Archived: Annette's Care Limited

Annette’s Care is a residential care home that was providing accommodation and is registered to provide personal care for up to 4 people with a primary need of Learning Disability. However, at the time of the inspection the care home was also supporting people whose primary need were mental health issues. Some people also had additional learning difficulties and physical disabilities. The care home is located on one site with four individual bedrooms. On the day of the inspection there were three people living at the service and one person on respite.

People’s experience of using this service:

• People who had lived in the service for many years mainly said they were happy.

• Risks in relation to people’s care and lifestyle were not assessed, understood and managed in a way that kept them safe. Some practices in relation to risk did not protect people’s human rights.

• People did not live in an environment that was well-maintained or promoted their dignity.

• People’s rights in relation to their capacity had not been fully understood and respected. Correct processes had not been followed when people lacked capacity to make decisions about their care.

• Risks and needs in relation to people’s physical and mental health had not been consistently understood and supported.

• The culture of the service did not respect and promote people’s rights, dignity and independence.

• The organisation of the service was poor. Leadership and auditing of the service had not been robust and had failed to identify the concerns we found in relation to practice, the environment and the culture of the service. This meant that people had continued to receive a service that was not safe, effective, caring or responsive to their needs.

• The service is now judged to be inadequate in keeping people safe, providing effective care, being caring, responsive and being well-led.

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

Rating at last inspection: The rating at the last inspection was Good (the last report was published July 2017)

Why we inspected: We inspected in line with our inspection methodology. The inspection was prompted due to concerns received from professionals.

Enforcement

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

Following the inspection we spoke to Plymouth City Council about our initial findings and practices we had concerns about. We also contacted Devon and Somerset Fire Service to share our concerns related to fire safety.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

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. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

The inspection took place on 4 July 2017 and was unannounced. Annette’s Care Limited provides care and accommodation for up to four people with learning disabilities.

The service had a registered 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 registered manager is also the joint provider of the service.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapist. One person said; “I like it here!” And went onto say; “I have a waking night staff which makes me feel safe at night.”

The Provider Information Return (PIR) records; “ We work alongside of health care professionals with our residents to strive for better quality of care, and accept their professional view on recommendations that may benefit our clients care here with us, we then implement these recommendations and document them in the care plan provided for staff to follow.”

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were involved with their care plans with staff support to complete and review and update their care plans accordingly. People’s preferences were sought and respected.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input as much as they were able to in preparing some meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed and updated safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

People who required it had two to one or one to one staffing at certain times. Staff confirmed there were sufficient staff to meet these requirements. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff completed and Induction programme when they started work. People were protected by safe recruitment procedures.

All significant events and incidences were document and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, relatives, professionals and staff.