the service.
There was no system in place to make sure that the acting manager and staff learnt from events such as accidents and incidents, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes that had occurred.
Staff were not aware of risk management plans and we were unable to see examples of these, or how they were followed. People were put at unnecessary risk and were not always included in decisions about their support, leaving them unable to remain in control of their care and lives.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
We found that people's medicines were not always managed safely; we found shortfalls in the recording, administration and effective ordering of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Is the service effective?
There was little direction and support for staff and the support given to people who used the service was inconsistent and contradictory. The service was for people with complex needs around their learning disability and or their mental health and often people presented with behaviours that challenged the service. Yet systems had not been put in place for all persons to safely manage these behaviours or have a consistent approach.
Some people told us they were involved in the development of their plans of support and were consulted about their assessment of their health and care needs. Whilst others told us decisions were made without their involvement.
There were gaps in the staff training and development programmes as some staff had not received training to meet the specialist needs of the people who used the service.
Staff had not completed training in The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This legislation protects people's rights to be involved in making decisions about their lives and where they do not have the capacity to do so, then safeguards must be put in place and followed to ensure decisions are made that are in the person's best interests. We found that one person who used the service was subject to a DoLS authorisation; however the specific restrictions that were in place to help to protect them had not been properly implemented.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
Is the service caring?
During the inspection we found that staff were supportive and attentive to the people who used the service. We observed people were given choices about their care. We observed staff speaking to people in a friendly and professional way.
We saw a lack of evidence to show that all people's preferences, interests, aspirations and individual needs were recorded or that care and support was provided in accordance with their wishes and feelings.
Is the service responsive?
People had access to a range of health and social care professionals for support and treatment but changes in their health needs were not always followed up.
Staff we spoke with told us they did not have access to key information about people's care needs. They told us they were at times supporting people based on verbal information received from head office, other staff or previous knowledge of their needs. This meant people may not always receive effective care.
Sufficient numbers of care workers were not always provided to respond to people's health and welfare needs.
Safe recruitment practices in line with the provider's policies and procedures had not always been followed to ensure new staff were safe to work with people who used the service.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
Is the service well-led?
There was no clear leadership in the service. Staff were given conflicting guidance from the management team and this guidance was not always written down, which led to confusion and inconsistency with the care provided.
The acting manager had been appointed from within the organisation, but following a high turnover of senior staff, they told us their workload had increased considerably and they needed additional support in order to fulfil their role.
We found the service did not have an effective quality assurance system in place and some records relating to the management of the service and people's care and welfare had either not been completed or were not on the premises.
There was some documentary evidence to show the views and opinions of people who used the service and staff were sought as part of the quality assurance process. But there was little evidence that the provider was taking action to address the shortfalls identified. This lack of documentary evidence made it difficult to establish if the service was being managed in people's best interest.
Turnover of staff was high and staff absence due to sickness was also significant. Although this was monitored by the provider there was little evidence of any action taken to improve staff sickness rates and staff retention.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
What people who used the service and those that matter to them said about the care and support they received:
People told us they generally liked the staff but the staffing shortages happened quite a lot. One person told us they thought most staff treated them as individuals.
People told us they went out into the community on their own and with support. One person explained how they could not stay at the service on their own and whenever staff accompanied another person who used the service into the community, they were asked to leave their home. They described how on occasions they had waited up to an hour on the door step after a pre- arranged time, before they could re-enter the home. They told us they had not been given an explanation for this.
We have raised our concerns about the care of people at the service with the local authority safeguarding team and with commissioners. We are working with all relevant authorities to protect and improve people's care.