Poppy Cottage Limited

Updated 19 May 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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. 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

Two inspectors visited the office location and people’s homes on 25 and 26 January 2022. A medicines inspector visited the office location 25 January 2022. An Expert by Experience made telephone calls to gain people’s feedback about the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in five ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

This service is also a domiciliary care agency. At the time of our inspection the service had not started to provide personal care to people living in their own homes. Therefore, we did not inspect this type of service delivery.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

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 and professionals who work with the service. We used all this information to plan our inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with eight people who used the service and five relatives about their experience of the care provided. We received written feedback from one relative. Some people used different ways of communicating including Makaton (a type of sign language), photos, pictures and their body language. We observed people’s care to help us understand the experience of people who could not talk with us. We spoke with 16 staff members including care worker, heads of care, administrative staff, manager, development manager, operations manager and registered manager, who was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received written responses to our questionnaires from nine staff members, including night-time and casual care workers.

After the inspection

We sought more information about fire safety, people’s risk assessments, staff training and policies and procedures. We spoke with a local authority fire officer and received feedback from social workers involved in people’s care.

Updated 19 May 2022

Poppy Cottage Limited is a supported living service. The service provides personal care to people living in five supported living settings, so that they can live as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 18 people used the service and 12 people received support with personal care. The service was set-up to provide support to adults under and over 65 years, living with dementia, learning disabilities, mental health conditions, physical disabilities and sensory impairments.

Poppy Cottage Limited is also a domiciliary care service. The service informed us they had provided domiciliary care to people in their own homes in the community in the past, but were not doing so at the time of our inspection.

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

People's risks were not always assessed appropriately to identify or effectively reduce risk in areas such as fire safety, health, finances and safety of chemicals. Governance systems did not manage risks to people well, or ensure records were well managed.

People's care and support was provided in a safe and clean environment. Systems were followed to ensure people were protected from abuse and poor care. The provider reviewed incidents but this did not include themes or outcomes. We have made a recommendation about this. People and relatives told us they felt the service was safe and that staffing levels had improved. Medicines systems had generally improved, however we have made a recommendation about the management of medicines records and audits. Staff recruitment checks were completed before they started supporting people. We have made a recommendation about the recruitment records.

The service did not effectively meet two people’s hydration needs to maintain their health and wellbeing. Other people received effective support to monitor their nutrition.

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 did not consistently support this this practice. We have made a recommendation about this.

People's care, treatment and support plans were holistic. However, they did not always include enough information about identified needs or how to provide support. We have made a recommendation about this.

People were supported to be independent, pursue their interests and achieve their own goals. Staff protected and respected people’s privacy and dignity. People told us they staff were caring and treated them well. We have made a recommendation about how people prefer to be addressed.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: The service supported people to have the maximum possible choice, control and independence. This was not consistently supported by recorded best interest decisions.

Right care: Staff provided person-centred care and promoted people’s dignity and privacy. This was not consistently supported by documentation, which did not always demonstrate how people’s human rights were considered and upheld.

Right culture: People were at increased risk of harm because the provider did not manage risk well to protect people. There was a transparent and open and honest culture between people, those important to them, staff and leaders.

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 for this service was inadequate (published 22 September 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. The provider remained in breach of two of the regulations and we found a new breach of regulation. It was no longer in breach of other regulations.

This service has been in Special Measures since 8 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. The service is now rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poppy Cottage Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 will take further action if needed.

We have identified breaches of regulation in relation to risk assessment, good governance and meeting people’s hydration needs.

We issued a notice of decision to impose conditions upon the providers registration. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.