About the service Cabot House is a residential care providing accommodation and personal care to 9 people. The service specialises in providing support to people with complex needs, learning disabilities, autism and challenging behaviour.
People’s experience of using this service and what we found
Risks to people's health and wellbeing during the global pandemic of coronavirus were not consistently managed. People were exposed to the risk of contracting and spreading COVID-19 because the provider did not always follow government guidelines to keep people in care homes safe. This included guidelines on forming bubbles, isolation and visiting inside and outside the care home and infection control.
There were not adequate processes in place for assessing and monitoring the quality of the service. Systems had failed to identify that government guidelines and the providers own policies and procedures were not being adhered to. Processes were not in place to support safe visiting inside and away from the service. Staff were not always recruited safely.
Staffing levels were enough to meet people’s individual needs. People were supported by a consistent staff team who knew people well. Staff were kind and compassionate and interacted with people in a positive and person-centred way. People and their relatives told us they were happy with the service they received.
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.
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.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
• The model of care and setting maximised people’s choice, control and independence and measures had been taken by the provider to promote this. The service was part of a local community and there were local amenities and public transport options.
Right care:
• People received person-centred care and support which promoted dignity, privacy and people’s human rights. People’s needs and preferences were known and respected. People had access to meaningful occupation and opportunities to form friendships away from the service. People had access to assistive technology to promote their independence. The provider had taken measures to ensure the environment was homely and people’s bedrooms were personalised with photographs and personal effects.
Right culture:
• The ethos, values, attitudes and behaviours of managers and care staff ensured people led confident, inclusive and empowered lives. People were empowered to have choice and control over their lives. People consistently received person centred support to live meaningful and active lives. People had opportunities to form community connections and make choices about the support they received.
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 13 June 2019)
CQC undertook a targeted inspection of Cabot House on 3 November 2020. The inspection was targeted to look at how the service was preventing and controlling infection. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.
At the inspection on the 3 November 2020 there was a breach of regulations. The provider completed an action plan after the inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous 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.
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with how people were being supported to remain safe during the global COVID-19 pandemic, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cabot House on our website at www.cqc.org.uk.
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 have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to infection control, safe care and treatment and good governance.
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
After the inspection we wrote to the provider about some of the urgent concerns found during inspection. The provider sent an action plan that informed us of the immediate actions they had taken to address our concerns.
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.