Livingstone House

Updated 20 January 2023

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

This inspection was carried out by three inspectors, two of whom visited on the first day of inspection. One inspector visited on the afternoon of the second day of the inspection and focused on engaging with people, using a symbol-based communication tool. A second inspector returned on the evening of the second day to continue the inspection.

Service and service type

Livingstone House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Livingstone House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We looked at all the information we had received about and from the home. We sought feedback from the local authority and professionals who work with the service. 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. We used all this information to plan our inspection.

During the inspection

We spoke with and did general observations of each person and their interactions with staff. Some people we met were not able to verbally communicate with us and we communicated with them using a symbol-based communication tool to tell us of their experience. We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use this symbol-based communication tool. We checked that this was a suitable communication method, and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves.

We spoke with five family members and five members of staff, including the manager. We reviewed a range of records. This included five people's care records and a range of medicines records. We looked at seven staff files in relation to recruitment, staff supervision and training. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 20 January 2023

About the service

Livingstone House is a residential care home personal care and support for up to six people with a learning disability and autism. At the time of our inspection there were five people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of the key questions safe, effective, caring, responsive and well led. The service was not able to demonstrate they were fully meeting the underpinning principles of Right support, right care, right culture.

Right Support:

People had plans in place to guide staff on how to support them if they became anxious or upset, however, these plans were not always regularly reviewed or updated. Staff were not always provided with clear guidance on how to support people safely. A failure to effectively monitor incidents meant there were missed opportunities to avoid and reduce reoccurrence. People not always supported to have the maximum possible choice, control and independence in their daily lives. People were not always enabled to access specialist health care support in a timely way.

Right Care:

Low staffing levels impacted on people receiving person-centred care. People were not provided with opportunities to try new activities tailored to them that enhanced and enriched their lives. We observed people participated in group activities more often, rather than pursuing their own individual interests or seeking opportunities for volunteering or employment. Poor compliance with training and inconsistent induction processes for staff new to the service meant that people were not always supported by suitably trained, skilled and competent staff. Not all staff could sufficiently demonstrate they knew about the person they were supporting or what was in their care plans.

Right Culture:

The provider failed to develop effective governance and quality assurance systems to assess the quality and safety of the support people received. There were a lack of audits and actions taken when things went wrong. Actions were not always documented, and it was unclear if actions were completed. This meant improvements were not always made to improve the care people received. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not effective. Where checks and audits were carried out, they had not always identified or prevented issues occurring or continuing at the service. Where issues had been identified, the provider had not always ensured actions were taken to maintain or improve the quality and safety of the support being delivered at the service. Some care staff told us they felt unsupported by senior management. Family members told us that until recently, there was insufficient engagement with them. This meant people's families were not sufficiently involved in developing the service. There was limited opportunity for staff to learn from incidents and improve practice.

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 17 November 2021).

Why we inspected

The inspection was prompted in part by a notification of an allegation of abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

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.

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 keeping people safe including from risks of harm and potential abuse. Breaches have been found related to staffing and staff training, medicine management, personalised care and governance of the home at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.