Archived: Church Lane

Updated 30 March 2015

The inspection team consisted of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The expert by experience who undertook this inspection had experience of learning disabilities and autistic spectrum conditions.

Before the inspection we reviewed the information we held about the service, which included the provider information return (PIR) and notifications. The PIR is a report that providers send to us giving information about the service, how they met people’s needs and any improvements they are planning to make. We also contacted a commissioner of the service to obtain their views.

We spoke to seven members of staff at the service. We also spoke to the acting manager and area manager. After the inspection we spoke to five relatives. People who used the service were unable to verbally communicate with us so we observed care and interactions between them and the staff.

We reviewed two people’s care records. This included their support plans, risk assessments, daily log books, weight monitoring charts and activity plans. We also reviewed staff records, which included training, supervision and appraisal records and observed care and support in communal areas.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

Updated 30 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

The inspection was unannounced and we visited on 8 and 9 July 2014. At our last inspection on 1 May 2013 we checked to see if the provider had made improvements in maintaining the dignity of people at the service. The service had made the improvements we required.

Church Lane is registered for six people and at the time of our visit was providing care to five men aged between 19 and 25 with a learning disability and/or autism spectrum disorder. The home has a sensory room and a garden. A registered manager was in post but had not been at the service for 10 months as they were on secondment. The CQC were initially informed about the three month absence but not for the remaining seven months. At the time of our inspection the deputy manager was acting as the lead manager. The deputy was supported by the area manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found that people’s privacy and dignity was not being maintained.

People were at risk of unsafe care as staff had not been given the training to keep their skills and knowledge up to date. Staff told us they were concerned about the safety of residents and wanted guidance on how best to keep them safe. Staff did not know how to manage behaviour that challenged the service and had not received up to date training about how to do this safely. We reviewed incidents where people had been injured at the service, but no notifications to the local authority or the CQC had been made. Some relatives wanted their family members to leave the service due to concerns around safety.

The acting manager demonstrated an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards however staff did not understand the implications. Staff were not aware of when they would be expected to request a best interests meeting or why they may need to deprive someone of their liberty. It was recorded in a care plan how one person’s finances were managed by the Court of Protection, but we could find no official paperwork in their file to confirm this. The acting manager told us that the person came to the service with this information in place, but the evidence was not recorded and it was not possible to see if this still was valid.

Medicine procedures were not always followed. This resulted in medicines signed as administered before they had been taken. There were also unexplained gaps in recording of medicine on the MAR chart.

People’s needs were initially assessed, but care plans and risk assessments were not up to date to reflect current care practice. Staff were not always following what was stated or sometimes they were not aware of what was in the care plan so effective care was not being given.

A person who was at risk of malnutrition had not been re-reviewed by the dietician after it had initially been sought.

Some staff spent time with people trying to interact with symbols and Makaton (a language programme that uses signs and symbols to help people communicate) and we observed positive responses from people when this took place. However, not everyone at the service experienced good interactions.

Communication with relatives was not consistent. Some relatives told us they received good communication by email and others said they always had to contact the service for information updates which made them feel like they were being “a nuisance.”

Staff team meetings took place, but not at regular intervals. Staff said they attended when they could and found them helpful. We found with team meetings and supervisions that staff found them helpful, but wanted to receive more feedback about concerns they had raised about people at the service and how to care for them. There was no audit system for records, in particular the checking of hand over sheets, food diaries or medicine records.

Staff were observed to be caring and spoke to people in a kind manner. Comments received from families were positive about staff being caring for their relatives.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report. Where there has been a more serious breach of regulation we will make sure action is taken. We will report on this when it is complete.