We carried out an unannounced inspection at Mather Fold House on 09, and 11 July 2018. Mather Fold 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.
Mather Fold House is a six-bed residential service in Higher Walton, Lancashire. This specialist autism service is for male and female adults aged 18 years and over but can also accommodate people who are 17 years and are going through transition from children to adult services. At the time of the inspection, there were four people accommodated in the home.
The care service is aware of the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found on this inspection that the service was failing to deliver these values.
There was a registered manager at the time of our inspection. However, they were not present during the inspection. 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.
At the last inspection carried out on 06 and 07 July 2017, we asked the provider to make improvements to arrangements for protecting people against improper treatment. This was because people were not protected against the inappropriate use of physical restraint. Following the inspection, the provider sent us an action plan and told us they would make the necessary improvements by November 2017.
During this inspection, we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found continuing shortfalls in the safeguarding of people against abuse and improper treatment. In addition, we identified further shortfalls in the way risks to people’s health, safety and welfare were managed, medicines management, infection control practices, staff training and development, procedures for treating people with dignity and the governance arrangements.
At the last inspection, the service was rated as overall ‘requires improvement’, at this inspection the rating had deteriorated to overall ‘inadequate’.
We are considering what action we will take in relation to these breaches. Full information about the CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
We received mixed feedback from relatives regarding the safety of their family members. One relative felt the care was unsafe and some felt the care provided was safe but needed improvements.
Safeguarding adults’ procedures were in place and staff spoken with understood how to safeguard people from abuse. However, we found two instances where staff had failed to recognise serious incidents as safeguarding concerns and delayed completing an incident report and reporting to the authorities. Whilst there was evidence to indicate the circumstances of one of the incidents had been investigated there was no evidence seen to confirm the incident had been reported under safeguarding adults’ procedures.
We saw people’s care files contained individual risk assessments, however, not all risks had been assessed and recorded and consistent action had not always been taken to mitigate risks. One person had no care plan to guide staff. Staff did not always follow risk management plans such as allergies and did not wear protective clothing.
People were not adequately protected from improper treatment and abuse from staff and disciplinary policies were not adequately followed.
We found measures for protecting people against the risk of infection were not robust and there were shortfalls in the management of medicines. Improvements were required to the maintenance of the premises.
We found significant shortfalls in the training that staff were required to complete as part of their role. A significant number of staff had not completed induction training when they commenced work in the home. Furthermore, not all staff had received supervisions as directed by the provider’s policies and procedures.
The arrangements for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. There were various audit tools to assess the quality of care which identified shortfalls. However, the shortfalls were not addressed in a timely manner and internal audit and quality assurance systems had not been effectively implemented to assess and improve the quality of the service. There was a lack of robust governance and leadership. Managerial oversight of staff and the care that people received was inadequate.
Two relatives told us the staff were caring and kind. However, some of the practices in the home demonstrated people had not always been treated with dignity and respect.
Each person had an individual care plan, however, we noted one person did not have a complete care plan also known as a behaviour support plan. Relatives were not involved in the planning or review of care plans.
Relatives informed us communication in the home was not effective and some did not feel they were listened to or that actions were taken if they raise a concern.
The provider was working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people's rights were protected.
People had access to healthcare services, and staff had responded in a timely way to seek medical advice. Staff had been safely recruited.
There was a complaints procedure in place and we saw evidence complaints had been investigated and responded to. Relatives did not always know who to approach if they had a complaint.
There were adequate number of staff to meet people’s needs. There was an end of life policy however staff had received training in this area.
People were supported to undertake activities of their choice in the community on a regular basis. We saw one person had thrived and made progress from our last inspection.
The provider and their relatives responded positively to the shortfalls and took immediate action to take corrective action.