Quinton House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around safeguarding service users from abuse and improper treatment in a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. People told us they felt safe living at Quinton House. However, staff did not always understand their duty to protect people from restrictive practice. Staff knew who to report concerns to internally but did not know who to report concerns to outside the organisation. Managers were not always aware of their responsibility to report safeguarding concerns to the safeguarding authority and CQC. Safety risks to people were assessed and documented within care records however they were not always detailed to ensure staff had correct guidance to ensure peoples risks were supported safely. People, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough staff to keep people safe, however there were not always enough staff on duty to ensure people live fulfilled and empowered lives. The registered manager acknowledged there had been staffing issues and they had recently reviewed staffing levels. Recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service. People told us the home was clean and tidy, however some areas of the home were in a state of disrepair which meant these areas could not be effectively cleaned.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Records we reviewed detailed some risks had been identified however we found these were not always monitored or managed to ensure they were effective. For example, we found risk assessments relating to emergency evacuation to be of a poor standard and these did not address people's individual needs. We found risk assessments were reviewed monthly by staff however there was no process in place to identify the issues we found. Risk assessments for all three people were of very similar nature and not specific for each person. For example, we found risk assessments for making a hot drink for an older adult and a younger person which were identical. The younger person worked one day a week at a café and this risk assessment was not relevant to them. We also found some risk assessments to be inaccurate, for example risk assessments relating to working in the garden stated the maintenance person would use electrical equipment, however there had not been a maintenance employed at the home since 2020. This meant despite the risk assessment being reviewed monthly this was not accurately completed. We found some referrals had been made to health services although there had been a delay in following up continence assessment for one person for a significant period of time.

People and their relatives told us staff supported them to gain access to health care professionals such as Doctor's, Dentists and Opticians. All relatives we spoke with told us staff managed people's ongoing needs well and felt there was a good consistency of care. Two of the relatives we spoke with told us they had been involved in planning care whereas one told us they had not.

The registered manager told us referrals were made to health and social care partners and gave an example of a referral made to the continence service for one person. However, we found other areas of peoples' care were not consistently well managed. The registered manager and staff did not demonstrate knowledge in regards to working with partners to increase people's independence, we found little action had been taken to encourage people to take positive risks in order for people to live fulfilled lives. Staff displayed limited knowledge in prompting independence to ensure people lived fulfilled lives. Staff told us, "We take the residents out walking and I tell them when to cross the road." Five staff meeting minutes were reviewed dating from February 2023 up to December 2023. Three of these discussed 'activities'. The staff meeting in March 2023, stated more activities would be arranged, however there was no discussion documented with staff how each person would be supported.

The provider did not always work in an effective and timely manner with partners to drive service improvement. There were limited assurances that lessons had been learnt to ensure the care people received continually improved. For example, we found little action had been taken to promote independence to ensure people lived fulfilled lives. This is not in line with current best practice guidance and places people's well-being at risk. The provider was written to in both September and November 2023 with clear feedback provided from the local authority to improve the service, but the provider had not fully acted upon this feedback.

Staff told us, they would report any safeguarding concerns to the registered manager or provider, however staff were not aware who to report safeguarding concerns to outside of the organisation. Staff told us they received training in safeguarding and told us of some concerns they would report to the manager. They knew how to keep people safe from some forms of abuse and they gave us examples of safeguarding concerns they would report such as physical and sexual abuse. However, they did not recognise some of the restrictions imposed on people were a safeguarding concern as we found no evidence restrictions had been reported. The registered manager told us of some of the concerns they would report to the local authority safeguarding team, but they were not aware of safeguarding concerns they had a legal duty to report to CQC. The registered manager was not aware of their duty to apply for DoLs where people had their liberty restricted. For example, two people were prevented from leaving the service alone as they would not be safe, the registered manager was not aware they should have applied for DoLs to ensure any restrictions were lawful. The registered manager did not always know how to respond to safeguarding concerns, they gave an example of potential financial abuse of a person using the service. Whilst the registered manager had taken some action, this concern had not been reported to the local authority safeguarding team for further investigation.

We observed people and staff to have positive interactions using mostly a caring approach, however we observed two interactions were people asked a member of staff for something and they were told ‘no’. This meant there were some concerns relating to the culture at the service. We heard a person ask if they could make a cup of tea and the member of staff told them ‘No’, Inspectors intervened and asked whey the person could not make a cup of tea, staff responded that it is because ‘CQC’ were in the kitchen. Both inspectors had made it clear prior to sitting anywhere in the home, people and staff should go about their day as normal. Staff failed to recognise this as restrictive practice. Inspectors intervened and the service user made themselves a cup of tea. Another example we observed, a person asked for a bar of chocolate after lunch, after they had returned from a walk, staff told them, “No you don’t have chocolate now,” there was no further conversation they were simply told no. Inspectors intervened and asked why the service user could not have a bar of chocolate (we had reviewed the care plan of this person and there were no clinical needs or MCA/BI in place to justify this restriction). Staff responded in front of the person and another service user “[Person] doesn’t have chocolate now, he used to be big (and used their arms as to demonstrate a large stomach area) and they (pointed to the office) tell me he’s not allowed chocolate until after tea.” We immediately fed this back to the registered manager who confirmed the service user was allowed chocolate. They advised staff would receive coaching to prevent this happening again. Staff failed to recognise these incidents as safeguarding concerns due to imposing unlawful and unnecessary restrictions on them.

People told us they felt safe living at Quinton House. A person we spoke with told us, "I feel safe. We have a direct line with the police. We do fire drills. They test all the equipment for us. When we go out staff are always there to help me.” People told us they had never felt unsafe living at the home and felt reassured staff were present to help them when needed, they told us they would speak to the manager if they felt unsafe. Relatives we spoke with told us they had no safeguarding concerns. A relative we spoke with told us, "[Name] is very safe, I have no concerns." Relatives knew who to raise concerns to both in the home and externally. A relative we spoke with told us, “I would speak to [manager] and if they didn’t do anything I would report to the safeguarding.”

There was not a robust process in place to ensure safeguarding concerns were reported, investigated, and shared to ensure lessons were learnt. We found an incident relating to an allegation of neglect had not been investigated by the provider to ensure lessons were learnt and the risk of re-occurrence was reduced. Poor safeguarding processes meant no safeguarding concerns had been reported in several years, one allegation as detailed above had been reported following instruction from the LA, however no other concerns had been reported. There had been no incidents or concerns recorded since March 2019. Safeguarding contact information was accurate and available in a folder at the home. There was a safeguarding policy in place which was available to staff. There were several different safeguarding policies covering specific areas such as financial abuse, sexual abuse and exploitation.

We observed people to be supported safely. For example, we observed staff supporting a person to prepare lunch in a safe manner. We also observed a person safely making themselves a hot drink with staff observing from a distance.

People told us that they were able to communicate their needs, to receive the support they wanted. One person we spoke with told us; staff had shown them how to use cleaning products safely to clean their room. Two of three relatives we spoke with told us, they felt risks were managed well and staff kept their relatives safe. For example, a relative said, “They do their upmost to keep [name] safe.”

Staff knew people’s needs and how to support risks safely. However, there was not a clear approach to supporting people’s risks in a person centred and least restrictive way. As detailed in the safeguarding section, staff did not always recognise some of their practice as restrictive. Staff did not always recognise risks to each individual person and consistently spoke about the people living at the home as a group rather than as individuals. For example, a staff member said, “I used to get nervous taking ‘them’ out but now I know 'them' and another staff member said, “They tend to do things like a family.” We found no evidence to support whether people had been involved in the staff’s approach to consistently taking people out as a group.

People’s needs were documented in care plans however they did not always include sufficient detail to ensure staff had the correct information to support them safely. Risk assessments for one person were contradictory. For example, in one area of the care records it stated the person was unsteady on their feet however this was not detailed in the mobility risk assessment. Furthermore, all people had the same risk assessments in place despite people having very different needs and varying levels of independence. Risk relating to people’s health needs were not always fully assessed to ensure staff had the correct information to support people safely. For example, risks relating to continence needs for one person lacked detailed to ensure the person remained safe with their dignity preserved. People were not always supported to take positive risks in order to live fulfilled lives. Whilst records showed some people were supported to undertake voluntary work, the person had been at the same unpaid placements for several years without incident, there had been no further discussion about developing their skills in order to live a fulfilled more independent life. When we discussed this with the registered manager they simply replied, “[name] is vulnerable” but could not explain further what they meant by this. There were no incidents recorded, this meant there were no opportunities for staff and people to review what had happened and ensure measures were put in place to prevent re-occurrence. Staff did not keep clear personalised records. For example, records we reviewed for showed daily records for people were identical in nature. It was not clear how staff had supported each person and at what time. This meant any changes in a person’s needs would not be identified easily.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We saw there were enough staff to provide support to people safely. We observed one member of staff throughout the day to support people safely. Although, as detailed above, we observed the ‘group’ approach throughout the day, the staff member escorted both people out for a walk and then they both played a game with the staff member. We observed the staff member did not give people a choice if they wanted to go for a walk, the staff member said, “We are going for a walk after lunch” and both people went. We observed the staff member to communicate clearly to people using the service.

There were not always enough staff on duty to ensure people live fulfilled and empowered lives. One person should have received 18 hours 1:1 support each week. However, records showed the person rarely received any 1:1 support. Staff documented they had provided 1:1 support when supporting the person with a walk in the community, however they also supported another 2 people with the same walk. Another occasion staff recorded 1:1 support as playing games with the person; however, the same member of staff had recorded the same for 2 other people living at the home. There was not always enough staff to enable people to spend time in their chosen way. Whilst we had no concerns raised, people were provided with limited social opportunities due to limited staffing. On some occasions people did not leave the home for over three days. Records we reviewed demonstrated people had made wishes to go on holiday and spend time undertaking hobbies of their choosing, however as there were not enough staff to support people individually none of these wishes had developed into reality. Daily records confirmed that most activities were done together with little focus on people’s individual preferences. Daily notes showed entries for activities that were exactly the same, with ages ranging from 30’s to 70's. Whilst low staffing numbers had not impacted the safety of people, limited staff meant people’s independence was not always a promoted and their right to live a fulfilled life. Staff were recruited safely. One member of staff was awaiting their DBS to come back but was not working independently. Staff received training in areas such as food hygiene, moving and handling and learning disability awareness. Only the manager had completed autism awareness training and only 2 staff members had completed PBS training. Staff had all recently completed RESTORE2 training. Although staff weren’t fully able to explain how they would apply this training in practice.

People told us there were enough staff, and any needs were responded to quickly. One person said, “Staff are always around if I need them.” Relative’s we spoke with had no concerns’ in regards to staffing. A relative we spoke with told us, “My [relative] has very low needs so staffing is not an issue.”

The registered manager fed back the staffing issues had impacted the service over the last year but felt they were now in a better position as they had recently recruited another member of staff. They fed back the aim was for people to go on holiday and engage in other activities of their choosing. Staff told us there were enough people to keep people safe. Staff we spoke with said the team worked together well and had good working relationships.

During the assessment, we observed parts of the home were in a poor state of repair meaning some areas could not be cleaned effectively. For example, we observed rust to some radiators and mould present in a person’s bathroom. We observed a mattress staff slept on to be stored in the games room where people spent their time. The home was tidy and did not appear to be unclean. There was a malodour to one person’s room who lived with a health condition however this was being managed through weekly deep cleaning. An empty bedroom required further refurbishment, whilst this was not in use, it was not locked and people could access this, the room had a strong malodour and contained a person’s personal belongings. We fed this back to the registered manager who advised the room should be locked. We observed staff safely supporting people during lunch time using safe infection prevention control practices to ensure their safety.

The registered manager spoke in detail about the precautions they had taken during COVID-19 and none of the people living at the service had contracted COVID-19. Staff told us they supported people to keep their bedrooms clean and tidy. The registered manager advised that staff were expected to clean the home (with support from people living there if able). The registered manager advised the provider had made the maintenance person redundant in 2021 and since then they have been making a list of jobs that need completing. However, simple tasks such as grouting a shower had not been completed which had been an issue for several years.

People told us that the home was always kept clean. One person said, “It’s clean here, I like to keep the place as clean as possible.” The person gave a very detailed explanation about how he cleaned his own room and bathroom and staff always made sure he had the cleaning products he needed. A relative we spoke with said, “It is clean, but it could do with a lick of paint, [name] has been their 13 years and it’s never been painted.”

There were some processes in place such as weekly deep cleaning. However poor monitoring meant issues were not always picked up. The registered manager with advice from the local authority and infection control team had recently introduced new infection control monitoring processes. This would protect people from the risk of infection. Staff had received training in infection control, on how to put on protective equipment and how to keep people safe in the event of an infection outbreak. An infection control policy was in place and had been reviewed within the last twelve months.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.