The Care Quality Commission (CQC) has dropped the rating for East Anglia Domiciliary Care Branch, run by Ambient Support Limited, from good to inadequate following an inspection from March to May. As a result, CQC has sent the service a warning notice and placed it in special measures to protect people.
East Anglia Domiciliary Care Branch supports people with a learning disability, some of whom are autistic to live in their own homes in Norfolk and Suffolk. At the time of this inspection, 48 people were using the service.
CQC inspected the service after receiving reports of potential financial abuse. These concerns were raised by people, partner organisations as well as self-reported by the provider. While financial crimes are not within CQC’s regulatory powers, this raised concerns about other areas of people’s care. Inspectors shared concerns they found about financial abuse with local authority safeguarding teams.
As well as being rated inadequate overall, the service has also dropped from good to inadequate for being safe and well-led. The service’s ratings for effective, caring, and responsive have dropped from good to requires improvement.
CQC also issued the provider a warning notice related to the management of the service, to focus their attention on making immediate improvements. 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.
Stuart Dunn, CQC deputy director of operations in the East of England, said:
“We were deeply concerned to find a culture in which people weren’t cared for as individuals and their human rights weren’t always respected. This was partly because of a serious shortage of staff with the right training to meet people’s needs, which also meant care wasn’t always safe.
“Staff lacked training on how to care for autistic people and people with a learning disability. The provider wasn’t supporting staff with enough training or supervision, and had failed to identify or address these issues, placing the people using their service at risk. We found leaders hadn’t always investigated or learned when things went wrong, and didn’t always listen to concerns raised by staff.
“Staff didn’t always support people to set goals or make as many choices as possible in their lives. For example, one person wasn’t supported when they wanted to bring home Christmas presents, they received while visiting their family.
“We found staff stopping people from leaving their homes, locking their doors, and performing intimate personal care on people who could not consent. Managers hadn’t always recorded best interest decisions for these actions or assessed people’s mental capacity as required by law.
“People didn’t always have control over what happened in their own home. Two people shared a bedroom in another person’s home due to flooding since January. Intended as a temporary solution, it extended for several months, negatively impacting all three people. The provider didn’t involve people in these decisions and failed to complete mental capacity assessments or best interests assessments.
“Following this inspection, we raised several safeguarding alerts to the local authority to keep people safe and issued the provider a warning notice on leadership to focus their attention on making immediate improvements. We’ll be monitoring the service closely, including through further inspections, to make sure people are cared for safely in the meantime.”
Inspectors also found:
- Managers and staff didn’t always feel managing risks to people’s safety was their responsibility. For example, the service did nothing to support someone who had lost a lot of weight, such as monitoring their weight or changing their diet, saying this was the responsibility of a nurse who visited weekly
- Some staff members spent people’s money inappropriately, such as buying staff refreshments, stationery and personal protective equipment. Inspectors raised these incidents as safeguarding alerts to the local authority following this inspection
- People weren’t always able to do activities outside the home because there weren’t enough staff to support them. This had led to some people becoming anxious about leaving their home and doing things they previously enjoyed
- People’s care records and risk assessments were often of poor quality or out of date, meaning staff didn’t always understand people’s needs or how to meet them.