The Care Quality Commission (CQC) has told Poppy Cottage Limited, in Denham, Middlesex, that urgent improvements are needed, following an inspection which found that people using the service were at risk of harm.
In July, CQC undertook an unannounced focused inspection due to concerns received about staffing levels, medicines errors, an allegation of abuse and poor management. A decision was then made to carry out a focused inspection to review the key questions of whether the service was safe and well-led. However, during the inspection more widespread concerns were found and a complete comprehensive inspection to include all key questions was undertaken instead.
Poppy Cottage Limited is a supported living service. The service provides personal care to people living in five supported living settings, so that they can live as independently as possible. At the time of the inspection 18 people with a learning disability, or autistic people were using the service.
Poppy Cottage Limited is now rated inadequate overall. It is also rated inadequate for being safe, effective and well-led and requires improvement for being responsive and caring.
Debbie Ivanova, CQC’s deputy chief inspector for people with a learning disability and autistic people said:
“When we inspected Poppy Cottage Limited, we found widespread and significant shortfalls in leadership and care which compromised the wellbeing and safety of people living in the service, as well as staff. This is clearly not acceptable.
“People should not be deprived of their liberty without legal authority, yet staff told us that they needed to lock one person in their home to keep them safe and that another person was subjected to seclusion in their bedroom, which records confirmed. We were also told that people living in one of the five settings could not go out alone, and that day-to-day activity was done in groups. A lack of meaningful activities had led to one person becoming dependent on their tablet, to the point they showed signs of distress when restrictions were placed on the use of the tablet.
“We also heard staff were using consistently disrespectful terminology when describing people living in the home, such as ‘naughty’, ‘bad’ or ‘lazy’. A written account said that a member of staff described a person’s behaviour as ‘disrespectful’ and indicated that staff support escalated the person’s distress. We expect health and social care providers to guarantee people with a learning disability the choices, dignity, and independence that most people take for granted.
“We also found that risk assessments did not provide staff with enough information to keep people safe in the event of an epileptic seizure or an incidence of choking.
“We have told the provider we expect urgent and significant improvements to be implemented. We will continue to monitor the service closely, and work in conjunction with local stakeholders to ensure that the improvements that are needed are made and fully embedded.
“We will also return to inspect to make sure improvements have been made. If we not are not satisfied that they have been, we will not hesitate to use our enforcement powers to drive the changes needed.”
There were several areas of concern found on inspection, including:
- The service was not able to demonstrate how it was meeting some of the underpinning principles of right support, right care, right culture
- Systems were not in place to make sure people were protected from abuse and poor care, or to ensure that medicines were management safely
- People's care and support was not always provided in a safe or clean environment
- People's care plans did not fully reflect all of their sensory, cognitive and functioning needs. People did not receive care, support and treatment from trained staff and specialists able to meet their needs and wishes
- People who had behaviours that could challenge themselves or others had care plans in place, however these did not always include proactive plans to reduce the need for restrictive practices
- People were not always supported to be independent or achieve their own goals. Where people were supported by staff who knew them well, and understood the support they required, people told inspectors they experienced caring and positive relationships with staff. However, people did not always have care from staff who protected and respected their privacy and dignity
- People were not supported by staff who understood best practice in relation to learning disability and/or autism
- People's communication needs were not always met or shared in a way that could be understood. People were not always supported to take part in meaningful activities which were part of their planned care and support.
Full details of the inspection are given in the report published on our website.
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