Background to this inspection
Updated
7 January 2022
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.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by two inspectors and an assistant inspector.
Service and service type
Mr Adrian Lyttle - Erdington 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was unannounced. However, we called the service on our arrival, from the carpark, to inform them that we would be carrying out the inspection and find out if anyone currently tested positive for COVID-19.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service. We also spoke with three relatives. We used a range of different methods to help us understand people's experiences. Some people were unable to tell us their experience of their life in the home, so we observed how the staff interacted with people in communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with nine members of staff, including care workers, team leaders, manager, registered manager and the provider.
We reviewed a range of records. This included three people's care records and three people’s medicine records. We also reviewed the process used for staff recruitment, records in relation to training and to the management of the home and a range of policies and procedures developed and implemented by the provider.
After the inspection
We continued to seek clarification from the registered manager and the provider to validate evidence found. However, they were unable to provide all of the information we required.
Updated
7 January 2022
About the service
Mr Adrian Lyttle – Erdington is a residential care home registered to provide personal care for up to 10 people with learning disabilities. At the time of the inspection there were seven people using the service.
People’s experience of using this service and what we found
The provider had failed to implement robust audits and quality assurance checks to assist with driving improvement within the service. They had not ensured the quality and safety of care was sufficiently monitored and appropriate action was taken to protect people from the ongoing risk of harm.
The registered manager had not been visiting to support the service on a regular and consistent basis. This meant there was insufficient oversight of the service, staff and systems and processes. This meant people were placed at risk as there was no oversight of the service by the registered manager or provider, placing people at risk of harm. The registered manager was unable to be present throughout the whole inspection and delegated this responsibility to the manager of the location and the provider.
The provider and registered manager failed to provide us with documentation and evidence as requested. This was due to them not being able locate the information or it was of such poor standard they made the decision not to submit the documentation.
During the inspection we identified concerns with poor Infection Prevention and Control (IPC) standards that exposed people to the risk of harm. The provider had failed to act on known risk which had been identified by an external auditor, which took place in April 2021. This placed people at risk of infection.
Staff were not always recruited safely. Safe recruitment practices were not followed and this place people at risk of harm due to police checks not being carried out prior to employment commencing.
People’s medicines were not always managed safely, and some improvement was still needed. We found multiple discrepancies with the stock of medicines which could not be explained.
People were supported by a staff team who told us they understood how to protect them from abuse. Staff also understood how to protect people from harm such as injury, accident and wounds.
However, the provider had failed to ensure all staff members had received up to date training. This placed people at risk from potential abuse and harm or injury.
On the day of the inspection we saw people were supported by sufficient numbers of staff to keep them safe.
People were supported to access external healthcare professionals to maintain their health and wellbeing.
The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include age, disability, race, religion or belief etc. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.
People were not always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Right support:
• People's choice, control and independence was not always maximised. People were involved in making choices around how they spent their time, however, meaningful activities did not always take place. People told us they would like more to do but they were aware that they had been unable to do certain things due to the pandemic.
Right care:
• Care staff support people in a person-centred way, and promote people's dignity, privacy and human rights. However, the care plans need to contain more robust information to ensure people receive the right care.
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
People said they felt safe and were comfortable around staff. Relatives told us they felt their family members were safe. Staff were observed to be kind and caring and there were good interactions including communication which was suitable for their needs. Staff spoke to people with dignity and respect.
Staff were supporting people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice although record keeping needed to be improved in relation to the use of the Mental Capacity Act 2005 (MCA).
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating of this service was requires improvement (published 29 January 2020) and we found breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance. During this inspection we found new breaches of Regulation 12, Regulation 16, Regulation18 and Regulation 19 although the provider was no longer in breach of Regulation 11.
At this inspection the overall rating for this service is ‘Inadequate’ and the service therefore is 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. We found that the provider had not made enough improvement in their oversight and management of the service and remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance. During this inspection we found new breaches of Regulation 12, Regulation 16, Regulation 18 and Regulation 19.
The service has a history of poor compliance with regulations. It was rated as requires improvement at the inspection we completed in October 2018 (report published 13 December 2018) and there were breaches of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Need for Consent. The service was rated as requires improvement at the inspection completed in May 2017 (report published 28 June 2017) and following the inspection in August 2016 (report published 15 September 2016) the service was also rated requires improvement.
Why we inspected
This was a responsive focused inspection based on CQC receiving concerns and complaints. Prior to the inspection CQC received concerns about poor standards of care and support, poor recruitment processes and lack of leadership. The information shared with CQC indicated potential concerns about how people were being supported and risks being managed. As a result of these concerns we looked at how the provider was managing risks, protecting people from potential harm, recruitment processes and management of the service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
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.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, good governance, staffing and fit and proper persons employed.
Please see the action we have told the provider to take at the end of this report.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will retur