The Care Quality Commission (CQC) has taken action to protect people at The Hall care home in Ashford, Kent, following an inspection in May that also sees them rated as inadequate and placed into special measures.
The Hall is a residential care home run by Nexus Programme Limited which provides personal care for up to ten autistic people or people who have a learning disability.
CQC carried out a focused inspection to follow up on information it held about the service.
At the time of the inspection in May, CQC took immediate action to prevent The Hall from admitting new people to the home and suspended its existing ratings (including good overall) as CQC was not confident this was an accurate reflection of the care being provided. CQC is also taking further enforcement action after ten breaches of regulations were identified at the inspection, which will be reported on further when legal processes are complete.
Following the inspection, the overall rating of The Hall has declined from good to inadequate overall, as well as for being safe and well-led. The areas of caring and responsive declined from good to requires improvement. Effective has been re-rated as requires improvement.
The service will be kept under close review by CQC to keep people safe and it will continue to monitor to check sufficient improvements are being made. If CQC doesn’t see rapid and widespread improvements, further action will be taken.
Natalie Reed, CQC deputy director of operations in the south, said:
“When we inspected The Hall care home, we found a chaotic environment with frequent incidents occurring and people being placed at risk of harm. People who called The Hall home, deserved much better.
“People living at the home witnessed resident on resident, and staff on resident abuse regularly. Staff also didn’t understand their role in safeguarding those living at the home, by reporting incidents to CQC or the local authority so they could be properly investigated. Staff told us that two people weren’t compatible to live together as they didn’t get along, but we didn’t see that any action had been taken to address this concern. In addition, staff who had committed abuse were allowed to continue working at the home, despite the obvious emotional distress this would cause the person who had been abused.
"People made vulnerable by their circumstances were relying on all staff members to act as their advocates, to help them live their best lives and it is unacceptable the people they relied on were treating them this way.
“We found people were subject to restraint which was unsafe, unlawful and sometimes excessive. When people were distressed, staff used restraint before other techniques to de-escalate the situation, and they didn’t always record observations and injuries afterwards. During one incident someone was trying to leave their bedroom and staff were holding their door closed, preventing them from leaving the room.
“Staff didn’t complete incident reports fully, they weren’t always recording when they happened, and leaders weren’t monitoring records or taking action to make improvements to prevent them from happening again. We witnessed three incidents during the inspection which hadn’t been documented when records were checked. Relatives also told inspectors they weren’t always updated when incidents occurred and that they felt staff weren’t open and honest with them.
“Staff didn’t always manage medicines safely. One relative told our inspectors that their loved one had overdosed on one of their prescribed medicines, but we saw no evidence that the incident had been reported, investigated, or shared with CQC.
“We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. We expect to see rapid and widespread improvements and will continue to monitor people living at The Hall closely to keep them safe while this happens. We will return to check on their progress, and won’t hesitate to take further action if people are not receiving the care they have a right to expect.”
CQC also found:
- There wasn’t enough staff to keep people safe, staff hadn’t been recruited with thorough checks on their work history or employment references, and staff lacked the right skills and experience to keep people safe. Staff told inspectors they regularly worked 14-hour shifts without a formal break, although staff who smoked were given a break
- The environment of the home wasn’t suitable for autistic people or people with a learning disability. Inspectors saw a resident leave the service in the direction of a busy road and staff had to intervene. We raised concerns and they agreed to install a gate to keep people safe. In another example, a resident’s distress could be triggered by loud noises, but their bedroom was next to the busy communal areas where incidents often occurred. Leaders confirmed they hadn’t assessed whether the room was best suited for this person
- There was CCTV throughout the home, but no evidence that people living there had the capacity to consent to this or that it was in their best interest to monitor them in this way. The home didn’t regularly review the use of CCTV to assess whether it remained appropriate and necessary
- Care plans lacked detail on supporting people’s individual needs
- Some safety checks were overdue: fire drills and safety evacuation plans hadn’t been reviewed recently.