8 May 2019
During an inspection looking at part of the service
43 Station Road is a care home which accommodates up to six adults with a learning disability or autism. At the time of our inspection four people used the service. The service was a domestic home. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service
People were not always protected from the risk of harm. Actions taken by the provider in response to behaviours that challenged were not always robust or effective to protect people from reoccurrences of these incidents. We have made recommendations about safeguarding training. Staff did not always follow safe medicine practices and people did not always receive their medicines as prescribed. Safe and robust recruitment procedures were used when people were employed. There were systems in place for the prevention of infection.
Systems were either not always in place or failed to identify areas requiring improvement and to mitigate the risks relating to the safety of people using the service. Contemporaneous records were not always held for people or for the management of the service. Leadership of the service had been inconsistent and staff reported low morale and a lack of support with managing behaviours that challenged the service. We have made a recommendation about the service business contingency plan. Staff were committed to people using the service and were beginning to feel more supported by the new leadership team. The service worked in partnership with health and social care professionals to meet people’s needs. The service was taking action to complete comprehensive quality assurance audits to drive improvement.
The service did not always (consistently) apply 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 because they did not always receive the support they needed for behaviours that challenge. For example, effective approaches to supporting people at times of crisis were not considered where this need was indicated.
Rating at last inspection
At the last inspection the service was rated Good (30 December 2018).
Why we inspected
We received concerns in relation to the management of medicines and people’s behavioural care and support needs. 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.
Enforcement
Please see the action we have told the provider to take at the end of this report.
Follow up
We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.