Updated 23 February 2024
We completed the assessment between 27 February 2024 and 04 March 2024. People did not always receive good quality care and support because staff were not always trained to meet their needs. Staff had failed to ensure the risk of a closed culture was minimalised. The provider had failed to ensure effective systems were in place to safeguard people from the risk of harm and abuse. Incident and accident management were inadequate and not effective. Medicines were not always managed safely. People’s needs were not sufficiently assessed, and care plans were not regularly updated to reflect changes in people’s needs. The management and oversight of the service was inadequate. The provider had failed to identify the urgent and serious, widespread concerns that were identified during the assessment. 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. The provider had failed to ensure they met the principles of ‘Right support, right care, right culture’. We found 7 breaches of the legal regulations in relation to safeguarding, safe care and treatment, staffing, dignity and respect, person centred care, notifications and governance. We took urgent action to prevent the provider from re-admitting people back into the service and from taking on new packages of care.