Background to this inspection
Updated
3 August 2022
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 Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by two inspectors.
Service and service type
Adrian Lyttle - Sutton Coldfield 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.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post.
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.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We met and spoke with six people who used the service. We also spoke with seven relatives and two health care professionals. We used a range of different methods to help us understand people's experiences. Some people were unable to tell us their experience of their life in the home, so we observed how the staff interacted with people in communal areas. 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 spoke with six members of staff, including care co-ordinator, care staff, the registered manager and the provider.
We reviewed a range of records. This included four people's care records and five people’s medicine records. We also reviewed the process used for staff recruitment, records in relation to training, the management of the home including audits.
After the inspection
We continued to seek clarification from the registered manager to validate evidence found. We looked at training data, monitoring records, policies and procedures and quality assurance records. We spoke with two professionals who support people using the service.
Updated
3 August 2022
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 autistic people and providers must have regard to it.
About the service
Mr Adrian Lyttle – Sutton Coldfield is a residential care home registered to provide personal care for up to nine people with learning disabilities. At the time of the inspection there were eight people using the service.
People’s experience of using this service and what we found
The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support.
Right Support
The service did not support people to have the maximum possible choice, independence or have control over their own lives.
We found staff were not always supporting people in the least restrictive way possible or in their best interests. For example; we found there was a restriction of the personal money for one person, for which there was no mental capacity assessment or best interest meetings held.
We also identified staff were using inappropriate responses and de-escalation techniques and there was a lack of positive re-enforcement.
We found staff used controlling language and restrictions towards people who were expressing emotional needs such as; hitting out at other people using the service, saying repetitive things to prompt a response or removing footstools from under people’s legs as they knew staff would then engage with them. This was in part due to the lack of training and guidance for staff to follow. This meant people using the service continued to display the same behaviours as they had no goals or targets in place and staff had no strategies to follow to decrease such incidents.
We found staff training and record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).
People did not always have the support they needed to meet their needs and keep them safe. This increased the risks to people’s health and wellbeing.
Right Care
The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe.
People’s care, treatment and support plans did not always reflect their range of needs or promote their wellbeing and enjoyment of life.
People who were distressed or expressing emotional distress did not have proactive behaviour strategies in their care records. This meant they did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person’s best interests.
Right culture
Care was not always person centred and people were not empowered to influence the care and support they received. One person told us, “I am talked through and not to.”
The systems for reporting were not robust. For example, where concerns in relation to incidents between people using the service had occurred, staff had recorded these but the registered manager and provider had not taken appropriate steps to identify these incidents and take appropriate actions to mitigate future occurrences.
The provider’s governance systems were not always effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.
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 Inadequate (report published 06 October 2021) and there were breaches of regulation.
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 the provider remained in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We had also received some concerns in relation to the management of the service and the safe care and treatment of people using the service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Inadequate. This is based on the findings 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mr Adrian Lyttle – Sutton Coldfield, on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing and fit and proper persons employed.
Since the last inspection we recognised that the provider had failed to adhere to the conditions of their registration. This was a breach of regulation.
Follow up
We will hold a meeting with 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service remains 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.