Archived: Inglewood House

Inglewood House provides accommodation and personal care for up to 12 people who have a learning disability and autism. At the time of our inspection, there were 9 people living at the service. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

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. We considered this guidance as there were people using the service who had a learning disability.

Right Support: Care plans were not always up to date or reflective of people’s current needs. However, staff we spoke with did have an understanding of the support people needed. There was limited information on people’s life histories and there was a lack of monthly key worker meetings. The audits at the service were not always robust and did not identify some of the concerns we found. Health care appointments were not always followed up or care records updated to reflect health care information. We have made a recommendation around this.

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.

Right Care: Staff treated people with dignity, courtesy and kindness. They respected people’s choices and encouraged people to live independent lives. People told us they had developed positive and supportive relationships with staff. Risks associated with people’s care were managed in a safe way. People’s medicines were reviewed regularly and managed well.

Right Culture: Staff and the management team showed a dedication to support people appropriately. People and their families fed back they felt the management team was supportive and listened to their views. Complaints were listened to and acted upon.

Rating at last inspection

The last rating for this service was inadequate (published 20 May 2022). We also undertook a targeted but not rated inspection (published 09 November 2022).

Why we inspected

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

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective, responsive and well-led sections of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Inglewood House provides accommodation and personal care for up to 12 people who have a learning disability and autism. At the time of our inspection, there were 11 people living at the service. The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

Right Support:

The provider could not show how they met the principles of Right support, right care, right culture. This meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Right Care:

The model of support did not promote maximum choice and independence. The ethos, attitudes and behaviours of managers and staff did not ensure that people lead confident inclusive and empowered lives.

Right culture:

The provider did not focus on people's quality of life, and care delivery was not person centred. Staff did not recognise how to promote people's rights, choice or independence.

People were not protected from abuse from staff. There were not sufficiently trained or supervised staff to safely meet the needs of people. Incidents of behaviours were not always recorded in sufficient detail to look for trends and themes. Staff were not always kind and respectful towards people.

People were not protected against risks associated with their care. Health care professional advice was not always being sought in relation to people’s care. Staff were not following the principles of the Mental Capacity Act 2005. There was a lack of management and provider oversight to review shortfalls of care to make improvements.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. We received concerns prior to the inspection related to people not being protected from abuse and unsafe care being delivered to people.

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.

We have identified breaches in relation to people not being protected from abuse, safe care and treatment and the lack of trained and appropriately supervised staff. We also identified breaches in relation to the staff not being caring and respectful, lack of meaningful activities, consent to care not being appropriately sought, complaints not being responded to and lack of robust management and provider oversight at this inspection.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inglewood House is a residential care home providing personal care to up to 12 people. The service provides support to people with a range of learning disabilities including people living with autism. At the time of our inspection there were nine people using the service. The home supported all people in one adapted building.

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.

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

This was a targeted inspection that considered safeguarding, infection control, staff training and how information is shared.

Right Support: 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.

Right Care: People were not always supported where there was a safeguarding concern. There had been a recent incident that had not been dealt with appropriately. This meant people had been left at risk of further safeguarding concerns for longer than necessary. Following this incident further training and support had been given to the staff team.

Right Culture: Information had not always been shared in a timely way. This was not in line with the culture of the home to include other professionals in significant events to ensure a good level of care for the people living in the home.

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 (published 25 May 2022) and there were breaches of regulation. CQC have met with the provider and the local authority as part of the location entering ‘special measures’. We only looked at specific areas at this targeted inspection which only included one of the previous identified breaches of safeguarding service users from abuse and improper treatment. At this inspection we found the provider remained in breach of this regulation.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained harm. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of safeguarding, reporting and training. This inspection examined those risks.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating

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.

The provider has taken action to mitigate the risks, however, at this early stage we are unable to confirm if this is effective.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Inglewood House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

At the last inspection we recognised that the provider had failed to deliver person-centred care, treat people with dignity and respect, ensure people always gave consent, deliver care and treatment safely, safeguard service users from abuse and improper treatment, acting on complaints, have good governance and have adequate staffing at the home. These were breaches of regulations 9, 10, 11, 12, 13, 16, 17 and 18. Full information about CQC’s regulatory response to this 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review. The service has existing conditions on their registration, and as we do not propose to cancel the registration, we will monitor the provider’s monthly submissions. We will reinspect within six months of the last comprehensive report (published May 2022) 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.

Inglewood House provides care to people that have a learning disability most of whom have a physical disability. There were 12 people living at the service at the time of our inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 12 people. This is larger than current best practice guidance. However. the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. 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 out with people.

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

Relatives fed back that at times there could be more activities in the service. However, we did see that people were able to take part in activities outside of the service. Care plans were detailed and person centred to the needs of people. The registered manager was passionate about providing good end of life care to people.

People care was provided in a safe and effective way. The environment was set up to ensure that people could access the home regardless of their disabilities. Bedrooms were personalised with the things that were important to people.

Staff were kind and caring towards people and encouraged them to be independent where possible. Training and supervisions were provided to staff and additional training was sought around people’s particular health conditions.

People liked the food at the service and staff ensured that people had enough to eat and drink. Where there were any concerns with people’s health staff consulted health care professionals.

Relatives and staff said that the leadership at the service was good and that they felt supported. People were given opportunities to feedback how they wanted their care to be delivered. Audits regularly took place to look at the quality of care.

Rating at last inspection

At the last inspection the service was rated Good (the report was published on the 10 November 2016).

Why we inspected

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living in Inglewood House were safe. Staff working in the service had received safeguarding training and understood the provider’s procedures for protecting people from abuse. People’s risks of avoidable harm were reduced as a result of risk assessments. The provider’s recruitment procedures were robust and there were sufficient numbers of staff to support people safely. People received their medicines safely and staff protected people by employing effective infection control measures.

People received effective care delivered by trained and supervised staff. Staff received training to meet people’s specific needs and met regularly with the manager to discuss their delivery of care and support. People consented to their care and their rights under legislation were upheld. People ate well and those who required support to eat had assessments and care plans to ensure they swallowed food and drink safely. People were supported to access health and social care professionals in a timely manner.

People were supported by kind and caring staff. People were treated with dignity and respect and their privacy was protected. People who were approaching the end of their lives were cared for in a compassionate and person centred way.

People’s needs were assessed and care plans were written to guide staff how to meet them. People had person centred plans which detailed their individual preferences. People chose the activities they participated in understood how to make a complaint if they had any concerns.

The manager demonstrated an open management style and staff felt supported. The quality of care being delivered to people was robustly audited. There were systems in place to monitor, review, and make improvements to the service. The service worked in partnership with health and social care professionals.

Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff communicated well with each person and had a good rapport. One person told us "the staff here are lovely - we have a laugh and it is fun". Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television, playing with the dog and interacting with each other. During our inspection we observed several people getting ready to go to college and other people preparing drinks and food in the kitchen.

One person told us "I like living here. I like the whole place - the staff are nice and they talk to me. I wouldn't change anything".

Staff we spoke with told us "I love my role and am very happy. It is nice because it doesn't feel like a job". Another member of staff said "I am very passionate about what I do. It is important that I ensure I deliver the best service possible".

We inspected the home to see if people that used the service were provided with opportunities to make decisions about their support, care and daily lives. Some people were able to describe how they were involved in making decisions, others needed support from staff. As some people were not able to tell us about their experiences, we used an observation tool called the Short observation framework for inspection (SOFI). The SOFI tool allowed us to spend time watching what was going on in a service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We saw that people that used the service had care records, plans and assessments of their care needs in place. All the records we looked at had been reviewed. This meant that records were up to date and reflected people's current needs.

Staff we spoke with knew how to report suspected abuse and how to protect people. They confirmed that they had received the training they needed to provide people with the support they required.

Complaints procedures where in place, people we spoke with told us that they had no concerns about the care and support they received.