Katherine House

Katherine House is a residential care home providing accommodation and personal care for up to 9 people. The service provides support to people with a learning disability, and autistic people.

Katherine House is a residential house with some adaptions. At the time of our inspection there were 8 people using 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.

Right Support:

Some risks to people had not been sufficiently assessed and documented in their care records. Some parts of the environment were not always kept clean. Medicines were not always managed safely and staff competency assessments were not completed in line with the provider's own policy, and good practice.

Katherine House is a small, ordinary home forming part of a local community. The property does not appear to be a care home and mirrors the other properties on the road. People's bedrooms were personalised in line with their preferences and choices. Staff communicated with people in a way that met their needs. People were safeguarded from abuse.

People were supported to have maximum 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:

People were supported by caring and kind staff. Staff had received appropriate training, knew people well and supported people in line with their preferences. Staff worked in partnership with other agencies to promote people's health and wellbeing.

Right Culture:

Governance systems were not always robust and actions identified were not always followed up in a timely way. The oversight of risk was not always effective. Relatives and professionals had not been asked to provide feedback about their views.

The registered manager promoted a positive culture and led by example. Staff demonstrated their knowledge of people and were respectful of people. Staff took time to offer support and reassurance when this was needed.

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 the service was good (published July 2021).

Why we inspected

We received some concerns about how safeguarding concerns were managed. A decision was made for us to inspect and examine those concerns.

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 have identified breaches in relation to safe care and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection program. If we receive any concerning information we may inspect sooner.

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

The service could show how they met the principles of right support, right care, right culture.

People lead confident, inclusive and empowered lives where they were in control and could focus on areas of importance to them. The ethos, values, attitudes and behaviours of the management and staff provided support in the way each person preferred with a view of individual development.

The needs and quality of life of people formed the basis of the culture at the service. Staff undertook their role in making sure that people were always put first with enthusiasm. They provided care that was genuinely person centred and directed by each person.

The leadership of the service had worked hard to create a learning culture. Staff felt valued and empowered through inclusion in the development of people’s care to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. They all felt confident to raise concerns and complaints with a view to improving outcomes for people.

People¿were¿supported to have maximum 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.¿

¿ People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.

¿ People were protected from abuse and poor care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

¿ People were supported to be independent and had control over their own lives. Their human rights were upheld.

¿ People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.

¿ People’s risks were assessed regularly in a person-centred way, people had opportunities for positive risk taking. People were involved in managing their own risks whenever possible.

¿ People who had behaviours that could challenge themselves or others had proactive plans in place to reduce the need for restrictive practices. Systems were in place to report and learn from any incidents where restrictive practices were used.

¿ People made choices and took part in meaningful activities which were part of their planned care and support. Staff supported people to achieve their aspirations and goals.

¿ People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.

¿ People received support that met their needs and aspirations. Support focused on people’s quality of life and followed best practice. Staff regularly evaluated the quality of support given, involving the person, their families and other professionals as appropriate.

¿ People received care and support from trained staff able to meet their needs and wishes. Managers ensured staff had relevant training, regular supervision and appraisal.

¿ People and those important to them, including advocates, were actively involved in planning their care. Where needed a multidisciplinary team worked well together to provide the planned care.

¿ Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.

¿ People were supported by staff who understood best practice in relation to learning disability and/or autism.

¿ Governance systems ensured people were kept safe and received a high quality of care and support in line with their personal needs. People and those important to them, worked with leaders to develop and improve the service.

Our last inspection found a breach of regulation 12 (Safe Care and Treatment). This inspection found improvements had been made to infection control systems which ensured they were in line with current government guidance. All staff wore masks, detailed COVID-19 risk assessments were in place and there were clear robust infection control procedures which informed staff practice. Incident reports were detailed, factual, complete and reviewed to identify trends and patterns.

Our last inspection found a breach of regulation 13 (Safeguarding Service Users from Abuse and Improper Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found staff understood safeguarding and whistleblowing procedures and all incidents had been reported to professional bodies as required.

Our last inspection found a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities). This inspection found an embedded governance system which provided oversight of the home. We found a detailed audit structure and the improvements to audits identified actions which were completed timely. A new culture of openness and involvement was established in the staff team and a new support structure was developed to support the manager.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this inspection to provide assurance that the service is applying the principles of Right support right care right culture.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Katherine House is a care home providing personal care and accommodates nine people in one adapted building. On the day of the inspection, the service was providing care and support for eight people who have a learning disability and behaviours that challenge others.

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

Care and treatment was not always provided in a safe way. The providers systems failed to identify risks to people or if risks were identified they were not managed effectively.

Systems in place failed to safeguard people from the risk of abuse. Support for staff to carry out their role was not effective.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes. Systems in place to manage the control of infection were not robust and did not always follow current government guidance in relation to COVID19.

People received their medicines when needed.

There was a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The systems in place failed to identify the areas for improvement found at this inspection.

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 Good (Published February 2018 ).

Why we inspected

The inspection was prompted due to whistleblowing concerns raised with us. These concerns related to people's care and their safety. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of effective, caring and responsive. 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.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Katherine 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 three breaches in relation to safe care and treatment, safeguarding and 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

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.

Special Measures

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 of 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.

Katherine House is a ‘care home’. 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.

Katherine House accommodates nine people in one adapted building. On the day of the inspection, the service was providing care and support for nine people who have a learning disability and behaviours that challenge others.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager. 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 were supported by staff who had received training in how to recognise signs of abuse and were aware of what actions they should take should they suspect someone was a risk of harm. Staff were aware of the individual risks to people and how to best to support them and manage those risks.

Staff were safely recruited and systems were in place to ensure the skill mix on each shift was able to meet the needs of the people being supported. Systems were in place to ensure people received their medicines as prescribed by their GP and staff competencies in this area were checked.

Systems were in place to protect people from the spread of infection. Where accidents and incidents took place, they were investigated and where appropriate lessons were learnt and actions taken.

People’s care, health and social well-being were part of a pre-assessment process that provided staff with the information required to meet their needs effectively. Staff were provided with an induction and regular training to ensure they had the skills and knowledge to support people. Systems were in place to monitor staff learning and to ensure that training provided, was put into practice.

People were supported to maintain good health and access a variety of healthcare services. Choices were routinely available at mealtimes and picture cards were in place to assist people in making those choices.

Staff routinely obtained people’s consent prior to offering support. 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 described as kind and caring and were respectful in their dealings with people. People communicated with staff in a variety of ways and systems were in place to ensure information was available to people in a format that they understood.

People were supported and encouraged to regain and maintain their independence and do as much for themselves as possible.

People contributed to the planning of their care, providing staff with the information required to help meet their needs. Care plans identified people’s strengths and aspirations and how people were to be supported to achieve their goals.

Where complaints were raised, they were investigated and responded to accordingly and where appropriate, lessons were learned. People were confident that if they did raise concerns they would be listened to and action would be taken.

People considered the service to be well led. The registered manager and project manager were well thought of by people, relatives and staff alike.

Staff felt supported in their role and there was an open and honest culture which led to lessons being learnt if things went wrong. Staff were motivated in their role and on board with the registered manager’s vision for the service.

People and staff were provided with the opportunity to give feedback on the service, which was then acted upon. There were a variety of audits in place to assist the registered manager in driving improvement across the service.

The registered manager and staff group worked alongside other agencies in order to obtain the appropriate care and support for people.

We saw that people were able to make choices and decisions about their care and treatment. People were asked to consent to what was happening in their lives and before any care was given.

Staff were aware of people's needs and plans were in place to deliver care in a personalised way. People's health care needs were met through community health services. There were systems in place to identify and manage risks to keep people safe.

People were supported to take part in a variety of activities in the home and the local community which meant that they led fulfilled lives. One person told us, ‘‘I am going to bingo tonight.’’ Another person told us they were going to watch some television and do some internet shopping.

Systems were in place to ensure only the appropriate people were employed to work at the home.

There were systems in place to ensure people’s views were listened to and acted on. Systems were in place to monitor the quality of the service.

Everyone living at the home that we spoke with said that they liked living there. We saw that people received the care and support they needed to help them live full and independent lives. One person told us,” I like living here.”

People told us that if they were worried about anything they would tell the staff. One person told us, “If I was worried about anything I would tell X, she is pretty good.” We saw that systems were in place to ensure that people were safeguarded from abuse.

People told us that they liked the staff that supported them. We found that staff were trained and supported to deliver care and treatment safely and to an appropriate standard.

People said that they were able to raise any concerns they had with staff. We found that there were systems in place to investigate and respond to people's complaints.