This inspection was unannounced and took place on 4 and 5 April 2017. The last comprehensive inspection of the service was on 24 and 25 September 2015 and there were no breaches of regulations at that time. Edward House is a residential care home and provides accommodation and personal care for up to 12 people with learning and physical disabilities. At the time of our inspection there were 12 people living at the home. There was no registered manager in post. The registered manager had not been working in the home since January 2017 when an internal quality audit by the provider had identified some concerns. The registered manager had de-registered with CQC on 11 March 2017. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ from another service who had been working at Edward House for two months.
The service was the subject of on-going monitoring by the local authority. This was because when they visited in 2016, they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was still in progress during our inspection.
We received information prior to this inspection from a health and social care professional telling us that people were at risk. This was because staff were not adequately trained and people were being placed at risk due to high numbers of agency staff being employed. The local authority had completed a visit to the service on 22 March 2017 and found concerns relating to people’s safety. Our inspection highlighted shortfalls where some regulations were not met. We also identified further areas where improvement was required.
People did not receive a service that was safe. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people.
Sufficient numbers of staff were available to keep people safe; however a high number of agency staff were being employed. This reduced staff consistency and this in turn negatively impacted on people’s care. Some people were not being supported to reach their full potential.
The service did not provide effective care and support. Staff had not received suitable training enabling them to effectively support the people living at Edward House such as people living with autism or with behaviours that may challenge. Many of the staff team had not attended mandatory training courses such as adult safeguarding, face to face first aid, MCA and DoLS and infection control.
There were some positive comments from relatives and health professionals about the care provided and the staff members who cared for their loved one.
The service was not responsive to people’s needs. Support plans and risk assessments were out of date and lacked detail required to provide consistent, high quality care and support. People did not always have sufficient activities to support them to socialise and lead a fulfilling life. Complaints were not documented or dealt with appropriately.
The provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around recording of information and assessing risks.
Staff we spoke with said they felt anxious about the service provided and that the morale was low. We observed staff trying to support people in a caring and patient way during the inspection; however staff did not appear to know the people they were caring for well. Staff were not respecting people’s choices on two occasions.
The service was not well led. The registered manager had left the service along with many staff members. The registered manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around recording of information, identifying staff training needs, ensuring staff were treating people with dignity and respect and assessing risks.
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.
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.