Archived: The Shrubbery

Updated 2 April 2020

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

The inspection was carried out by one inspector.

Service and service type

The Shrubbery 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.

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 the information we already held about the service. This was in the form of notifications that had been submitted to us. Notifications are information about events providers are required by law to inform us about. We reviewed the feedback received from registration inspectors who had considered an application to vary the conditions registration by adding a bedroom; this application was withdrawn. 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 of this information to plan our inspection.

During the inspection

During the inspection we spoke with four people who lived in the home. We spoke with five members of staff including the registered manager, the interim deputy manager, the third in charge, the chef and a support worker. We reviewed three people’s care files including assessments, care plans, risk assessments and records of care. We reviewed five staff files including recruitment, supervision and training records. We reviewed incident, accident and safeguarding reports, as well as various meeting records. We made observations around the building including in communal areas of the home.

After the inspection

We requested quality assurance information and analysis by email which we reviewed. We also received updated information from the registered manager which was considered as part of the inspection.

Updated 2 April 2020

About the service

The Shrubbery is a care home for up to 15 men. It is one adapted building arranged across three floors. Each bedroom has either en-suite or a private access bathroom. There are shared facilities including lounges and a games room, as well as kitchen, utilities spaces and food stores. There are two offices within the building. The Shrubbery is also registered to deliver personal care to people who live in the community in their own houses or flats. At the time of the inspection they were not delivering personal care.

The service was registered before Registering the Right Support was developed. The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The guidance ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. The provider had not applied the principles and values of RRS.

People’s experience of using this service

People received support that reflected the level of risk they posed due to their offending histories. Risks linked with their medicines, or to areas other than offending, had not been clearly identified or addressed. Although staff were able to describe the steps they took to mitigate these risks, they were not captured in risk assessments or care plans.

People told us, and staff agreed, their experience of care was affected by high use of agency staff at the home. Permanent staff had been recruited in a way that ensured they were suitable to work in a care setting. Staff did not receive the training they needed to perform their roles, although they did receive regular supervision.

People told us, and records confirmed, their opportunities for activities and engagement outside the home were limited. We saw people had been supported to identify goals, but there were no detailed plans in place about how to support them to achieve their goals. We have made a recommendation about care planning.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as people were not supported to develop their independence and had limited choices in their day to day lives.

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had not had their capacity to consent to their care assessed when there was reason to believe they may lack capacity to understand all aspects of their care.

The governance systems in place had failed to identify and address the issues we found during the inspection.

People told us they felt safe. Staff took action to ensure people’s safety if allegations of abuse were made, however, they had not always followed local safeguarding adults procedures. This was addressed during the inspection.

People told us, and we saw, staff knew people well and supported them in a kind and sensitive way. Staff behaviour reflected the ethos of the provider that no one should be disadvantaged by their past behaviours.

People were supported to access specialist services, and to have their health needs met. People were supported to have their nutrition and hydration needs met, although people were not always happy with the menu options.

People were supported to have their dignity upheld. People’s protected characteristics were respected and people felt safe to disclose their sexuality and gender identity. People knew how to make complaints and the provider investigated these thoroughly.

The provider had a clear values base. People and staff were actively engaged by the provider's systems.

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

Rating at last inspection:

The last rating for this service was good (published August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessment and medicines management, staff training and the governance of the service.

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 from 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.