Archived: McLaren House

Updated 25 August 2020

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 Care Act 2014.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

McLaren House 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 nominated individual is responsible for supervising the management of the service on behalf of the provider. The nominated individual was also the registered provider and registered manager for this service. Registered persons are legally responsible for how the service is run and for the quality and safety of the care provided. We refer to the nominated individual and registered manager as the ‘registered provider’ or ‘provider’ within this report. The provider did not attend the inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We liaised with the local authority and professionals who work with the service. We checked for any feedback available through Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return 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.

During the inspection

We spoke with four people who lived at the home and observed the care and support people received. We spoke with six staff members including five senior support workers, one care assistant and a new starter who advised they were the deputy manager. We held discussions with local authorities and health professionals involved in people’s care throughout our inspection and enforcement processes.

We reviewed a range of records. This included records related to each person living at the home and three people’s medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

During and after our inspection, we continued to share information and the concerns we had identified with the provider and the local authorities and professionals involved in people’s care. We continued to seek updates and assurances from the provider. We made formal requests for some information related to the quality and safety of the service including a person’s care plan which was not available during the inspection. We also requested three staff recruitment files yet the provider was only able to provide evidence of recruitment checks for two of those staff members.

Updated 25 August 2020

About the service

McLaren House is a care home which is registered to provide personal care for up to 9 people with mental health needs. There were 7 people being supported at the time of our inspection.

People’s experience of using this service and what we found

Although people told us they felt safe, the systems in place failed to ensure people would always be protected and safe from risk of harm and abuse. Numerous incidents including abuse and/or allegations of abuse had been overlooked. These concerns were not escalated to relevant partner agencies as required, such as the local authority and notified to CQC. This amounted to two breaches of regulations due to the provider’s failure to protect people from harm and abuse, and to always notify the Commission as required of specific incidents and events including safeguarding matters. The provider and staff failed to respond appropriately to safeguarding concerns and people remained at ongoing risk of harm and abuse as a result.

We identified a third breach of the regulations due to the poor management of people’s risks, medicines, and further significant shortfalls in the safety of the service. Incidents including where people had come to harm, were not learned from to prevent reoccurrences and to safely manage risks. Our inspection found people’s risks were not adequately assessed and known to all staff, and poor management and oversight of the premises and medicines management presented further risks to people’s safety.

We identified a fourth breach of the regulations because staff were poorly deployed. Systems were not in place to establish how many staff were needed to safely meet people’s needs at all times and to ensure staffing levels were always safe. This included the provider’s absence from the service although they were on the rota to attend on the day of our inspection. Recruitment processes were not robust. We found infection control concerns and improvements were required to health and safety checks.

Although people spoke positively about their support, our review of records found people’s needs were not adequately assessed or detailed to inform effective support at all times. Information and/or learning about incidents were not shared with staff. Staff did not have sufficient training and guidance for their roles and the service was not fully adapted and maintained to promote people’s safety as far as possible.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support consistently good practice.

People were supported by staff to access further healthcare support when needed. Most people spoke positively about the home’s food and some people prepared their own meals. Staff told us they felt supported.

We saw positive interactions from staff and most people spoke positively about staff. However, the inadequate response to safeguarding matters and incidents at the service, by staff and the provider, failed to ensure people were always well treated and supported. People were not supported to always have their views heard and acted on; and to be involved in their care as far as possible. We saw and heard examples of how people’s privacy and independence was promoted.

Care planning processes failed to capture people’s individual needs and preferences and ensure these could be met as far as possible, including people’s communication needs. Most people spoke positively about the service and told us they would recommend it. People had access to doing things they enjoyed but told us there were not enough activities led by the home. Most people told us they would feel comfortable complaining if they needed to, although we saw other concerns and issues were not always adequately responded to.

We identified a fifth breach of the regulations because the provider did not have systems and processes in place to adequately support people and staff. We found widespread and significant shortfalls in the quality and safety of the service which exposed people to ongoing risk of harm and poor care, including around medicines management, learning from incidents, risk management, the safety of the premises and ensuring staff were sufficiently skilled and suitably deployed. Despite our urgent prompts, the provider failed to act on the serious concerns we brought to their attention.

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 this service was Good (published July 2017).

Why we inspected

The inspection was prompted in part due to concerns about the provider’s governance systems and oversight of the quality and safety of care provided, identified through our inspection activity at another service registered with the provider. We decided to inspect and examine those risks.

We identified serious concerns and breaches of the regulations at this inspection. We found evidence that people were at risk of harm as a result. Despite our urgent prompts and enforcement activity, the provider did not take enough action to mitigate those risks. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We identified five breaches of the regulations at this inspection. This was because the provider failed to protect people from abuse and ensure any allegations of abuse were immediately investigated. The provider failed to adequately assess and mitigate risks to people’s health and safety, including risks posed by their poor upkeep of the premises and poor management of medicines. We identified further safety shortfalls that the provider failed to ensure there were sufficient numbers of suitably skilled and competent persons deployed to safely meet people’s needs. The provider failed to operate effective systems and processes to assess, monitor and improve the quality and safety of the service. This included the further breach of the provider’s failure to notify CQC of all incidents that affect the health, safety and welfare of people using the service.

After our inspection, we took urgent enforcement action to require the provider to immediately address significant concerns that placed people at immediate risk of harm. We informed relevant partner agencies of our serious concerns. The provider failed to take enough action to ensure people’s safety which continued to place people at immediate risk of harm. We continued to liaise closely with the local authorities and other relevant partners. We carried out a responsive inspection of the third service registered with the provider based on the concerns we had identified.

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

During and after our inspection processes, we requested information from the provider about what action they were taking to address our serious concerns. We also worked alongside the relevant local authorities in light of the concerns we identified. We carried out urgent enforcement action in relation to this service. During our enforcement processes, we continued to monitor the service for any further concerning information to help inform our inspection activity.

Special Measures

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.