Archived: Moseley Gardens

Updated 25 May 2018

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 unannounced inspection took place on 29 and 30 November 2017. The inspection was conducted by two inspectors. We carried out this inspection because we had received some information of concern regarding a number of safeguarding incidents that had occurred within the home.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give us some key information about the service, what the service does well and any improvements they plan to make. We did not receive the PIR until after the inspection site visit and therefore could not use this to inform our inspection plans. We looked at the information that we hold about the service prior to visiting the home. This included statutory notifications from the provider that they are required to send to us by law about events that occur at the home, such as deaths, accidents/incidents and safeguarding alerts. We contacted the local authority and commissioning services to request their views about the service provided to people at the home, and also consulted Healthwatch. Healthwatch is the independent consumer champion created to listen and gather the public and patient’s experiences of using local health and social care services. This includes services like GPs, pharmacists, hospitals, dentists, care homes and community based care.

During our inspection, we spoke or spent time with five of the people who lived at the home. We also attempted contact with four people’s relatives and managed to speak with one. We spoke with five members of staff including the manager, a shift leader, two care assistants and an agency worker. Some of the people living at the home had complex care needs and were unable to tell us about their experiences of living at the home. Therefore, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of people who could not talk with us. We also made general observations around the home and reviewed the care records of three people to see how their care was planned. We also looked at the medicine administration processes within the home. Furthermore, we reviewed training records for staff and at two staff files to check the provider’s recruitment and supervision processes. We also looked at records which supported the provider to monitor the quality and management of the service, including health and safety audits, accidents and incident records and compliments and complaints.

Updated 25 May 2018

This inspection took place on 28 March 2018 and 12 April 2018. This was an unannounced inspection.

Moseley Gardens provides accommodation and personal care for up to eight people who require specialist support relating to their learning disabilities and/or mental health needs. At the time of our inspection, there were five people living at the home. At the last inspection in November 2017 the service was rated as Inadequate in four out of the five areas we looked at. At that time, we found that sufficient improvements had not been made since our previous inspection in January 2017 and a further deterioration was noted. The provider was found to be in breach of the conditions of their registration because they had failed to ensure a registered manager was in post. They were also in breach of regulations 11, 12, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to consent, safe care and treatment and good governance, respectively. We imposed urgent conditions upon the provider’s registration at this location requiring them to take immediate action to safeguard people against the poor quality and potentially unsafe care that they were receiving at this service. We also proposed to cancel the provider’s registration at this location if sufficient improvements were not made. We received representations from the provider against this action alongside an action plan assuring us that improvements had been made since our inspection in November 2017. We carried out this inspection on 28 March 2018 to check whether improvements had been made and to inform our decisions about whether or not to continue with our proposal to cancel the provider’s registration at this location.

We found sufficient improvements had not been made a further deterioration was noted; this was namely due to the provider’s failing to learn lessons in order to promote and maintain the safety and comfort of people living at the home. We found sufficient evidence to demonstrate a continued breach of regulations 12 and 17 of the Health and Social Care Act Regulated Activities) Regulations 2014 concerning the safety and governance of the service. We also found breaches of regulations 10, 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to dignity and respect, safeguarding and staffing. You can see what action we have taken at the bottom of this report.

The provider was required to deploy a Registered Manager to manage the service as part of the conditions of their registration. 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 had not been a registered manager in post since August 2017. The provider had appointed a new manager who had been managing the day to day running of the service since October 2017 but they withdrew their application to register with us and left the service in January 2018. A further manager had since been deployed to the service and had been in post since February 2018. They had initiated their application to register with us but this had not yet been completed. This meant that the service remained without a registered manager and the provider continued to be in breach of the conditions of their registration. We are in the process of deciding what action we shall take regarding this offence.

The service was not always safe because staff did not know people well enough to recognise or did not always recognise the potential or actual signs of abuse. The provider had not always followed robust recruitment practices to ensure only staff with the sufficient level of skills and experience had been deployed to support people within the home. The provider had also failed to ensure that fire safety practices and the home environment had been maintained to promote peoples safety, privacy, dignity and comfort. The provider had not consistently implemented effective quality monitoring systems and processes which meant they had failed to proactively and independently identify the shortfalls we found during the inspection.

The provider had undertaken a full staff reform, which meant that only three members of staff were still employed by the provider, two of these were night staff. The remaining staff were deployed from an agency. The provider had recently initiated a new staff development programme, but this was still in its infancy and the provider was unable to assure us that staff deployed had the knowledge, skills, training and experience to support people safely and effectively. People were not always cared for in the least restrictive ways possible and the provider had not always treated people with dignity or respect because their privacy was not always maintained and the home environment continued to require improvement.

People were supported to maintain good health because the provider worked collaboratively with other agencies. However, due to the inconsistent staffing team, recommendations made to support people’s care and support needs were not always implemented.

The provider had increased the staffing levels within the home which meant people were supported to engage in more activities of interest both in and outside of the home. Staff were seen to engage and interact well with people and people appeared comfortable in the presence of staff. People were encouraged to develop and maintain their independence as far as reasonably possible and were supported to sustain relationships with people that were important to them. Visitors were welcome at any time.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains 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 has been made within this timeframe and we continue to find 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 of our return visit if they do not improve. After which, this service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will then be conducted within a further six months, and if there is still not enough improvement and an on-going rating of inadequate is awarded for any key question or overall, we will take further 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.