The Care Quality Commission (CQC) has rated Redlands in Eastleigh, Hampshire, inadequate overall, following an inspection in March.
Redlands is a care home run by Choice Care Group, which provides personal care for up to eight people, predominantly people with a learning disability or autistic people.
CQC carried out an unannounced comprehensive inspection after receiving concerning information regarding the safeguarding process within the service.
Following the inspection, the overall rating for the service dropped from requires improvement to inadequate. The home’s ratings for being safe and well-led also dropped from requires improvement to inadequate, and its ratings for being effective, caring and responsive to people’s needs dropped from good to requires improvement.
CQC has told the provider to take action to address the concerns identified. The service is now in special measures, which means it will be monitored closely, both by CQC and the local authority’s safeguarding team, and re-inspected to assess whether sufficient improvements have been made.
Rebecca Bauers, CQC’s head of inspection for adult social care, said:
“When we inspected Redlands, we found the provider didn’t have enough oversight of the service to ensure it was being managed safely.
“Care plans and risk assessments were inconsistent and lacked sufficient detail, putting people at risk of harm because staff didn’t always have information needed to support people safely.
“For example, two people were at risk of falls, but the risk assessment plan relating to how staff should respond in the event of a fall lacked detail. When we asked the registered manager what they could do to improve this, they told us, “In the event of a fall, stuff would happen as common sense”. Unfortunately, we witnessed one person fall during our inspection, but staff didn’t report this to the management team.
“The provider did not have enough competent and skilled staff to care for people safely, they relied on agency staff who weren’t familiar with people living in the service and they hadn’t been trained to support people. This was disruptive for the people living there and could heighten their anxiety. We saw people trying to interact and engage with staff, but they got no response.”
“Permanent members of staff didn’t feel fully supported. They told us they were concerned incidents could escalate when untrained staff were supporting people, so they had to be continually alert and prepared to support people in the best way they could. This was particularly stressful when several people needed support at the same time.
“On one occasion, we saw a person who appeared distressed and showing signs they were in pain. Staff commented that the person might be in pain but didn’t immediately offer them pain relief.
“Although the provider took steps to address these issues following our inspection, further improvements still need to be made. We will continue to monitor the service, working with partners including the local authority, to ensure sufficient improvements are made, and return to inspect to check on progress.”
Inspectors found the following during this inspection:
- Indicators of a closed culture were identified, and staff morale was low. This meant people did not always receive high quality care.
- Quality assurance systems to assess and monitor the service were not always in place or effective. Records were not always complete. Risks to people's health and wellbeing had not been monitored or mitigated effectively.
- The provider had failed to notify CQC of significant events that happened in the service as required by law. Safeguarding incidents had not always been reported as required to the local authority. A lack of timely action by leaders to ensure safeguarding incidents were responded to meant people did not lead inclusive or empowered lives.
- Recruitment files for care workers employed in the past year showed appropriate checks had not always been undertaken prior to their employment. There was no evidence of a structured or recorded induction for agency staff. Systems to promote staff learning and development were ineffective.
- The processes for incidents to be recorded, reviewed and monitored were ineffective, as not all incidents of physical intervention within the service were included. This impacted learning opportunities to reduce the likelihood of incidents reoccurring. There had been incidents where injuries had been received by staff when supporting people, but there was no evidence of any wellbeing checks or de-briefs with staff to ensure lessons could be learnt, or a review of any relevant care plans or risk assessments.
- The provider had not established an effective system to ensure people were protected from the risk of abuse, including financial abuse. There were discrepancies within people's financial records which had not been identified by the provider.
- There was a lack of person-centred care and people's human rights were not always upheld. People were not supported to have maximum choice and control of their lives. Health and social care providers are expected 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.
- People were not always supported in an open, inclusive and empowering way. Some staff talked about people in front of people to other staff. These conversations were not discreet, and staff did not attempt to include people in the discussions. This meant people were not treated with respect or treated as adults.
- There were potential fire hazards within the service, such as a portable heater with broken feet and a bent wire, and inspectors were concerned about the approach to fire risk management.
- The premises were not hygienic. There were poorly maintained areas of the home and dirty fixtures and fittings. Care staff were responsible for cleaning the home which they found difficult to do as well as caring for people. Shared spaces in the home were sparsely furnished and noisy.
However:
- During the inspection, the provider started to take immediate action in response to the concerns raised. Retrospective notifications were submitted to the local safeguarding authority team and CQC, and a comprehensive review of records relating to incidents was carried out to identify any further concerns. A full financial audit of all finances within the service was carried out, and notifications made to the police, safeguarding adults’ team and CQC. The area manager also ensured similar reviews were carried out in other services across the wider organisation.
- People received the correct medicines at the right time. There were effective systems in place for the administration, storage and record keeping of medicines.
- Most people were supported with their dietary needs and preferences. Menus were decided weekly, and staff discussed menu options with people and offered alternatives if they did not like the meal choice on offer.
- People could personalise their room and keep their personal belongings safe. People had access to quiet areas for privacy. Staff knocked on people's doors and waited for permission before entering.
- People were being supported to widen their social networks. For example, one staff member had found a nightclub event for people to attend.
Notes to editors
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