43 Station Road

Updated 19 July 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

43 Station Road 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. The service accommodates up to six people in an adapted residential home.

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The manager of the service submitted an application to register the day before our inspection.

Notice of inspection

The inspection was unannounced on 8 May 2019. We informed the registered manager we would return on 10 May 2019. We reviewed further information sent to us from the service on the 24 May 2019.

What we did

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

The provider was not asked to complete a provider information return (PIR) prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

People were unable to tell us about their experiences of living at 43 Station Road because of communication difficulties. We observed staff interactions with people throughout our visit to help us understand the experience of people. We spoke with the manager, one team leader, three care workers, the operations manager, the service improvement manager and the quality and compliance manager. We received email feedback from the safeguarding local authority, quality monitoring team and a local authority commissioner. We spoke with two relatives, a social worker and an advocate.

We reviewed parts of four people's care records including care plans, risk assessments and medicines administration records and other records about the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, quality assurance records and updated care plans and risk assessments.

Updated 19 July 2019

About the service

43 Station Road is a care home which accommodates up to six adults with a learning disability or autism. At the time of our inspection four people used the service. The service was a domestic home. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service

People were not always protected from the risk of harm. Actions taken by the provider in response to behaviours that challenged were not always robust or effective to protect people from reoccurrences of these incidents. We have made recommendations about safeguarding training. Staff did not always follow safe medicine practices and people did not always receive their medicines as prescribed. Safe and robust recruitment procedures were used when people were employed. There were systems in place for the prevention of infection.

Systems were either not always in place or failed to identify areas requiring improvement and to mitigate the risks relating to the safety of people using the service. Contemporaneous records were not always held for people or for the management of the service. Leadership of the service had been inconsistent and staff reported low morale and a lack of support with managing behaviours that challenged the service. We have made a recommendation about the service business contingency plan. Staff were committed to people using the service and were beginning to feel more supported by the new leadership team. The service worked in partnership with health and social care professionals to meet people’s needs. The service was taking action to complete comprehensive quality assurance audits to drive improvement.

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support because they did not always receive the support they needed for behaviours that challenge. For example, effective approaches to supporting people at times of crisis were not considered where this need was indicated.

Rating at last inspection

At the last inspection the service was rated Good (30 December 2018).

Why we inspected

We received concerns in relation to the management of medicines and people’s behavioural care and support needs. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

Enforcement

Please see the action we have told the provider to take at the end of this report.

Follow up

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.