The Care Quality Commission (CQC) has rated Enham Trust Care Home Services in Andover inadequate overall, following an inspection in February.
Enham Care Homes provides personal care for up to 60 people who may be living with a learning or physical disability, or both. The service operates three homes, Michael House, William House and Elizabeth House. Each house has accessible facilities and can accommodate up to 20 people in flat or bedsit style accommodation. At the time of the inspection, 14 people were living in Michael House, 13 were living in William House and 14 people were in Elizabeth House.
CQC carried out an unannounced comprehensive inspection of the service due to concerns received about how people were being supported to make decisions, as well as concerns about the environment and leadership within the service.
Following the inspection, the overall rating for the service dropped from requires improvement to inadequate. The ratings for being safe and well-led also dropped from requires improvement to inadequate. The rating for being effective and caring remain requires improvement. The rating for being responsive to people’s needs dropped from good to requires improvement.
The service is now in special measures which means it will be kept under review, both by CQC and the local authority safeguarding team, and re-inspected to check sufficient improvements have been made.
At the time of the inspection Enham Trust was in a process of consultation and transition to change the current service model from a registered care home to a supported living service.
Rebecca Bauers, CQC’s head of inspection for adult social care, said:
“When we inspected Enham Trust, we found the staff were caring and did their best to promote people’s individuality.
“However, there were widespread and significant shortfalls in the leadership of the service. Senior staff weren’t clear about their roles and responsibilities in relation to the overall quality of care delivered, risk management, or their regulatory responsibilities.
“The manager told us they were working on a quality improvement plan, yet we found the buildings and equipment were poorly maintained, putting people at significant risk of physical and emotional harm.
“Maintenance records described broken lifts, hoists, toilets, washing machines and tumble dryers, leaking toilets, broken heating and water coming out of the pipes in a wall, yet there was no indication anything had been done to address these issues. Staff said they had reported a leak in one of the laundry rooms a number of times, but water was still dripping from the ceiling during our inspection.
“While we were on site, we heard a loud bang and someone saying, ‘Oh God, are you okay?’ When we checked to see what had happened, we found a member of staff lying on the floor after they tripped over a metal bar in a doorway which hadn’t been properly secured to the floor.
“At the time of our inspection, Enham Trust was transitioning from a registered care home to a supported living service. Relatives and the people living there told us communication regarding the change had been poor, and people were left feeling worried about what was happening.
“There were no records of people agreeing to move home or agreeing to the new model of care, which meant they weren’t offered the chance to make their own decisions regarding their care. In addition, the provider hadn’t reviewed people’s care needs to assess the number of staff needed in a supported living service. One person told us, ‘they are more worried about what’s happening with the supported living project, they have forgotten about what is important to us.’
“We have now told the provider to send us a report outlining what action they will take to address our concerns. We will review this and continue to monitor the service closely to ensure the improvements are made and fully embedded alongside other local health and social care partners. If we find no improvements have been made when we return we will not hesitate to take action”
Inspectors found the following during this inspection:
- The provider failed to ensure the service was consistently well led. Governance systems did not protect people from possible harm or from the risks associated with an unsafe premises.
- The leadership failed to create a culture of inclusion which empowered people’s lives. Care was not always tailored to individuals and people weren’t supported to make their own choices. People told inspectors they felt isolated from the community.
- There were not enough staff available to meet people’s needs across all three houses all the time.
- Staff did not always follow systems and processes to administer, record and store medicines safely. People were not protected from the risks associated with unsafe medicines management as guidance was either not available, lacking in information, or still in place for medicines that were no longer prescribed.
- Infection control procedures were not always carried out safely. Staff failed to wear personal protective equipment appropriately which placed people at risk.
- People who had the capacity to make decisions were not always provided with sufficient information to help them make their own decisions about their care, support and accommodation.
- Not all complaints were appropriately dealt with in a timely manner. People were not always kept updated on progress.
However:
- Staff were caring and compassionate, they respected people’s dignity and independence and delivered care and support in line with best practice guidelines.
- Safe recruitment practices were followed with regular supervision and training provided.
- Staff were provided sufficient learning and development opportunities including regular supervision with their manager.
- Care plans and risk assessments contained useful information to help staff to understand people’s needs.
- Staff ensured people had access to information in formats they could understand.
- People were protected from the risk of abuse because staff knew them well and understood how to protect them. The service worked well with other agencies to do so.
- People were supported to maintain a balanced diet and people with complex needs received support to eat and drink in a way that met their personal preferences as far as possible.
- People were assisted to access external healthcare appointments when needed.
- The provider was properly registered and licensed with the Information Commissioner’s Office in respect of the use of surveillance.