Background to this inspection
Updated
17 November 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 carried out by 3 inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service
Service and service type
Lambert 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. Lambert 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 a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
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 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. We used all this information to plan our inspection.
During the inspection
None of the people who used the service could speak with us verbally. We observed the care and support provided. We spoke with eight relatives about their experience of the care provided. We spoke with 12 members of staff including the registered manager, three interim managers, three agency staff members, three core staff members, the chief executive officer, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the registered provider.
We reviewed a range of records. These included various care and support records for five people using the service. We reviewed all personal evacuation plans and deprivation of liberty applications. We looked at three staff files in relation to recruitment and three agency staff profiles. A variety of records relating to the management of the service, including audits and incidents were reviewed.
Due to the significant concerns identified during the inspection we met regularly with the provider, and professionals from the local authority and integrated care board to discuss and monitor the concerns identified.
Updated
17 November 2022
About the service
Lambert House is a residential care home providing personal care to up to 11 people. The service provides support to autistic people. At the time of our inspection there were 11 people using the service. The care home is a large two-storey building, with a communal bathroom and toilet on each floor. A communal lounge, dining room, recreation room and sensory room were located on the ground floor.
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/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
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.
Right Support: Model of Care and setting that maximises people’s choice, control and independence
The model of care did not maximise people's choice, control and independence. People were subject to restrictive practices without proper due regard to legal processes and requirements. People were not supported to have maximum choice and control of their lives and staff 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 were not supported to engage in activities that met all their needs. Some people living in the service had sensory loss but were not supported to engage in activities that met these needs. People were not always supported to communicate their wishes and feelings as there was limited use of communicate strategies.
Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights
People were not supported in a manner which promoted their dignity, privacy and human rights. Some practices dehumanised people living in the service which was of significant concern. People were living in a poorly maintained and dirty environment which did not uphold their dignity. Safeguarding concerns had not always been shared in a timely manner. The support provided was not person-centred because staff did not follow risk assessments or care plans. This placed people at risk of harm. People were not supported by staff who knew them well due to the high use of agency staff and ineffective systems ensuring staff understood how to support people.
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
We identified a closed culture in the service. A closed culture is 'a poor culture that can lead to harm, including human rights breaches such as abuse'. In these services, people are more likely to be at risk of deliberate or unintentional harm. The provider had not taken effective action to identify and address the poor culture in the service. Leadership was weak and did not hold staff to high standards. Governance systems in the service were ineffective as they had failed to ensure regulatory requirements were met.
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 15 May 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staff conduct in relation to people using the service, restrictive practices and governance. A decision was made for us to inspect and examine 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.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified breaches in relation to safeguarding people from risk of harm, safe care and treatment, person-centred care, safe use of medicines, premises and equipment and good governance.
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
The overall rating for this service is ‘Inadequate’ and the service is therefore 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.