26 June 2017
During a routine inspection
The Care Quality Commission has reviewed the way it registers services for people with a learning disability. Our website includes this information about ‘registering the right support’. This was discussed with the manager who was aware of this guidance and understood how this should be considered with any future service developments.
The home did not have a registered 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 2008 and associated regulations about how the service is run.
At the last inspection in January 2017, we identified breaches of Regulations relating to safeguarding, the management of risk, the manner in which people were treated and the governance systems. We made four requirements. The provider sent us an action plan stating the action they were taking to meet the requirements of the regulations. At this inspection we found the previous concerns had not been addressed and also identified additional breaches of regulations.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Monitoring systems were not effective in identifying areas for improvement and as a result, people’s safety and the service they received was compromised. We found continuing concerns with the management of medicines and health care needs, risk and care planning, quality of records, people were not treated with dignity and respect, their personal finances were not managed for their best interests and their legal rights were not protected. The home’s environment and facilities were not well maintained and robust recruitment procedures had not been undertaken.
Care files and individual risk assessments contained conflicting and out of date information which and did not reflect the care and support people needed. Action to meet health needs had not always been taken. Systems to manage medicines were inadequate and did not ensure people received all prescribed medicines safely.
There were insufficient staff employed. Staff had not received an induction, all necessary training and were not supported in their roles. Recruitment procedures had not ensured all necessary pre-employment checks had been completed before staff commenced working at the home.
Emergency procedures were inadequate to ensure people’s safety. Staff had not received fire awareness or other training to provide them with the knowledge as to what action they should take in the event of a fire placing them and people at risk. People were not supported to eat a balance healthy diet. People were not receiving adequate mental and physical stimulation.
Staff did not follow legislation designed to protect people’s legal rights. Although adults, people were not always treated as such or with dignity and respect.
People were happy with the food they received although healthy alternatives were not always offered or encouraged. People were not receiving adequate mental and physical stimulation and activities were limited.
People felt able to raise concerns with the acting manager who took time to listen to people and seek resolution for their concerns.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to the provider and will report on this when it is completed.