Imola

Updated 25 August 2021

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.

As part of this inspection we looked at the infection control and prevention measures in place. 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

The inspection team included two inspectors.

Service and service type

Imola 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 service had a manager newly 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

The inspection was unannounced. Inspection activity started with the care home visit on 12 July 2021 and ended on 22 July 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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

Two inspectors visited Imola on 12 July 2021. They met with the registered manager, the deputy manager, the area manager and eight care staff.

We reviewed a range of care records, including five people’s selected care and medicine records. We looked at three staff files in relation to recruitment, staff supervision and training. We reviewed a variety of records relating to the management of the service.

After the inspection

After the site visit, we continued to collect information from the provider. We also had a phone call with the registered manager, area manager and two directors of the company, one which was the provider’s clinical psychologist.

We had email or phone contact with four family members and five staff. We sought feedback from the local authority and professionals who work with the service and had contact with four health and social care professionals.

Updated 25 August 2021

About the service

Imola is a care home that provides care and support for up to eight people who have a learning disability or who are autistic and have complex support needs. At the time of the inspection there were eight people living at Imola.

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

We observed people engaging positively with staff who were committed to promoting their wellbeing. We received largely positive feedback from relatives, who spoke warmly of the support their family members received, particularly from established staff who knew people well.

There had been changes at Imola since our last inspection. There was a new registered manager, deputy and new care staff. The provider had systems in place to check the quality of care and of the accommodation, however these were not always effective. We had concerns around how well some risks were managed across the service, including poor infection control. The provider had also not submitted the notifications and safeguarding alerts to CQC and the local authority, as required.

There were not always enough experienced and skilled staff on each shift. Some families and staff told us this affected the quality of care people received. Prior to our inspection the provider had already started to take action to address staffing retention and practice.

The provider was open to our feedback and demonstrated a commitment to improving care and safety at Imola. They had set up workshops to promote people’s quality of life, which were positive and reflected a commitment to promoting person-centred care. Despite some concerns around infection control, the provider and staff had worked hard to promote people’s wellbeing during the COVID-19 pandemic. The provider engaged well with external professionals to make decisions in people’s best interests.

Staff knew what to do when they had concerns about people’s safety. The provider carried out investigations into safety concerns and incidents, making changes to people’s care as required. Individual risk assessments were personalised and provided practical guidance to staff.

People received support to take their medicines safely, and to reduce unnecessary use of medicines.

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 supported this practice.

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.

This service was able to demonstrate how they were working towards meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting maximises people’s choice, control and Independence. There is a demand for the type of service Imola provides as it enables people to move out of more restrictive accommodation, such as long-stay hospitals. The provider is working to ensure the property does not feel institutional and meets people’s sensory needs and preferences.

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights. People are treated as individuals and care is provided flexibly in line with their preferences. The provider works in line with guidance around Positive Behaviour Support to provide care which minimises restrictions to people’s freedom.

Right culture:

Staff and management seek to promote a positive ethos, values, attitudes and behaviours which enable people using services to lead confident, inclusive and empowered lives. High staff turnover has meant it has been challenging to establish a consistently positive culture.

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 30 April 2019).

Why we inspected

We received concerns in relation safety, a medicine error and the culture at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 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.

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.

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.

At this inspection we have identified breaches in relation to the lack of oversight and management of risk and in relation to the provider’s failure to send CQC notifications as require.

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 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.