Archived: Quince House

Updated 17 December 2019

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.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Quince House 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

This inspection was unannounced and was carried out on 11, 20 and 23 September 2019.

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 the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke two members of staff, an agency staff member, the deputy manager and the registered manager. 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 reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with a relative and social care professionals who regularly visit the service.

Updated 17 December 2019

About the service

Quince House accommodates six people with learning difficulty in one adapted building. At the time of our inspection five people were living at Quince House.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons lack of choice and control, limited independence, limited inclusion. People were not supported to develop independence, access the community and express their choices.

People were exposed to risk of harm in case of fire because the provider failed to ensure they appropriately assessed the risk of a fire and completed actions in a timely way to ensure appropriate fire protection and detection was in place. Fire Marshall training was not provided for staff responsible for running a shift in the home although this is required by

Risk assessments were not always developed and individualised for people without giving staff specific guidance in how to mitigate risks and keep people safe.

People were not always protected from the risk of infections as the environment was not well maintained and in high risk areas like the kitchen the floor and kitchen units had not been replaced when damaged.

People were at risk of social isolation because there were not enough staff employed. Funded one to one support was not always provided to people, people`s holiday was cancelled. Arrangements were not in place to ensure people could access the community and engage in meaningful activities.

Care plans were developed, however these were not effectively reviewed to evaluate if people achieved positive outcomes. Positive behaviour plans were not developed to fully address areas where people needed staff`s support to prevent behaviours that challenged them and others.

Processes to learn lessons when incidents or mistakes happened were not embedded within the culture of the staff team. Where incidents had occurred within the service, these had been documented within the care records but then not discussed as a team or reported to safeguarding authorities.

Staff were not offered opportunities to further develop. Champions roles were being developed within the service which would enable staff to have additional training in a specific area, such as safeguarding, mental capacity or learning disability. The training for these roles were all occupied by only one member of staff.

Governance and performance management was not always reliable and effective. There was a lack of clarity around the governance arrangements and authority to make decisions. The registered manager had no delegated responsibility from the provider to make decisions where a cost was involved. This had to be approved and arranged by the provider and some actions were outstanding since 2018.

Governance systems were not developed or used effectively to identify and improve the concerns we found in this inspection. The provider failed to ensure appropriate management arrangements were in place when the registered manager was absent for more than 28 days from the service.

Following the inspection, we reported our concerns to the Local Fire Service, Environmental Health and the Local Authority and Clinical Commissioning Group.

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 requires improvement (published 24 October 2018). After this inspection we met with the provider to discuss what they were planning to do to improve. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received from the Local Authority about the lack of appropriate care and support people received. Concerns about people`s dietary needs not being met, and people not being supported to access the community due to lack of staff. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. 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.

Enforcement

We have identified breaches at this inspection in relation to safe care and treatment, staffing, person centred care, consent to care, safeguarding, environment and equipment, governance, and not submitting notifications for incidents in a timely manner.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.