Archived: Howard Goble House

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.

Howard Goble House provides care and support for older adults with profound and multiple

learning disabilities and some who live with dementia. It can accommodate up to 12 people over two floors. At the time of the inspection the home was providing care and support to 11 people.

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. This meant that people who use the service did not 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. However, people using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People's experience of using this service Medicines were not always safely managed. Medicine Administration Records (MAR) were not always completed in full and medicines handover sheets were not always signed. People were protected against the risk of infection. Assessments were carried out to ensure people's needs could be met. Risks were identified, and management plans were in place to manage these safely. Accidents and incidents were appropriately managed, however, learning from this was disseminated to staff.

Appropriate numbers of suitably skilled staff were not available to meet people's needs in a timely manner. Staff were supported through induction, training and supervisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were not always kind and caring and people’s privacy and dignity was not always respected, and their independence was not always promoted. People were encouraged to eat a healthy and well-balanced diet. People had access to different healthcare professionals when required to maintain good health.

Information was available to people in a range of formats to meet their communication needs if required. There was a system in place to respond to complaints in timely manner.

There were systems in place to assess and monitor the quality of the service provided, however these were not effective. The service was not currently supporting people with end of life care needs, if they did this would be recorded in their care plans. The provider worked in partnership with key organisations to ensure people's needs were planned and met.

The outcomes for people using the service did not reflect the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support was not focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 of the service was good (published on 12 January 2017)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Enforcement: We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, good governance and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 8 and 9 November 2016 and was unannounced. Howard Globe House care home was registered with the Care Quality Commission on 10 December 2010. At the last inspection in 2013, the service was meeting the legal requirements in force at that time.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People using the service could not always express their views so we observed the support offered and spoke with relatives and staff. Relatives told us that their family members were safe and well treated. During the inspection we saw that people appeared happy and content and their relatives felt confident they were not at risk of harm. Family members supported most of the people but those who weren’t had an independently appointed advocate who could express their views and help them to ensure their voice was heard.

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

The service employed sufficient number of staff to support people. Staff were encouraged to raise issues as they occurred and said that there was an open environment and felt supported by the manager and provider. Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were being supported to have a healthy balanced diet. People’s medicines were managed safely and they received their medicines as prescribed by health care professionals.

People’s relatives and health care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as individual as possible and to do things they wanted to do. People’s relatives were aware of the complaints procedure and were confident their complaints would be fully investigated and action taken if necessary.

The manager recognised the importance of regularly monitoring the quality of the service provided to people. The provider sought the views of relatives of people using the service, staff and health care professionals through annual surveys and regular meetings. They used feedback from these events to make improvements at the home. Staff said they enjoyed working at the home and they received good support from the manager.

We found that people had risk assessments and care plans. People had a staff member allocated as their key worker who would regularly review their care. Staff told us that people were supported to make their own decisions and that they would build in choices to the daily routine. Staff had access to a consent policy and received training on the mental health act.

The provider had a complaints policy and had made suitable arrangements to obtain people's feedback on the service provided. Relatives we spoke with told us that they had no cause to complain and that they were very happy with the care. We found that staff had been trained on the control of infection and appropriate arrangements were in place for the cleaning of the home. We found that there were effective recruitment procedures in place and the relevant checks were carried out on staff before they started in post. Staff were suitably qualified and had access to appropriate training and development opportunities.