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
Foxley Lane is a residential care home providing personal care to 7 people at the time of the inspection. The service can support up to 8 people.
People’s experience of using this service and what we found
Right Support
The service did not always make sure people received care and support in a safe and clean environment. Risks to people’s safety had not been fully mitigated and people were at risk from infection and hygiene risks. Staff did not always support people with their medicines to achieve the best possible health outcome. Information about some of the medicines people took was not accessible to staff when required, which might have delayed when they received this. Records of medicines stock were not always accurate so staff could not be assured they had the right quantities in stock. However, we saw people received their prescribed medicines at the right time. The provider could not be assured staff supported people to achieve their aspirations and goals. Staff had not met regularly with people to assess and review people’s progress in achieving positive outcomes.
The service supported people to have the maximum possible choice, control and independence. The environment was well equipped, well-furnished and mainly well-maintained to support people to meet their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. People benefitted from the interactive and stimulating environment. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Right Care
People did not always receive kind and compassionate care. We saw staff did not always use positive, respectful language when interacting with people or when discussing people with others. Staff did not always engage with people when they were supporting them.
Staff understood people’s cultural needs and provided culturally appropriate care. Staff understood and responded when people needed space or privacy. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right culture
Staff turnover at the service had been high so people were not always supported to receive consistent care from staff who knew them well. The service lost a significant number of staff after it became a legal requirement for all care staff to be vaccinated against COVID-19. New staff were quickly recruited. However, new staff had not been given enough support to develop their knowledge and understanding of people and their needs so did not know people as well as they could. People’s quality of life was being impacted by some staff who did not demonstrate the values, attitudes and behaviours required to support this. The provider was addressing these issues with a programme of improvement aimed at supporting people to achieve positive outcomes in all aspects of the care and support they received.
People received the care and support they required as staff had been trained to meet their needs and wishes. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.
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 11/10/2019).
Why we inspected
We received concerns in relation to; poor leadership and management at the service, poor communication with relatives, poor staff culture, high turnover of staff, new staff poorly trained, staff slow to seek support for people with deteriorating healthcare needs and people not being engaged or stimulated. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. When we inspected we found there was a concern with the dignity and respect shown to people so we widened the scope of the inspection to include the key question of caring.
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.
We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
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 dignity and respect, safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from 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.