Archived: Gypsy Corner (Registered Care Home)

Gypsy Corner is care home providing personal care for three people with autism, cerebral palsy and acquired brain injury. People who use the service may have additional needs and present behaviours which can be perceived as challenging. There were three people using the service at the time of the inspection.

There was no registered manager in post at Gypsy Corner. 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.’ When the Lifeways quality team had completed an internal audit in January 2017 a number of concerns had been identified and the registered manager had left the provider’s employment one month prior to the inspection. A manager from another Lifeways service was providing management support at Gypsy Corner. However, staff told us this was minimal and they would only have a manager on site for approximately an hour a day. Staff said they could telephone the acting manager if they required further support but felt this was not the same as having somebody present in the service. The area manager told us a new manager had been recruited and would be commencing their role the day after the inspection.

The Local Authority had completed a visit to the service and found concerns relating to people’s safety. A number of concerns had also been raised from an inspection of another Lifeways service which had been managed by the same registered manager. Our inspection highlighted shortfalls where a number of regulations were not met and improvements were required.

People did not always receive a service that was safe. Although staffing levels appeared to be safe, staff informed us there was an increased use of agency staff who did not always know the needs of people living at Gypsy Corner. Not all risk assessments were adequate or contained sufficient levels of information to enable staff to provide safe care and treatment. Medicines had not always been managed safely. There were a number of missed signatures on Medicine Administration Record (MAR) charts and two cases where medicine had been miscounted by the staff. The infection control practices in the home were not adequate. People were not always protected from hazardous substances as the laundry room had been left unlocked where several hazardous chemicals were kept. The environment was not always maintained to ensure the safety of the people living at Gypsy Corner was always maintained. Fire safety checks were not occurring regularly and people’s emergency evacuation plans (PEEPs) had not been reviewed. Staff demonstrated a good understanding of safeguarding and felt confident to report any concerns to management or external agencies. Recruitment practices at Gypsy Corner were safe and ensured suitable people were employed at the home.

People were not receiving effective care and support. Staff training had lapsed in core areas. People’s nutritional needs were not always clearly detailed in their care plans and where people needed their weight to be monitored; there were no clear guidelines around this. Health action plans had not been followed up to reflect staff had followed guidelines from health professionals. Staff supervision had not always occurred as per the provider’s policy. Where supervision had taken place, the notes from these were brief and it was difficult to understand the context of the discussion. Everyone at Gypsy Corner had an assessment of their mental capacity and Deprivation of Liberty Safeguards (DoLS) applications had been made to the relevant authority. People had been given the opportunity to personalise their living environment.

The service was not always caring. We could not be satisfied people were always treated with dignity and respect. There were no care plans referencing people’s behaviour. Despite this, behavioural charts were kept but there was no information as to details what the recordings in these charts stood for. People had end of life care plans which clearly reflected their wishes and preferences. Relatives spoke positively about the staff at the home.

The service was not always responsive. People’s care plans were not always person centred and did not provide sufficient detail to enable staff to provide safe care and treatment to people. People had sufficient activities to support them to lead an active and fulfilling life. Complaints had been dealt with in line with the provider’s policy.

The service was not well-led. There was no registered manager or team leaders at the time of the inspection. The majority of the staff we spoke with stated communication between management and the staff was poor and this had resulted in low staff morale across the majority of the staff group. Quality assurance checks and audits being were inconsistent and this had led to several shortfalls across the whole service. The confidentiality of people living at Gypsy Corner had not always been maintained. We found a number of files containing personal information being stored in an unsecured location.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Following our inspection, the provider for this location submitted an application to cancel the registration to provide a regulated activity at Gypsy Corner. We will be following our processes to de-register the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

The care we observed took into account what staff knew about people's preferences and needs. We saw increased communication and interaction between staff and the people living at the home. We saw that the availability of activities had improved. Staff told us they were trying to be more creative with in-house activities such as skittles, playing with balloons and painting.

We reviewed the care records for two people and found a clear system for recording people's daily activities. There was more active monitoring of people's behaviour and support needs. The care records contained useful information on people's preferences and needs. There was also a communication passport to give staff more information on how a person communicated and about important people, places and past events.

We reviewed the administration of medication. Staff were supported with relevant policies. Medication paperwork had been rationalised and only included current information. Medication reviews had been completed for each person and best interests decisions had been revisited. All staff had current training and had received a medication competency assessment.

People were consulted about their care and safeguards were in place to ensure their best interests were met when they could not make a decision independently.

We observed some very good care and received positive feedback from relatives such as 'They wouldn't be there if I wasn't happy with it'. We also observed that in some instances, care plans were not followed and staff seemed unfamiliar with people's preferences. Some opportunities to interact were missed and some people had lost skills they previously had. Relatives and the manager attributed this to high staff turn over.

Although medicines appeared to be administered safely and staff understood the processes in place, reviews of how medication was administered and the medication that people were taking were not being reviewed as per the company medication policy or the review dates in each person's care record.

The service had implemented a training record and an appraisal schedule following our last inspection.

We found that the service had not yet found a way to get feedback on quality from people living in the home. One relative was negative about communication whilst another was neutral. Other quality assessments systems were in place.

We saw positive care during our inspection although there were instances when people were not as involved in decisions as they could have been. Staff were knowledgeable about the needs of the people living in the home but we could not see evidence of ongoing reviews to ensure these hadn't changed. The manager was working to improve how staff sought to increase the independence of the people living at the home. People felt comfortable with staff and interactions were appropriate.

Staff were happy with the training they received and felt well supported. We were told by staff that 'this is a lovely place to work'. However, we found the system for recording training to be lacking as it was not clear what training was outstanding for each member of staff.

Staff were knowledgeable about identifying and reporting abuse and there were systems in place to protect people living in the home. Systems were in place to monitor quality but there was little evidence that the people themselves contributed to this. The environment in the home was pleasant and well planned.