The Pastures

Updated 6 July 2024

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 3 inspectors which included a member of the medicines team and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service .

Service and service type

The Pastures is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Pastures is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 18 October 2023 when we visited the service, and we visited the service again on 23 October 2023. We provided formal feedback on 07 November 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we held about the service. We used all this information to plan our inspection.

During the inspection

We reviewed records including 5 care plans. We reviewed medicine administration and associated records for 10 people and spoke with 2 members of staff about medicines, toured the environment and spoke with the registered manager, the registered nurse on duty, the activities coordinators, 2 deputy managers, 7 staff, the domestic staff and 8 relatives. Observations of people’s care and support was our main method of seeking feedback about people’s care and support. Following the inspection, we continued to request information to clarify evidence collated, including quality assurance records, staff training etc.

Updated 6 July 2024

About the service

The Pastures is a residential care home providing care for up to 13 people. There were 12 people living at the service at the time of the inspection. The service accommodates people with a learning disability and autistic people who also have sensory and medical and health care needs. Accommodation is over 3 bungalows which were personalised, and people had the equipment they needed. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People's experience of using this service and what we found.

Right Support:

Although staffing levels were maintained in line with people's assessed needs and agreed funding levels there was a high staff vacancy which impacted on people's care and support. Not all temporary staff had the same level of training as permanent staff and 30 staff had started in the last year. This meant a lot of staff were inexperienced and did not have a good insight into people's needs. The number of incidents is a good indicator that people experienced distress and had a lack of control over their environment and the staff that supported them.

The model of care did not always support people to make choices and have some control over their daily lives. Most people living at the service were supported by a core team of staff but not all. Staff allocation was completed on the day of the shift and considered the skill mix, training and whether staff were drivers. People could be supported by multiple staff across the day and changes to staffing was not well planned for. This led to frustration as people were not always supported in line with their communication and sensory needs.

We had concerns about the admission process and if this always considered the scope of the service and skill mix of staff. The support needs of people already living at the service were not considered when decisions were made about new people moving into the service.

Records showed a high level of incidents and medicine related incidents which were reducing month on month. However, any incidents could significantly increase the risk of avoidable harm. Oversight of staff practice and people's clinical care was the responsibility of the registered nurse, who was overseeing 3 bungalows and had high numbers of temporary staff to deploy across the shift and provide supervision for.

Staff did not always support people in the least restrictive way possible and in their best interests. Policies and systems were in place but variations in staff and a lack of clear guidance when supporting people new

to the service led to variations in care.

Right Care:

We found care was not always person-centred and did not always promote people's rights. During our inspection we identified some good interactions with people, but this was limited to some staff. Staff did not always speak with people on a regular basis to help reduce the risk of social isolation. We also noted some staff were not able to use sign language and were supporting people with sensory impairments and limited communication.

People's needs were clearly documented, kept under review and where changing needs were identified these were followed up with relevant professionals. There were close working relationships with family and the community. Safeguarding concerns were being identified and acted upon as appropriate.

Right Culture:

The provider was not ensuring that the culture of the service always enhanced peoples experiences and safety. Staff received training to enable them to meet people's care needs and training was updated as required. Staff spoken with stated the training provided was of the highest standard, but we found the care and support people received was variable depending on who was supporting them. A number of recent safeguarding concerns had been raised about poor staff conduct. The registered manager was addressing this. There was a lack of person-centred activities and care was not always planned in the right way to meet a person's needs and empower them. A range of audits were completed but did not sufficiently focus on peoples experiences and safety.

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

Rating at last inspection

The last rating for the service under this provider was good (published on 11 November 2022).

Why we inspected

We received concerns in relation to safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from good to inadequate. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Pastures. house on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people's safety, staffing, governance, and oversight of the service and person-centred care in line with Right support, right care, right culture. Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.