The Care Quality Commission (CQC) has rated Unite Highland Care in Dartford, Kent as inadequate, and placed it into special measures to protect people, following an inspection in August and September.
Unite Highland Care, run by a company of the same name, supports people to live in their own homes in Kent, and it also cares for some people in supported living accommodation. Some of the people who use the service have a learning disability or are autistic.
At the time of this inspection 23 people were using the service across its two functions.
A focused inspection was carried out as part of CQC’s checks on the safety and quality of services.
Following the inspection, the service’s overall rating, as well as the areas of safe and well-led, have declined from good to inadequate. How caring, effective and responsive, the service is, has declined from good to requires improvement.
Following the inspection, CQC took immediate action to suspend its ratings to ensure that people looking for information about Unite Highland Care would not be misled by previous ratings, which may not be an accurate reflection of the current care provided. CQC also issued urgent conditions to restrict care packages at the service. CQC also requested immediate action to address people’s safety risks and CQC is looking to use its regulatory powers further.
The service is now in special measures which means it will be kept under close review and re-inspected to check on the progress of these improvements.
Serena Coleman, CQC deputy director of operations in the south said:
We expect health and social care providers to guarantee people with a learning disability and autistic people the respect, equality, dignity, choices and independence, and good access to local communities that most people take for granted. We weren’t assured this was the case at Unite Highland Care.
They didn’t understand the type of service they were running, and that the principles of supported living accommodation mean these spaces are people’s homes. We found leaders had installed visitors’ books inside people’s rooms, built staff and visitors toilets, an office, and put office signage on the walls, which institutionalised the building rather than treating the area like people’s home.
Staff didn’t support people to have maximum choice and control of their lives, in the least restrictive way possible. Staff had removed cigarettes from some people using the service so they would smoke less, but there was no evidence they’d asked people what they wanted to do, sought consent, or assessed if they had the capacity to make such decisions for themselves. In the supported living homes, they had moved all of one resident’s kitchen knives into a locked room labelled the staff room, without any evidence supporting this decision.
The service also wasn’t respecting people’s dignity and privacy in their own homes. CCTV had been installed in all of the supported living homes, without clear reason. We saw one monitor which showed CCTV footage of different areas of the building was in a communal area which anyone could access.
Leaders weren’t managing the service well and we weren’t assured of the registered manager’s integrity. They weren’t aware of or acting on risks at the service, or making improvements after incidents occurred. We found safeguarding issues, such as incidents between people, hadn’t been raised with us or the local authority which meant people were at risk of abuse. The registered manager also referred to people with autism and attention-deficit/hyperactivity disorder (ADHD) as having a mental health condition, which clearly shows a lack of understanding about the people they were supporting.
We’ve told the service where we expect to see significant improvements and will continue to monitor the service closely to keep people safe during this time. We will return to check on their progress and won’t hesitate to take further action if people aren’t receiving the care and treatment they have a right to expect.
Inspectors found:
- Incident notifications hadn’t always been submitted to CQC, as required by law. Leaders also weren’t effectively auditing or monitoring how the service performed.
- Staff care calls were poorly organised and managed. Sometimes they were early, late, or overlapped in the staff rota with other people’s calls. One relative told inspectors their loved one sometimes took prescribed medicines later than they needed to because of staff delays.
- People’s care plans lacked detail, including on how to support medical conditions or manage risks to their safety. Records weren’t kept updated when incidents occurred, or people’s needs changed.
- Recruitment checks to ensure staff were suitable for their roles hadn’t been carried out.
- Medicines weren’t always managed safely. Someone missed taking their prescribed medicines when they left their home because there wasn’t a system or risk assessment in place to support this.
- However, some relatives and people using the service spoke positively about their care.
The report will be published on CQC’s website in the coming days.