Background to this inspection
Updated
28 January 2020
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 team consisted of one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Victoria House 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 did not have a manager registered with the Care Quality Commission at the time of the inspection. A manager had recently been appointed by the provider to oversee the running of the home and had made an application to register. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.
Notice of inspection:
The inspection took place on the 5, 6 and 8 November 2019, the first day was unannounced
What we did:
Before the inspection we reviewed information, we held about the service, including notifications we had received. Notifications are changes, events or incidents the provider is legally required to tell us about within required timescales. We also asked the provider to complete a Provider Information Return (PIR). The PIR is information we require providers to send us at least once annually to give us some key information about the service, what the service does well and improvements they plan to make. We used this information to plan the inspection.
During the inspection
We spent time with three people living at the service, five members of staff, the manager who managed the home on a day to day basis and two senior managers. To help us assess and understand how people's care needs were being met we reviewed three people’s care records. We also reviewed a number of records relating to the running of the home. These included staff recruitment and training records, medicine records and records associated with the provider's quality assurance systems.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and updated copies of the service’s improvement plan. We sought views from relatives and asked the local authority who commissions care services from the home for their views on the care and support provided. We received feedback from four health and social care professionals and two relatives. We also contacted South Devon and Torbay NHS Foundation Trust's quality assurance and improvement team (QAIT).
Updated
28 January 2020
About the service:
S.S Care Limited, hereafter referred to as Victoria House, is a residential care home that provides personal care and support for up to six people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were four people living at the home and two people being supported in the community as extensive refurbishments were carried out to the basement flats.
People’s experience of using this service and what we found
People told us they were happy and felt safe living at Victoria House. We found the service was not operating in accordance with the regulation and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.
The provider did not have sufficient oversight of the service to ensure people received the care and support they needed that promoted their wellbeing and protected them from harm. Systems and processes to monitor the service were not effective and did not drive improvement. These included concerns with records, risk management, medicines, a lack of person-centred care, infection control and the environment.
The service did not 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.
Although the manager and staff demonstrated a strong commitment to the people living in the service and spoke passionately about providing good quality care. They did not always understand how their actions impacted on people’s privacy, dignity and/or human rights.
Whilst we did not find people were being disadvantaged, people were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible.
Staff told us they felt supported and appreciated by the manager. We found the service did not have an effective system in place for recording what training staff had received. This meant that neither the provider or manager could be assured that staff had the necessary skills to carry out their roles.
People told us they could make decisions about what they ate and drank and when and support plans contained clear information about what each person could do for themselves.
Staff who knew people well were familiar with people's different communication methods and how they made their wishes and needs known.
People were encouraged and supported to lead full and active lifestyles, follow their interests, and take part in social activities
People were encouraged to share their views through regular reviews and relatives felt comfortable raising complaints and were confident these would be acted on.
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 24 May 2017). Since this rating was awarded S.S Care Limited had been purchased by another healthcare provider. Whilst there had been no change to the legal entity there had been a complete change in the senior management of the service. We have used the previous rating to inform our planning and decisions about the rating at this inspection.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the need for consent, dignity and respect, person-centred care, recruitment, training, notifications, and governance. We have also made recommendations in relation to the environment.
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
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 of 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.
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 and continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.