Nak Centre

Updated 1 February 2024

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 2 inspectors.

Service and service type

The Nak Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection a registered manager was in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We had not requested the provider send us a provider information return as this inspection was completed in response to information of concern that the commission had received. 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

We met all the people living at The Nak Centre. Some people were unable to speak to us due to their health conditions. We therefore spent time in the communal lounges observing care practices, so that we could gain an understanding of people's experience in how they received support.

We spoke with staff, read people's care plans, and other records kept about them, carried out a formal observation of care, and reviewed other records about how the service was managed. We looked around the premises.

We spoke with the registered provider, administrator and 2 support workers and the cook. We looked at 4 records relating to the care of individuals, medicine records, staff training records, staff duty rosters and records relating to the running of the service.

We attended safeguarding meetings with health and social care professionals and gained their views on the service.

Updated 1 February 2024

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.

The service was not able to demonstrate how they were meeting some of underpinning principles of "Right Support, Right Care, Right Culture.

The Nak Centre is a residential care home providing personal care for up to 6 people with learning and /or physical disabilities and autistic people. At the time of our inspection there were 6 people using the service. The Nak Centre is a detached building located in its own gardens near the city of Truro.

The registered provider, has the joint role of registered manager, and will be referred to in this report as registered provider.

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

Right Support

The registered provider did not have effective safeguarding systems in place. The registered provider , did not demonstrate a clear understanding of their responsibilities to report safeguarding concerns. Staff had limited understanding of what to do to help ensure people were protected from the risk of harm or abuse.

People were not always supported by enough staff on duty which placed restrictions on their everyday lives.

Staff supported people to have some choice and control in their everyday lives. Their ability to do this had been impacted by staffing shortages in the service which meant people were not always able to access the community or take part in activities that they enjoyed.

Risk assessments varied in their quality; some identified a person's risk but did not state what should happen to reduce the risk, and therefore didn’t mitigate risk.

Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

People lived in a safe and well-maintained environment.

Staff supported people with their medicines and worked with health professionals to achieve good health outcomes.

People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

The service did not have enough appropriately skilled staff to meet people's needs.

People using the service told us they felt they were cared for, comments included “They are looking after me” and “It is nice here.”

We observed many kind and caring interactions between staff and people.

Right culture

The service was a long-standing family run business, and the size of the staff team was small. Five people had lived with the registered provider since they were young children, therefore they had built a familiar routine with people that they appeared to be comfortable with and it felt more akin to a family unit. This allowed the potential of a closed culture to form. The registered provider had not kept up to date with good working practices and was not part of any manager forums or other similar groups. This meant the service was isolated and there was a risk of a closed culture developing.

The service had fixed routines that were not flexible, for example drink and meal times routines. This was due to how the service had been organised, and perpetuated by the lack of staff available within the service. This meant people lacked opportunity to choose what they wanted to do and when.

Staffing levels had impacted on the registered providers availability to ensure that managerial tasks were completed. Feedback from staff, and the review of records and care documentation evidenced there was poor oversight of the service which was affecting aspects of the operations of the service. Audits to oversee the service were not up to date and therefore were ineffective in identifying areas for improvement.

The service had not sought the views and opinions of people using the service, staff and professionals. Staff team meetings and staff supervisions had not been held which meant that opportunities for staff and managers to discuss any issues or proposed changes within the service had been missed.

The registered provider had not been open and transparent with people and relatives and commissioners in respect of the recent concerns at the service. The lack of opportunity for stakeholders to provide feedback or raise concerns increased the risk of a closed culture developing.

The registered provider was inconsistent in how they worked with professionals. For example, they were welcoming of support but had not attended a meeting that had been arranged.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Last rating and update

At the last inspection the service was rated as good (published 20 July 2022).

Why we inspected

The inspection was prompted in part due to concerns received about people's safety, staffing and leadership. A person using the service was placed at significant harm. The information CQC received about the incident indicated concerns about the leadership of the service, the safety of people using the service and that staffing was not sufficient to meet people’s needs. This inspection examined those risks. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the registered provider needs to make improvements. Please see the safe, and well led sections of this full report.

Enforcement and recommendations

We found breaches relating to safeguarding, staffing and the governance of the service. Please see the action we have told the registered 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.

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.