Tithe Barn is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.Tithe Barn provides accommodation and personal care for up to thirteen adults who have learning difficulties and may also autism and/or have behaviour that may challenge. Some people had sensory impairments, epilepsy, limited mobility and difficulties communicating.
The home is split up into five shared flats.
The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. There was a risk the size of the service had a negative impact on people.
The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, independence and inclusion. The outcomes for people at Tithe Barn did not reflect the principles and values of Registering the Right Support. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interest. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. People with learning disabilities and autism living at Tithe Barn were not supported to live as ordinary a life as any citizen.
People's experience of using this service
The management and staff had not supported an empowering, inclusive culture.
People were not treated with dignity and respect. The language and actions of some staff was disrespectful and at times allegedly abusive. The local authority safeguarding team were investigating, and the investigations have not yet been concluded.
People were not always safeguarded from abuse and improper treatment. The registered persons failed to consistently ensure people were protected from avoidable and intentional harm. Some incidents had not been reported to local authority safeguarding team when they should have been. Individual risks to people had not been fully identified and mitigated.
People were not being supported to be as independent as they could be with their daily activities. There was lack of choice and people were controlled by staff. People were told what they could do and when they could do it. The kitchen doors in the flats were locked so people who were able to with staff support could not freely help themselves to drinks and snacks. People said if they wanted drinks or snacks outside meal and drink times they had to ask permissions from the staff. Apart from one person, people were not supported to choose what they wanted to eat and were not able to choose the activities they wanted to do. These decisions were made by staff.
People's health needs, such as constipation and epilepsy, were not always being met effectively. When people's fluid intake was monitored this was not accurately recorded to make sure they were drinking enough. People did not always receive personalised care. Some people's communication needs were not met in a personalised way.
Medicines were not managed as safely as they should be. Medicines delivered to the home had not been booked in correctly. Medication temperatures were not consistently monitored. Medication keys were not kept secure. People’s ‘when required/’PRN medication protocols were not giving staff clear instructions as to when they should be administered.
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Some of the staff working with people did not have suitable skills, understanding and values to work with people. These concerns had been identified at staff meetings, but no action was taken by the registered persons. Staff continued to work with people in a controlling, disrespectful and restrictive ways.
Staff told us that they had made complaints to the registered manager about the way people and they were being treated but their concerns had not been taken seriously and no action had been taken.
Action was not taken to learn lessons and improve the service people received when things went wrong.
People were not involved in planning their care and support in the way they would have preferred.
The governance arrangements including the checks and audits had not picked up the range of issues found at the inspection. The culture of staff being in control had not been identified and addressed, so it continued. The home environment was not always clean, and measures were not in place to prevent the spread of infection.
There was a lack of oversight and scrutiny by the registered provider and senior management. This had led to unsafe risks and care for the people living at Tithe Barn. Systems for checking and improving the quality of care and support people received did not identify concerns and affect change. Concerns relating to keeping people safe, protecting them from abuse, minimising restrictions upon people, the staff culture and oversight of the care and support people received to stay safe, had not been recognised, identified and improvements had not been made.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tithe Barn on our website at www.cqc.org.uk.
The last rating for this service was Good (The last inspection report was published on 17 January 2019).
Why we inspected
The inspection was prompted due to whistle blowing concerns received about the restrictive and controlling culture of the staff. A decision was made for us to inspect and examine those risks.
The provider has taken action to mitigate the risks and we are monitoring the service to ensure the action the provider is taking is effective.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to failing to protect people from avoidable harm, failing to effectively risk assess, failing effectively monitor the service, failing to safeguard people, failing to provide person centred care, failing to ensure competent and trained staff were deployed at this inspection, failure to supervise and monitor staff and failing to submit statutory notifications to CQC.
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 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.
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.