12 September 2023
During a routine inspection
About the service
Littlemoor House is a residential care home providing personal care to up to 5 people. The service provides support to older people and people with a learning disability. At the time of our inspection there were 5 people using the service.
The home has a communal lounge, dining room and kitchen. Bedrooms are set over 2 floors.
People’s experience of using this service and what we found
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 underpinning principles of “Right Support, Right Care, Right Culture".
Right support: Safe recruitment processes were not established and carried out. Pre-employment checks, to ensure staff had the correct skills, knowledge, and characteristics for working with vulnerable people, were not always carried out properly. The provider had not ensured they had the required information available about each member of staff.
Amendments were needed to people's care plans to demonstrate how people were being enabled to have maximum choice and control over their lives as restrictions had not always been consented to and recorded.
Risks to people from the environment were not always assessed and managed. Mould and damp were found in 2 bedrooms and cleaning schedules had not been effective at removing surface mould. Chemicals were not always stored safely. The environment required redecoration and refurbishment, for example paint was peeling from the walls in 1 bathroom and door threshold strips were loose.
Right care: Medicines were not always managed safely. Protocols were not clear for staff applying creams and there were no records of where the creams had been applied. We recommended the provider undertake a review of their medicines management systems and processes to improve storage and medicines protocols.
People did have a personalised package of care. However, the provider was not able to demonstrate how they were ensuring people's human rights were maintained alongside a number of restrictive practices that were in place.
End of life care information in people’s care plans concentrated on people’s wishes after they had died and there was no information on how people wished to be supported before they died.
Right culture: The provider was not aware of the inspection criteria for services supporting people with a learning disability or autistic people. Governance systems were not robust, and audits did not cover all areas of the service. Information from audits was not analysed or used to make improvements to the service. Records were not always maintained. For example, people’s money had not been recorded from February 2023 to September 2023. The service had not received any complaints and the registered manager told us minor concerns raised by people who used the service or their relatives were usually dealt with, however these were not recorded. We recommended the provider reviewed the complaints procedure in line with Regulation 16 of the Health and Social Care Act.
Consideration had not been given to how the service would meet the underpinning principles of right care right support right culture. However, staff received specific training to support people with a learning disability.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.
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
Rating at last inspection:
The last rating for this service was good (published 08 December 2017).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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
We have found breaches in relation to consent, maintenance of the premises and governance of the service at this inspection.
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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.