31 May 2019
During a routine inspection
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