Archived: The Dukes House 3

Updated 3 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by an inspector and an assistant inspector.

Service and service type

The Duke’s House 3 is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The registered manager had left the service. There was a newly appointed manager who had not applied to become registered with the CQC. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service about their experience of the care provided. We spoke with ten members of staff including an area manager, a manager who had been seconded to the service, the home manager, deputy manager, five support workers and a cook.

We reviewed a range of records. This included two people’s care records and medication records. We looked at one staff file in relation to recruitment and staff supervision; along with a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate the evidence found in relation to training data.

Updated 3 April 2020

About the service

The Duke’s House 3 is a residential care home providing accommodation, support and personal care to three people who have a learning disability, autism or a mental health support need. The service can support up to six people. The home is a three storey Victorian building, in a residential area of New Brighton. Each person has an en-suite room; and there were communal areas.

The Duke’s House 3 shares the same staff team, management team, outdoor space, office and many other systems with the providers location The Duke’s House which is next door. We inspected both services at the same time; specific information regarding The Dukes House is reported in a separate report.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. Registering the Right Support, 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.

The service was next door to another location provided by Lifeways Inclusive Lifestyles. To the public they look like and in many aspects operate as one care home; between them can accommodate up to 14 people. This is larger than current best practice guidance. In some ways this was mitigated, for example; there were no identifying signs to indicate it was a care home and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people. However, in other ways the care home was in contrast to the surrounding homes. For example, the three front gardens had been converted into one large car park, there were large gates across all entrances and there were no bay window coverings and when the lights were on the public could see into people’s communal areas from the street.

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

Staff were caring in their interactions with people and it was evident that staff endeavoured to have positive relationships with people. Whilst staff as individuals had a caring approach towards people; the provider had not developed, promoted or ensured that there was a caring culture at the home that respected and enabled people.

The home had a very restrictive environment. The provider had taken depriving people of their liberties for granted and had not ensured that people’s fundamental rights were acknowledged and protected.

The systems in place for assessing, monitoring and managing risks when supporting people were inadequate. They had not always ensured that the use of restraint had been safe and effective. This meant that important information regarding people’s safety was not always available for staff.

People’s risk assessments had not always been reviewed following a significant incident. The safe and effective use of restraint had not always been reviewed after significant physical interventions. There was inadequate debriefing and learning from incidents; even when staff members told us that they had raised safety concerns about the management of incidents.

Staff had not always been effective in listening to a person’s communication and actions. The culture at the home had not promoted staff being curious and exploring with them, what views or decisions they were communicating.

People were not supported to have maximum choice and 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 didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. There were limited opportunities for people to develop skills and increase their independence. People’ support plans were not focused on; and the design of the home’s environment did not support this and promoted people’s reliance on staff members.

Some aspects of the design and adaptation of the environment was not working for people. Some people had been supported to decorate and personalise their rooms; they told us that they liked their rooms. However, overall the environment of the home was not homely and was mostly bland, featureless and uninviting.

There were enough staff to meet people’s support needs safely. However, staff had not received appropriate support and training to enable them to be effective in their role. The provider had not maintained their programme of training and refreshment training for staff.

The previous managers of the service had left. The home had a new deputy manager and a new manager who was in their induction period and was not registered with the Care Quality Commission. The provider told us that they were supporting the service during this period using managers from other areas of the organisation. However, the provider had not ensured that the home had a positive culture. Staff including senior staff told us that there had been a very negative culture at the home.

The provider had a lack of oversight of the safety and quality of the service being provided for people.

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 25 July 2018).

Why we inspected

The inspection was prompted due to concerns received about the leadership of the service from a whistle-blower and the police. A decision was made for us to inspect and examine any risks.

We have found evidence that the provider needs to make improvements. Please see the is the service safe; is the service effective; is the service caring; is the service responsive and is the service well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the identification and management of risks; including the provider ensuring as much as possible that people were safeguarded from the risk of abuse. The environment of the home and people’s support not always reflecting their needs and preferences; at times people’s support did not reflect what had been agreed in their support plan. People’s records did not always demonstrate that their health needs had been met. The provider had not ensured that people’s fundamental rights were acknowledged and protected.

Staff had not received appropriate support and training to enable them to be effective in their roles. The provider had not ensured that the CQC had been informed of all notifiable events; and the provider had not assessed and improved the quality and safety of the service provided for people.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.