14 Thornholme Close

Updated 6 July 2022

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 one inspector.

Service and service type

14 Thornholme Close 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.

This service is required to have a registered manager. A registered manager is a person who has registered with CQC 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

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 31 March 2022 and ended on 19 April 2022.

What we did before inspection

Before the inspection we reviewed the information we held about the service and the service provider. We sought feedback from the local authority and professionals who work with the service. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

People living at the service were unable to communicate with us due to their level of need. We therefore spoke with relatives. We spoke with four staff members, this included the director, care coordinator, one nurse and one support worker.

We reviewed a range of records. This included people’s risk assessments, support plans and two staff files in relation to recruitment. We also reviewed records related to the management of the service, which included incident reports and safety records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with two professionals who were involved in the emergency placement for the person receiving a service.

Updated 6 July 2022

About the service

14 Thornholme Close is a care home and provides accommodation and personal care for up to two people who have a range of needs including autism, mental health needs and/or learning disabilities. There was one person using the service at the time of this inspection.

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 the Care Quality Commission follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

Staff attempted to support people with activities they liked, however these were limited due to the constraints of the support and environment. The service didn't always escalate incidents to the safeguarding team, when people experienced distress. Staff and managers failed to learn from incidents and how they might be avoided or reduced. The service design of the home did not always promote strategies to enhance people's independence or reduce anxieties. People receiving support only had access to the bathroom, their bedroom and lounge.

Right Care

The service did not have appropriately skilled staff to meet people’s needs and keep them safe. Staff had not be trained to fully understand people they were supporting. People had individual ways of communicating such as using body language, sounds, Makaton (a form of sign language), pictures and symbols. However, we found not all staff had the necessary skills to understand how to interact with people. Relatives told us they were concerned about people’s health and wellbeing at this service due to the staff not having the necessary skills to support people with autism.

Right culture

People could not be assured the culture at the service was inclusive and empowered lives. This service stated within their statement of purpose they could meet a number of needs, however we found this was not the case. The service could not assure us that there wasn’t a closed culture, as there was a lack of oversight and over reliance on agency staff. The provider’s monitoring and oversight processes were not effective and had not identified the substantial shortfalls we identified during our inspection.

The provider/staff had not always identified incidents as safeguarding concerns and had not appropriately reported safeguarding concerns to the local authority. This placed people at risk of not having safe care and treatment.

There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor staff provision, lack of oversight of accidents and incidents and limited oversight of safeguarding had not been identified prior to our inspection. These failings resulted in multiple breaches of regulation.

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

This service was registered with us on 22 July 2019 and this is the first inspection.

Why we inspected

This was the first inspection of a newly registered 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 and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment.

Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have requested an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 the 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.