Summary:We expect¿health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right¿support, right care, right culture’ is the guidance CQC¿follows to make assessments and judgements about services supporting¿people with a learning disability and autistic people and providers must have regard to it.
About the service
Matthew Residential Care Ltd – 59 Woodgrange Avenue is a small care home which is registered to provide care and support to three people with learning disabilities autism or who have complex needs associated with their mental health. At the time of the inspection there were three people living at the service.
People’s experience of using this service and what we found
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
The service did not effectively support people through recognised models of care and treatment for people with a learning disability, autism and behaviours that challenge, such as positive behaviour support approaches (PBS). As a result, whilst we saw features of positive support, including choice, participation, and inclusion, these were not firmly embedded. People did not have maximum choice and control of their lives because the service did not embrace a PBS approach in its entirety.
Right care:
People’s behaviour indicated that they found the environment challenging. However, we observed the environment was not fully adapted to match people’s needs. Functional assessments had not been carried out to understand the function of people’s behaviours. Therefore, without a comprehensive understanding of people’s needs, care was not always person-centred.
Right culture:
There were signs that suggested the service was at risk of developing a closed culture. Staff and managers had not received training in managing behaviours that challenge or PBS. There were limited interventions designed to help people cope with challenging environments. The absence of communication plans and strategies to ensure the environment was predictable to people increased people’s dependence on staff for their basic needs.
The failure to fully meet the underpinning principles of Right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.
We made recommendations on the management of people’s finances, building people’s skill, promoting equal opportunities, and partnership work.
People were not always supported to have maximum choice and control of their lives and staff did not always supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.
Although people told us they were safe, we were not satisfied the service was set up to respond to their needs appropriately. The service did not support people through recognised models of care and treatment for people with a learning disability or autistic people.
When restrictive practices were used, the service did not have a reporting system in place to ensure reviews were carried out to try and reduce the use of these practices.
The environment was not fully adapted to respond to people’s needs. Several environmental factors, including opportunities for meaningful activities had not been adapted to meet people’s needs. People did not always take part in activities as planned.
People were not always protected from financial abuse. The service did not demonstrate sound financial management practice. Whilst we did not see evidence of financial dishonesty, people were not supported with their finances in ways that reduced the potential for abuse.
There was lack of input from a multi-disciplinary team to build core skills and competencies, including designing and implementing behavioural support plans. Staff did not have necessary skills and resources to implement behavioural support, even low-level interventions. Managers did not always ensure staff had relevant training, supervision and appraisal.
The governance processes did not help the service to always keep people safe, protect their human rights and provide good care, support and treatment. Whilst there were a range of factors as identified in the report, the lack of resources including specialist input to support a recognised model of care for people with a learning disability who displayed behaviours that challenged was significant.
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 Good (published on 11 April 2019)
Why we inspected
We received concerns in relation to the management of risk, staffing levels, staff training, the management and leadership within the service and people’s personal care needs. A decision was made for us to inspect and examine those risks.
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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive 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 Matthew Residential Care Ltd – 59 Woodgrange Avenue on our website at www.cqc.org.uk.
Enforcement
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 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 regulation in relation to safe care and treatment, safeguarding people from abuse, staffing, consent, dignity and respect, person centred care and governance. Please see the action we have told the provider to take at the end of this report.
At the time of the inspection the service had enlisted input from a consultancy company, and we saw that an improvement plan had been developed, which broadly mapped ways to address identified risks. On the second day of the inspection, there was evidence improvement work had commenced.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.