Archived: Peterhouse

Updated 18 September 2019

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.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Peterhouse is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

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. 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. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and three relatives about their experience of the care provided. We observed the support provided to people who were unable to speak with us. We spoke with three care staff, the cook, two deputy managers and the learning disability director. We looked at five care plans, four medication records, two staff files as well as other records and audit documents relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at policies, health and safety and quality assurance records. We received feedback from the local authority.

Updated 18 September 2019

About the service

Peterhouse provides accommodation and personal care for nine people who have a learning disability or autistic spectrum disorder. The service can support up to 11 people. Since our last inspection, the supported living settings have been registered separately and are not included within this report.

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 guidance ensures people who use the service can 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. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them and did not always have choice and control over what they could do.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Nine people were using the service. This is larger than current best practice guidance. However. the size of the service fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

Measures were not always in place to ensure people and the environment they lived in was safe and some risks to individuals had not been identified or addressed. Staffing levels had not been reviewed and there were not always enough staff to support people to access to the community. Medicines were not always managed safely. People were protected by the prevention and control of infection and staff received training in infection control. The environment continued to require refurbishment. Some parts of the grounds of Peterhouse were not suitable for people with mobility issues.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. Although the management team were aware of the Registering the Right Support guidance, the outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not always have choice or control about what they wanted to do due to inadequate staffing levels and this did not demonstrate a caring service.

People were not always able to take part in community activities due to a lack of staffing and people were not always supported to engage in meaningful activity. We made a recommendation that the provider reviews the provision of activities and meaningful engagement to ensure that it meets the individual interests of those living at Peterhouse. Where feedback was received from people using the service, this was not always acted on to ensure positive outcomes. There was a lack of easy read information available to aid people’s understanding in line with the Accessible Information Standard (AIS). We made a recommendation that the provider consults a reputable source and further develops the use of easy read and pictorial information to ensure that they meet the AIS.

People were supported by staff who knew them well. Staff were kind and supported people with dignity and respect although their independence could be further promoted. Staff received training, support and supervision to enable them to carry out their roles. The service worked in partnership with other health and social care professionals and these relationships had supported people to have good outcomes. End of life planning required further development. We made a recommendation that the provider consults a reputable source to further develop end of life planning.

The registered manager did not manage the service day to day. Auditing systems were ineffective and had failed to address key concerns identified at this inspection. Some recommendations made at the previous inspection had not been implemented. The oversight and governance of the service required review to ensure any issues were identified and rectified to ensure the service continuously improved.

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 17 July 2018).

At this inspection, not enough improvement had been made or sustained and the provider was in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified four breaches in relation to risk assessment, staffing and managerial oversight and governance at this inspection. The provider took some action to mitigate the risks after the first day of inspection, however further improvement was still required.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.