Pathway House

Updated 8 October 2021

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was completed by one inspector.

Service and service type

Pathway House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection. -

During the inspection

We spoke with three people who used the service and four relatives about their experience of the care provided. We spoke with ten members of staff including the registered manager, deputy manager, senior support workers, support workers and the positive behaviour support lead for the service.

We reviewed a range of records. This included four people’s care records and medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 8 October 2021

About the service

Pathway House is a residential care home providing personal care to seven younger adults who may be autistic or living with a learning disability. The service can support up to 12 people.

People had their own bedrooms at the service and shared communal areas such as kitchens, lounges, bathrooms and gardens.

People’s experience of using this service and what we found

People were not always supported in line with their personal choices and preferences. Staffing levels at the service prevented people from following their preferred past times. People were not always being supported to communicate and understand information in ways that made sense to them. People’s home environment was not treated with dignity and respect. Several areas were visibly dirty and notices around the service gave it a feel of being a ‘care home’ rather than a service that had been personalised according to people’s choices. Staff did not always describe people with dignity and respect in records.

The service was visibly dirty in some areas and there was mouldy food in cupboards. Audits had not been effective in identifying these concerns. Other audits completed at the service had not been effective in picking up on the areas for improvement which we found at this inspection in areas such as incident reporting, staffing levels and person-centred care. People and relatives were not always asked for their feedback about the service. We have made a recommendation about collecting feedback about the service.

Improvements needed to be made to the way that incidents, including those where physical restraint was used, were recorded and reviewed. We have made a recommendation that the incident reporting procedure at the service be reviewed. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support 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.

Based on our review of safe, responsive and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staffing levels at the service prevented people from having maximum choice and control in their lives. People’s living environment was not always treated with dignity and respect. The service was in a remote location meaning having staff support to leave the service was essential, however staffing levels did not always allow this. The provider was taking action to mitigate this by reviewing their staff recruitment procedures and by the registered manager and deputy manager supporting people directly on shift to leave the service if they chose to do so. The registered manager was also ensuring that occupancy at the service remained low so that people could be supported in line with their personal preferences as much as possible.

Despite the areas we found to be needing improvement, people and their relatives were positive about the support at the service. One relative told us, ‘‘The service is the best place that [family member] has ever lived at. [Staff] really do care.’’

Staff were trained in safeguarding and knew how to report concerns. Risks to people had been assessed and plans were in place to mitigate risks as far as possible. Whilst staffing levels were impacting on people’s choices, there were enough staff to keep people safe. Staff, including agency staff were trained and understood how to support people. Staff were recruited safely in line with legislation. People were supported safely with their medicines. Staff followed effective infection control measures with regards to COVID-19.

Staff knew people well as individuals and knew what their likes and dislikes were. Support plans were very detailed and gave a clear overview of how to support people in line with their preferences. People were happy and relaxed being supported by the staff team. People were positive about how staff supported them to take part in preferred past times when this happened. A complaints procedure was in place and people and relatives knew how to raise concerns.

Feedback about the registered manager and deputy manager was positive. They were trying hard to instil a positive culture at the service which achieved good outcomes for people. The registered manager responded immediately to concerns raised at this inspection and gave us assurances that areas for improvement would be taken seriously and actioned. The staff team linked and worked with external professionals to help achieve good outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was good (report published 31 January 2018).

Why we inspected

We received concerns in relation to the care and treatment of people using the service in areas such as the management of incidents and being supported to achieve good health outcomes. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pathway 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person centred care, dignity and respect and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.