CareTech Community Services Limited - 34 Porthill Bank

CareTech Community Services Limited - 34 Porthill Bank is a care home which provides care and accommodation for up to 6 people with a learning disability or autistic spectrum disorder. At the time of inspection five people lived at the home.

While the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, the practices in the service were not always meeting the principles. Registering the Right Support principles ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. In the majority of the cases people using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

We received mixed feedback from visiting relatives regarding their family member’s safety. One relative spoke positively and expressed that their relative was safe and received excellent care. However, two other relatives said they did not feel their relatives were safe due to incidents that had occurred in the home. Staff deployment and arrangements for one to one observation for people were not always robust to ensure one to one support for each individual was maintained. The provider had no arrangements to protect staff from risks of being bitten. We received mixed feedback regarding the staffing levels in the home and the level of oversight provided to care staff by management.

While staff had continued to receive a range of training and supervision, the providers' systems and processes for supporting staff to gain relevant competences for their role were not robust. Not all staff had received induction and training in a timely manner. The manager had assessed people’s needs and provided staff with guidance on how these needs were to be met. However, staff had not always consistently followed the plans to prevent incidents between people. There was no registered manager. A new manager had been employed and they were also managing two other services. People’s relatives raised concerns regarding the management support at the home. People and their relatives had not been supported to share their end of life care preferences. We made a recommendation about end of life care.

Staff considered positive risk-taking approaches to enhance people’s independence and well-being and new how to report safeguarding concerns. People were supported with the safe use of medicines. Staff had received training in safe medicines management and had access to national guidance and best practice. Staff had been safely recruited and employment checks carried out.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. They sought consent before delivering care. Some improvements were required to ensure documentation was kept on how the use of restraint was in the best interest of people where it was required to keep people safe. We made a recommendation about mental capacity assessment and best interest records for the use of restraint.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. While people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent, this was not always consistently meet.

People received support to maintain good nutrition and hydration and their healthcare needs were understood and met. Staff consulted with specialist professionals and reviewed people’s needs regularly. There were arrangements to maintain regular communication between relatives and staff. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident their complaint would be listened to and acted upon quickly.

The manager and the deputy manager showed they were committed to improving the service. They displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 05 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report. We have identified breaches in relation to staff training. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

34-36 Porthill Bank provides accommodation and personal care for up to six people with a learning disability. At the time of this inspection four people were using the service.

There was a new manager in post who was in the process of registering with us. 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.

People were safeguarded from the risk of abuse as the manager and staff knew what to do if they suspected someone had been abused. Incidents of alleged abuse were being referred to the local safeguarding authority for investigation.

There were sufficient suitably trained staff to safely meet the needs of people who used the service. They had been recruited using safe recruitment procedures to ensure they were of good character and fit to work with people.

Risks of harm to people were assessed and minimised through effective use of risk assessments. Staff knew people's risk and how to keep them safe.

The principles of the Mental Capacity Act 2005 were being followed as people were consenting to or being supported to consent their care.

People were supported to maintain a healthy diet and staff sought medical advice if people's health care needs changed. The manager and staff worked alongside other health care professionals to ensure people's physical and mental health care needs were met.

Staff were supervised, supported and received training to be effective in their roles.

People were treated with dignity and respect and their right to privacy was upheld. People were able to spend time alone whist maintaining their safety.

People were receiving care that met their individual needs and preferences. People were supported to be involved in the community and participate in hobbies and activities of their choice.

There was a complaints procedure and people's relatives knew how and who to report their concerns to and they had confidence they would be acted upon.

The systems in place to monitor and improve the service were effective. There was a plan for continuous improvement.

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.

34-36 Porthill bank provides accommodation and personal care to up to six people with a learning disability, autism and associated challenging behaviours. At the time of the inspection six people were using the service.

There was no registered manager. The manager had recently left prior to registering with us. 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.’

People who used the service were not safeguarded from abuse as incidents of abuse had not been reported to the local authority for investigation. Some incidents of abuse had not been recognised and no action had been taken to minimise the risk of further incidents.

There were insufficient suitably experienced staff to safely meet the needs of people. Care staff were being required to provide one to one care to people and complete management duties.

The provider had recruitment procedures in place although we were unable to clarify if appropriate references had been gained prior to employment.

Risks were not reviewed and assessed to ensure that risk of harm to people were minimised following incidents of harm.

People did not always receive health care support in a timely manner. When people complained of being unwell support was not always gained.

People were supported to maintain a healthy diet.

Staff did not feel supported to fulfil their role effectively and had received no formal supervision or competency checks.

The provider did not consistently follow the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care, treatment and support.

People were not always treated with dignity and respect. Care staff lacked clear leadership and a culture of poor staff practise had developed.

Staff did not always have the information they needed to be able to meet people's individual needs. People did not always receive care that personalised and met their individual preferences.

Complaints were not always taken seriously and acted upon. Not everyone had confidence in the provider to deal with the complaints.

The systems the provider had in place to monitor the service were ineffective ad people were receiving care that was Inadequate.

We found that people were involved in all aspects of planning and reviewing their care and treatment plans. People made choices about how they spent their time and how they were supported by staff to achieve their goals and promote their independence.

We saw that people's care records contained detailed information about their needs and they had access to a range of health and social care professionals. Care and treatment was planned in a way that ensured each person's safety and wellbeing. People were supported to achieve independence.

We found that suitable arrangements were in place to protect people from abuse or harm.

There was a system in place to ensure that people were protected against the risks associated with medicines. We found that people were receiving medicines safely and as prescribed.

We found that correct recruitment checks had been carried out before staff commenced work. This ensures that people were protected from potential harm.

We observed the routines and daily activities were flexible and staff responded to people's needs. Some people were supported on an individual basis to ensure they were safe and had access to activities in the home and the community.

People received care and support that met their individual needs. People had care records which had been written in a style that people understood, and people told us they had decided how they wanted to be supported.

We checked the cleanliness of the home and spoke to staff and relatives about cleaning routines and infection control.

We checked records to help us see if people had the care they needed, and records to show that the home was kept clean and safe.

We saw that there was a complaints procedure and people were supported to use it.