Background to this inspection
Updated
13 July 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 23 March and 15 April 2015 and was unannounced. The service was inspected by one inspector and a specialist advisor whose specialism was learning disabilities and behaviours that challenge.
We usually ask the provider for a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We carried out this inspection at short notice so we did not ask for a PIR.
Before the inspection we looked at all the information we held about the care people received along with information from the local authority and safeguarding team. We looked at previous inspection reports and notifications received by the Care Quality Commission (CQC). A notification is information about significant events which the provider is required to tell us by law.
The three people who used the service were not able to tell us about their experience of the service so we used observations throughout the inspection to engage with them. We spoke with the head of care, the acting manager and three members of staff including an agency worker. People’s relatives or visitors were not available to speak to us. We had information from and spoke with, local authority case managers, commissioning officers community nurses, speech and language therapists, occupational therapists and the safeguarding team. We looked at records relating to two care staff, two care plans, medication records, staff rotas, training records, and policies and procedures.
The last inspection was conducted on 7 and 11 August 2014 when we found improvements were needed to meet regulations relating to care and welfare of people and supporting staff.
Updated
13 July 2015
This inspection took place on 23 March 2015 and we returned to gather further information on 15 April 2015 after the Easter break. Both inspection visits were unannounced.
At our last inspection of 7 and 11 August 2014 we found breaches of regulations in relation to care and welfare of people and in supporting staff. We followed up these breaches at this inspection and found that the breaches continued and that there were other breaches.
34 Lancaster Gardens is a service for up to 5 adults with learning disabilities. People were accommodated in two bungalows on the same site. At the time of the inspection a service was being provided to three people whose disability was severe and profound and all of whom had communication difficulties and behaviours that challenged. Two people were living in one bungalow and another person was living in the bungalow next door. This was on a temporary basis, while their room was being altered at another location run by the provider organisation.
An acting manager had been in place at the service since January 2015. There was no registered manager at the service; there had been no registered manager since 2 April 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Concerns were raised about the care people received at 34 Lancaster Gardens from the local authority safeguarding team; we responded by carrying out this inspection to assess whether people were receiving safe, effective, caring, responsive and well led care.
Not all risks to people had been recognised and assessed. Action had not always been taken to keep people safe. Risk assessments had not been reviewed and changed to make sure they were up to date and accurate. Regular checks of emergency equipment and systems had not been completed.
Staff knew how to recognise some of the different types of abuse and said they would report any concerns to the manager. They did not know how to report abuse to other agencies outside of the service. The manager did not understand their role in safeguarding and the provider had not reported all allegations of abuse to the local authority.
Restraint was not used appropriately and was not monitored to make sure it was used in line with legislation. People’s consent to the use of restraint was not sought or recorded.
There were enough staff on duty to meet peoples assessed needs and recruitment checks were carried out to make sure staff were suitable to work with people.
Staff did not have the competencies and knowledge to meet people’s needs and deliver care in the way they needed them to. Staff did not always have an induction and they had not all completed the required training.
Care plans and behaviour plans were not up to date and information was held in different places so was not easy to find. Despite the care plans being recently reviewed, information was not always accurate and did not reflect changes in people’s needs. Staff were following conflicting and out of date information.
Medicines were kept safely and administered correctly. Recommendations from health and social care professionals for referrals to the positive behaviour support team were not followed up. Health action plans were not up to date.
The provider did not make sure that people felt that they mattered and practical action was not always taken to relieve people’s distress.
People's nutritional and hydration needs were met but were not always monitored effectively.
People were not always involved in assessments of their needs and the planning of their care. Care plans did not include information on what people could do well or what their personal goals were.
People were not involved in decisions about the service and were not always treated with dignity and respect. People’s decisions about what they had to drink and when they had a drink were not always respected.
People were not supported to make a complaint. The complaints process was not in a format people could understand.
The service was not well led and the staff lacked the direction and support they needed to meet people’s needs and provide care safely.
When people lacked the capacity to make decisions the provider did not always follow the principals of the Mental Capacity Act 2005 to make sure that any decisions were made in the individual person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some DoLS applications were needed and had been made.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.