Nutbush Cottage

Updated 27 January 2024

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 Health and Social Care Act 2008.

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 was carried out by 2 inspectors.

Service and service type

Nutbush Cottage is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Nutbush Cottage is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The current manager had applied to register with CQC but had withdrawn their application prior to the full assessment being completed. They informed us they intended to re-apply at a later date.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from the local authority and professionals who work with the service. We used this information to plan our inspection.

During the inspection

We spoke with 1 person and 2 relatives about their experience at Nutbush Cottage and received feedback from 3 professionals. For those people who were unable to provide verbal feedback about the support they received we observed their interactions with staff and each other throughout the inspection visits. We spoke with 7 members of staff including the provider, senior management team, the manager and care staff. We reviewed a range of records. This included 4 people's records relating to their care, finances and medicines. We looked at 3 staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, including, audits, policies and procedures were reviewed.

Updated 27 January 2024

About the service

Nutbush Cottage provides accommodation and personal care for up to 4 people who have a learning disability and/or autistic people. At the time of our inspection, there were 4 people living at the service.

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

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.

Right Support: People were not supported to develop ways to reduce their anxiety and distress in situations they found difficult. Robust safeguarding processes were not followed which meant people were not fully protected from the risk of potential abuse. Risks to people’s safety and well-being were not always recognised or acted upon.

People had limited opportunities to do things they enjoyed or develop interests and did not benefit from an interactive, stimulating environment. People spent long periods of time in their rooms, walking around the house, watching films or listening to music. Staff had not explored people’s communication needs or developed plans to support people in being more involved in their own care and support.

Improvements had been made in the way medicines were managed and safe systems were now in place. People were generally supported by sufficient staff who were recruited safely. The building of an office in the grounds of the home had led to a decrease in one person’s anxiety. People lived in a clean and comfortable environment.

Right Care: People were not always treated with dignity and their privacy was not always protected although some individual interactions with staff were kind. Staff did not demonstrate an understanding that Nutbush Cottage was people’s home and did not always treat people as equals. People were not involved in the running of their home in a meaningful way and choices in respect of meals and how to spend their time were limited. People were not always supported to develop skills and independence.

Although improvements had been made to the monitoring of healthcare appointments, advice provided from healthcare professionals was not always followed and staff were not fully aware of people’s healthcare needs.

Right Culture: The ethos, values, attitudes and behaviours of leaders did not support people to lead confident, inclusive and empowered lives. The provider had failed to develop a skilled staff team who understood how to support people in a person-centred way. The principles of the Right Support, Right Care, Right culture guidance was not embedded into the culture of the service and audit systems were not in place to monitor this.

A task based approach had developed which did not focus on supporting people to live fulfilled lives. This has not been identified by the manager, as there was a lack of provider oversight and support for the manager.

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 inadequate (6 July 2023) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence 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.

The overall rating for the service has remained inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to people not being protected from abuse; people not always receiving safe care and treatment and staff not having the appropriate training to meet people’s needs effectively. We also identified breaches in relation to the staff not always being caring and respectful, people not being supported to do things they enjoyed, people not receiving personalised care and a lack of robust management and provider oversight.

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 remains 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.