Background to this inspection
Updated
19 January 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 Care Act 2014.
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 two inspectors.
Service and service type
Howard Goble House is a care home and provides care and support for adults with profound learning disabilities and autistic people. Some people also live with physical disabilities and dementia. People in care homes receive accommodation and 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.
At the time of the inspection there was no registered manager in post. There was a new manager who told us they would be applying to register as registered manager with CQC.
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included the provider’s action plan from the last inspection and information about incidents the provider is required to notify us about. We sought feedback from the local authority who commissions services from the provider.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with the ten people living at Howard Goble House. However, most of them were unable to express their views about the care they received. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also observed the support they received in the communal areas and tracked their care to check if it matched with their care and support plan.
We reviewed records related to the running of the home. These included the care records for four people using the service, fire safety records, meeting minutes, accident and incident records and audits.
We spoke with four relatives of people using the service and an advocate by phone following the site visit.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We requested further information from the provider including staff training data, recruitment records and quality assurance records.
Updated
19 January 2022
About the service
Howard Goble House provides care and support for older adults with learning disabilities, physical disabilities and people living with autism, some people also live with dementia. It accommodates up to 12 people over two floors with separate adapted facilities. At the time of the inspection the home was providing care and support to ten people.
People’s experience of using this service and what we found
We identified concerns in relation to fire safety, the premises and people’s health risks. There were not always sufficient numbers of staff deployed and the provider’s system for managing the quality and safety of the service remained ineffective. The previous registered manager had failed to notify us of an incident of serious injury to a person earlier this year.
Deprivation of Liberty Safeguard authorisations were complied with; however, people were not always supported in the least restrictive way possible. We have made a recommendation that the provider seek best practice guidance in this area.
Improvements were needed to ensure people’s care and support was person-centred and supported them to be an active part of the local community. The new manager had identified this and started to address this area.
Some improvements had been made since the last inspection. People and their relatives were all positive about the care and support they received from staff. We observed some warm interactions and people were treated with dignity and respect.
Medicines were safely managed and the home was clean and followed safe infection control practice. People’s nutritional and health needs were met.
The new manager was working to make improvements. People and their relatives had met the new manager and said the home was well run.
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 (RSRCRC) 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 always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support: The care home was designed to accommodate a larger than recommended number of people and was not best suited to increasing person centred care, or people's independence and skills. The care home shared a building with a supported living service and the provider treated aspects of these service together so that it had some of the characteristics of an even larger campus style setting.
Right care: People and their relatives were positive about the support and care provided. However, we found some people’s care needs were not being consistently met in a person-centred way. The new manager was working to introduce goals to improve outcomes for people. Improvement was needed to evidence that people were encouraged and consistently supported to develop and maintain skills and that any goals and outcomes were regularly reviewed with them and their families.
Right culture: The providers ethos was for people to lead inclusive and empowered lives and the manager demonstrated commitment to these values. Further work was needed to increase people's involvement in the community. Some adaptive equipment had been introduced to support people to be more independent or become involved in daily living skills. However, the provider had not identified the shortfalls in their current model of care and best practice principles for people with learning disabilities and autistic people to empower them to lead as full a life as possible.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 31 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvements had been made and the provider was in continued breach of some regulations.
This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating. We carried out an unannounced comprehensive inspection of this service on 25 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, dignity and respect, person centred care, staffing and the governance of the service.
We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.
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.
The provider and manager took prompt action to mitigate risks we found.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Howard Goble House on our website at www.cqc.org.uk.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified continued breaches in relation to fire safety, the assessment of some risks, staffing levels and the absence of good oversight of the service from the provider.
We served a warning notice on the provider in respect of the continued breaches we identified. We told them to comply with the notice by 31 December 2021.
Follow up
We will request an action plan for 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 to check our notice has been complied with. If we receive any concerning information we may inspect sooner.