The Care Quality Commission (CQC) has rated St James Mews in Dartford, Kent, inadequate overall, following an inspection in May.
St James Mews is a care home run by Sequence Care Limited, which provides personal care for up to nine 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 has declined from good to inadequate. The home’s ratings for being safe, effective and well-led have also declined from good to inadequate, and its ratings for being caring and responsive to people’s needs have declined 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.
Hazel Roberts, CQC’s head of inspection for adult social care, said:
“When we inspected St James Mews, we found the manager had recently left and the provider didn’t have enough oversight of the service to ensure it was being managed safely and effectively.
“We had concerns that the provider wasn’t effectively managing the risks to people living with conditions such as epilepsy, choking risks or diabetes . Where people experienced constipation there was nothing in the care plans to tell staff what action to take.
“The provider didn’t 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 hadn’t been trained to support people.
“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.
“Although the provider took some steps to address these issues following our inspection, further improvements still need to be made. We will continue to monitor the service, to ensure sufficient improvements are made, and return to inspect to check on progress.”
Inspectors found the following during this inspection:
- People living in the service were not supported to have full control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice
- The service had not always supported people to make decisions that followed best practice in decisions making. For example, the kitchen was sometimes locked, and people were unable to access the kitchen freely
- People who needed their medicine covertly (given to them without their knowledge) did not have best decision meetings to ensure that decisions was being made for the right reasons
- The service did not always give people care and support in a safe and well-maintained environment. For example, there was broken flooring causing a trip hazard and a broken electrical box which a person told us had fallen on their head
- People did not always receive good quality care, support and treatment because staff were not always trained to support people's specific needs. Risks to people's health were not always identified. No guidance had been provided to staff about how to support people with other risks. Risks relating to the environment had not been mitigated to keep people safe. The service had not been consistently or correctly reporting incidents to CQC
- The registered manager had not always included accurate information when referring safeguarding incidents to the local authority. One incident had failed to accurately detail there had also been an accusation of physical abuse. The relative of the service user felt the registered manager did not take the concerns of abuse seriously when they raised them
- The service had also failed to raise a safeguarding alert when a person who lived at the service expressed, they felt unsafe and worried
- Guidance for staff regarding best practice, including positive behaviour support (PBS) plans, were not always clear and easy for staff to follow. One person had five different PBS plans in their care plan which contained conflicting information. For example, one PBS plan mentioned the use of physical restraint and another did not. The manager could not be assured that staff are following the relevant and most up to date support plan for that person
- The provider was not meeting people's communication needs who used alternative methods to communicate. They provider had not ensured up to date Makaton training was available to staff. One person used Makaton and staff told us they needed more training to be able to communicate with the person using their preferred method. Staff told us that they had training in Makaton in the past. However, they needed to keep updated to keep a good level of communication.