Background to this inspection
Updated
29 March 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.
The Local Authority made us aware of an incident that occurred at the service just after Christmas. Although individuals did not suffer any harm, we decided to bring our comprehensive inspection forward to ensure the wellbeing of people using the service.
The inspection took place on 7 February 2018. The inspection was unannounced in line with our methodology.
Two inspectors carried out this inspection after some additional concerns were received. Before the inspection we had very little information or feedback about the service. We have not received any notifications. We did not have a provider information return, which is information from the provider about what the service does well, and improvements they plan to make. Previous inspection reports were viewed and showed the service has always been rated as compliant with the regulations and rated Good overall at our last comprehensive inspection. However, we had not been aware of previous incidents and safeguarding concerns identified as part of this inspection.
Before the inspection, we spoke with members of staff from the Local Authority safeguarding team and Quality improvement team. During the inspection, we spoke with the three people using the service and the Registered provider/manager. We looked at people’s medication records, care plans and the diary.
Updated
29 March 2018
The inspection took place 7 February 2018 and was unannounced. The last inspection to this service was on 4 May 2016 and we rated the service as good in each key question. However, since October 2017 we have reviewed and refined our assessment framework. Under this new framework, a number of the key questions have been extended to include different key lines of enquiry.
43 Freeman Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides residential accommodation for three adults with a learning disability. They live with Miss Bridget Jane Marshall who is the registered provider/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.
The service represented an extended family and people at times referred to the registered provider/manager as ‘Mum’. People took comfort and support in being part of an extended family and had lived as a ‘family group’ for many years. In terms of the scope of registration, the service had been registered as a residential home and was therefore expected to meet regulations laid out by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found seven breaches because there was an absence of systems, and audits, which underpinned the health, safety, and well -being of people that used the service. The registered provider/manager supported people with their day-to-day activities and recorded people’s needs in a set care plan and daily diary, which were reviewed at least annually. However, we were unable to see how the manager worked collaboratively with others and sought their views about the care they provided. Feedback from people and their families was sought as part of on-going communication but not always recorded.
The registered provider/manager had not informed us and did not show us records relating to a number of incidents, which had occurred at the service. They are required to notify us of specific events affecting the wellbeing and safety of people using the service. This helps us make a judgement about the service and helps inform our inspection schedule. We might bring forward inspections based on information received. It helps the provider to demonstrate they have taken effective action when people have been injured or involved in incidents that have caused them harm. We look to see if the provider had systems in place to identify and mitigate known risks and how they keep people using the service, staff and visitors informed about how they are learning and limiting reoccurrence. This also involves a ’duty of candour’ when investigating such matters. Without this information, we could not be assured that actions taken to keep people safe from risk, and or harm were sufficiently robust. Information was not shared on a need to know basis with family members and people's wider circles of support.
The key question about staffing was not applicable at this inspection as the registered provider/manager was the sole staff member. However, the provider’s partner was also in the household and we asked the registered provider/manager for a copy of their disclosure, and barring check. Following the inspection the provider sent us evidence that a DBS had been applied for both themselves and their partner.
The service was sufficiently clean and people were having their needs met in relation to a safe environment.
People were prescribed medication and the registered provider/manager administered these along with their partner who assisted at times. The provider/manager told us they were trained to undertake this but their partner had received no training. Although there were records of the medication people took and when it was administered there were no audits or stock checks in place so we could not see if errors had occurred.
The Registered provider/manager did not provide us with any evidence of training but were knowledgeable about people’s needs. However without regular training and the opportunity to meet others and share ideas and gain mutual support we did not know how the registered provider/manager was keeping up to date with legislation and best practice.
People were supported to eat and drink enough for their needs and there was some monitoring of people’s weights. The registered provider/manager took people to see their GP if there were any concerns about their health. However, other professionals told us appointments had been cancelled and routine appointments with other health care professionals were not always kept.
The manager understood legislation relating to mental capacity and told us people were involved in decisions about their care and welfare. Mental capacity assessments were being completed by the Local Authority to help support people in light of the proposed house move to another part of Britain. The registered provider/manager said mental capacity assessments had been completed in the past but there was no evidence of this.
The service ran like an extended family and people had established relationships with each other and with the Registered provider/manager. People were supported to keep in contact with their own families and involved in day-to-day decisions. We could not ascertain if people’s independence was fully facilitated or that people were encouraged to live lives as others do and take responsibilities within their capabilities.
Care plans and daily notes gave us an insight into people’s needs and how these were being met. These were kept under review. The care plans did not record what people’s aspirations and goals were and steps towards achieving these. The terminology used was sometimes restrictive.
Feedback about the service was limited. People felt able to raise concerns to the registered provider/manager and had contact details for the Local Authority. We were not confident that all information that should be shared with us had been which reduced our confidence in the provider.
The service was difficult to assess against regulation because there was a lack of paperwork providing a good audit trail. However, people appeared to be very happy in the service and the registered provider/manager was confident they were meeting their needs.
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 than12 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.