Archived: Angela House

Updated 9 August 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector.

Service and service type

Angela House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 manager was not yet registered with the Care Quality Commission. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons are legally responsible for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the provider a days’ notice of the inspection site visit because it is a small service. We needed to be sure that someone would be in to support us with the inspection process.

What we did before the inspection

Before the inspection took place, we reviewed information we held about the service. This included the provider’s improvement plans and notifications which providers or others send us about certain changes, events or incidents that occur and which affect the service or the people who use it.

We used all of the above information to plan our inspection.

We did not ask the provider to complete the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. The provider was given the opportunity to discuss their plans for the service during this inspection.

During the inspection

People using the service could not let us know what they thought about the home because they could not communicate with us verbally. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at the following records

Notifications we received from or about the service

Three people’s care records and related information including daily notes and medicines records

Records of accidents, incidents and complaints

Meeting minutes

Four staff recruitment records and related supervision and appraisal documents

Training data

Policies and procedures

Audits and quality assurance reports

Health and safety records

We spoke with

A support worker, a deputy manager, an HR officer, the service manager and a director of care and support

Following the inspection, we spoke with

Two relatives

Two healthcare practitioners and an advocacy worker.

We contacted but did not hear back from two health and social care professionals based within the Hammersmith and Fulham Learning Disability Team.

Updated 9 August 2019

About the service:

Angela House is a care home registered to provide care and accommodation for up to six adults with a learning disability or an autistic spectrum disorder. At the time of this inspection there were three adults living at the service. The accommodation comprises a communal lounge, kitchen diner and communal bathrooms and toilets. Bedrooms do not have en-suite facilities.

People’s experience of using this service:

The service didn’t always 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.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the reasons outlined below:

People were not always supported to have maximum choice and control of their lives.

Staff were not always supporting people in a kind or caring manner. We witnessed abuse taking place. These concerns are currently being investigated by the local authority safeguarding team.

Risks to people's health and wellbeing were not always being assessed, mitigated or reviewed appropriately. This impacted on people’s safety and dignity.

Staff were not always supporting people in the least restrictive and safest way possible.

People were at risk of harm because staff were not always following guidelines and recommendations provided by healthcare professionals.

Incidents were not being referred to safeguarding authorities as required to ensure a thorough investigation was completed and people were protected from harm.

The environment was poorly adapted and failed to meet people’s needs appropriately.

Opportunities to observe, review and adjust care practice were being missed.

The provider's systems for assessing and reviewing the quality of the service were not always effective. Improvements to the service and how it was managed were overdue.

The previous inspection rating was displayed in line with CQC requirements.

Rating at last inspection and update:

The last rating for this service was requires improvement (report published 8 August 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made to the specific issues we identified in relation to the safe storage of medicines, sharp knives and COSHH (Control of Substances Hazardous to health). However, we found repeated breaches of the regulations in relation to risk management and medicines management.

Why we inspected:

This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we had found at our previous inspection.

Enforcement:

We have identified repeated breaches of regulations in relation to safe care and treatment. We found further breaches related to person-centred care, dignity and respect, safeguarding, premises and equipment, good governance and failure to notify. Please see the action we have told the provider to take at the end of the full version of the 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.

We made a recommendation in relation to home improvement and relocation plans.

Follow up:

We will contact 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.

Special Measures:

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