Archived: Clark Hall

Updated 8 May 2019

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.

The inspection was carried out by one adult social care inspector on 27 December 2018 and was announced. We gave the service short notice of the inspection site visit because we needed to be sure someone would be available for us, to review records and speak with staff.

We reviewed information we held about the service, such as notifications, information from the local authority and the contracting team. There were 12 people using the service, four of whom were receiving personal care.

We looked at care documentation for one person as no others were made available on site. The provider sent further samples of care documentation which were considered following the inspection. We reviewed three staff files and some records relating to how the service was run. We spoke with the registered manager at the time of the visit. Following the inspection visit we spoke with nine members of staff over the telephone. We spoke with one person who used the service, one social worker and four relatives by telephone after the inspection visit.

Updated 8 May 2019

Clark Hall is registered to provide personal care for people in their own homes. When we inspected the service there were 12 people who were supported by the service, four of whom were supported with personal care. The inspection took place on 27 December 2018 and was announced. This was the first inspection of the service because the provider had previously told us there were no people supported with personal care.

There was a registered manager in post. However, the service was not well run and the registered manager did not demonstrate a clear understanding of the regulations. When we arrived at the service we found the premises empty and the registered manager told us the service had moved to a new address. The Care Quality Commission had not been notified of this. We found there were breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to regulation 12 Safe care and treatment, regulation 16 Receiving and acting on complaints, regulation 17 Good governance and regulation 18 Staffing.

There was little evidence of any robust oversight of the quality of the provision and no evidence of systems and processes in place to ensure people received appropriate care and support.

The provider was unable to provide sufficient evidence of how people were kept safe from harm. Staff understood their safeguarding responsibilities but there were limited procedures and guidance in place for staff to know or manage risks. CQC had not received statutory notifications in relation to safeguarding matters. Risk assessments were not comprehensively in place. Systems for supporting people with medicines were not clear.

The provider was unable to evidence people were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems were in place, although staff were not all aware of these. The assessment process did not provide sufficient evidence people had choice and involvement in their care and support.

There was limited evidence staff were appropriately supported. There was some evidence of staff supervision meetings but no clear system in place to ensure this was carried out robustly and with any consistency. Staff training had been completed but there was a lack of evidence of specific training where staff supported people with specific needs, such as autism. There was no evidence how the skill of staff was considered when providing care to individuals.

Staff demonstrated kind and caring attitudes towards the people they supported and their families. Staff showed awareness of people's rights and told us how they respected people's privacy and dignity.

Care records were not fully available at inspection because there was no documentation held at the registered location. The one care record made available to us contained information which was easy to locate. However, there was not enough information in this for staff to support the person safely or effectively and information in their daily records was not up to date. Relatives and staff we spoke with expressed concerns at the lack of care documentation for individuals whose records we were unable to see. The provider sent some further examples of documents from people’s care and support plans but these did not evidence sufficient information.

Complaints were not recorded appropriately or responded to. Some relatives we spoke with were not confident complaints would be managed well.

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.

You can see what action we have told the provider to take at the back of the full version of the report.