Edwin Therapeutic Unit

Updated 15 October 2022

Background to this inspection

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:

Edwin Therapeutic Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We sought and received feedback from commissioners of the service and the social worker of the young person living at the service. We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with the one young person living at the service. We also spoke with three staff members including the registered manager and two support workers.

We reviewed a range of records. This included the young person’s risks assessments and medicines records. We looked at staff training, supervision and staff rotas. A variety of records relating to the management of the service were reviewed including accidents and incidents and audits.

After the inspection

We continued to seek clarification from the provider to validate evidence found. The provider sent us the following documents in a timely manner: Restraint and CCTV policy, positive behavioural support plan, restraint incident forms and staff training certificates in restraint.

Updated 15 October 2022

About the Service

Edwin Therapeutic unit is a residential care home providing personal for up to three people who have complex needs. This includes people with a learning disability, autistic spectrum disorder, mental health difficulties, an eating disorder and people with anxieties which can affect their behaviours. There was one young person living at the service at the time of the inspection.

Accommodation was provided over three floors. There was a communal lounge, kitchen and dining room.

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.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care did not always maximise people’s choice, control and independence. When people’s freedoms had been restricted there was not a review of this restriction to assess if there was a less restrictive alternative. People were supported by staff to pursue their interests and to achieve their aspirations and goals. People were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.

Right care:

• Care was not always person-centred as it did not always promote people’s dignity, privacy and human rights. One person had no privacy as they were supervised at all times. This restriction had not been reviewed in line with a condition in their DoLS. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. People received kind and compassionate care.

Right culture:

• Staff knew and understood people well and were responsive to their needs. People’s quality of life was enhanced by the service’s positive culture of inclusivity.

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

Young people told us staff were kind and caring, spent time talking to them and they were confident any concern they raised would be addressed.

Young people were supported to have maximum choice and control of their lives, but a restriction on one young person’s privacy had not been reviewed to ensure it was the least restrictive, since it had been put into practice. In addition, this young person’s risk assessment for them to receive regular timed checks contradicted the staff practice of constant supervision during the day and night. Reviewing this young person’s restrictions monthly was also a condition of their Deprivation of Liberty Safeguards (DoLS).

Quality monitoring systems were not always effective and lacked the robustness to identify shortfalls and drive continuous improvement in the service.

Since our last inspection a new registered manager had been appointed who had changed the culture of the service from poor to positive. As a result, there was effective communication, staff felt valued and supported and young people received better outcomes.

The provider had acted on two recommendations made at the last inspection. This was to consult with young people in the redecoration of their home; and to follow national guidance in promoting health eating for young people.

Young people were listened to and encourage to raise any concerns or complaints.

There had been improvements in the management of medicines so young people could be confident they received the right medicines at the right time. Medicines were stored, recorded and administered by staff who had been assessed as having the necessary skills.

We were assured the provider was making sure infection outbreaks could be effectively prevented or managed. The registered manager took an active role and had oversight of infection control prevention.

Staff training plans were designed around young people’s care and support needs. Staff supervision and support was consistent and included reflective practice. Staff told us they felt well supported.

Staff were checked that they were suitable to work with young people before they started to support people.

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 Inadequate (published 11 December 2021) and there were breaches of regulations. At this inspection, enough improvement had been made and the provider was no longer in breach of these regulations, except the monitoring of the quality of care, which remained a breach of regulation. In addition, we found a new breach of regulation with regards to applying the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 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 breaches in relation to the management and oversight of the service, the MCA and DoLS and protecting people from abusive practices.

The enforcement action we took:

We issued a Notice of Decision to impose a condition of registration pursuant to Section 12(5)(b) of the Health and Social Care Act 2008.

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.