We last carried out a comprehensive inspection of Redstone House in July 2016 where we found the registered provider was rated ‘Good’ in each of the five key questions that we ask. This inspection took place on 06 December 2018 and was unannounced.
Redstone House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were not supported to live as ordinary a life as any citizen.
Redstone House in Redhill is registered to provide accommodation and personal care for up to four adults who have a learning disability. At the time of our inspection four people live here. The service is delivered from a two-story house in a residential area.
It is a requirement of the provider's registration that they have a registered manager in post. 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. The registered manager was present during this inspection.
This inspection had been bought forward as we had received concerning information about peoples care and support needs not being met. During the inspection we found a number of issues that needed to improve, however the care staff were seen to be kind and caring to people.
We found areas that required improvement across all five of the key questions that we ask during an inspection (Is the service safe, effective, caring responsive and well led?). In total we have identified seven breaches in the regulations.
The breaches were around managing risks to people, while minimising the impact to their independence; not having enough staff at all times to meet people’s needs; the safe management of medicines; not providing care and support that met people’s needs and preferences; not providing information in an accessible format; failing to carry out maintenance to the home environment in a timely manner; and not having quality assurance processes that promoted continuous improvement.
The provider had not ensured the home was well led. Staff were focussed on giving day to day care, however little structured and documented work had been completed to improve people’s lives. All the people who live at the home had some form of behaviour that may challenge themselves or others. This meant that they required one to one, or even two to one support at times of the day. The providers failure to promote continuous improvement meant that although these behaviours were known and documented when they happened, people had not been supported to overcome them. The records of accidents and incidents had not been reviewed to try to reduce the risk of repeat concerns arising.
The providers quality assurance processes were not effective at ensuring areas for improvement that had been identified were actioned in a timely manner. Maintenance issues such as exterior doors not being able to be locked had taken months to fix leaving people at risk as the house had not been secure.
Redstone house did not provide a consistently safe standard of care. There were risks to people’s health and safety because behaviours that may challenge had not been well managed. Although incidents had been recorded no structured approach had been taken to try to help people manage and overcome behaviours. Risk management also had an impact on people’s independence as they were restricted from doing things themselves because staff had failed to investigate less restrictive options. For example, using small jugs, and small kettles/coffee pod machines to enable people to make their own drinks in a safe way, rather than staff having to step in and help. Guidance from health care professionals had also not been consistently followed effectively, or sought to help people overcome behaviours that impacted their lives.
Levels of staffing were not always adequate to meet people’s needs. Prior to the inspection we received information that a lack of staff had impacted people’s care and support. During our inspection, we identified times where people were at risk, or their activities delayed due to the deployment of staff. For example, a staff member supported one person to go to college, however this meant the other three people had to wait for them to return if they want to go out, due to their behavioural support needs.
People were not always supported to take part in activities that interest them. Where activities had ceased, due closure of a service, or people’s behaviours meant they were excluded, alternatives had not been sought. Activities planners did not reflect the activities (or lack of) that people had access to. Care plans were basic and contained little information about the person as an individual, such as their goals and aspirations for their life. No information or guidance for staff had been obtained to ensure that peoples preferences and choices were know should they approach the end of their lives.
Peoples medicines were managed in a safe way and they received them when needed. However, staff did not always know what the medicine was for, or the possible side effects. They did know they could look in a person’s care file if they needed the information, such as should a person have an unexpected reaction after taking medicine.
Staff had the skill and training to meet people’s needs, although there were some gaps, and out of date training identified. The provider had already identified this and was taking action to give staff the training they needed.
There was a complaints process in place, however this was not in a format that would make it easy for people to understand. Everyone we spoke or interacted with was happy with the service, and no complaints had been recorded in the complaints file. There were three positive comments in the compliments file from relatives.
People were supported to have enough to eat and drink. People had access to health care professionals when the need arose, as well as for routine check-ups to keep them healthy. Where people lacked the capacity to make specific decisions, staff understood and followed the requirements of the Mental Capacity Act 2005. This ensured that decisions made for people in their best interest and any restrictions put into place to keep them safe were done in a lawful way.
Despite the issues we found during the inspection we did see that people were supported by kind, caring and friendly staff. People formed caring relationships with staff and enjoyed their company. People were supported to maintain relationships that are important to them.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
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. 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.
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