Date of Assessment: 7 to 14 January 2025. The service is a residential care home providing support for up to 43 adults of all ages living with mental health conditions. An assessment has been undertaken of a service that is used by autistic people or people with a learning disability but is not registered as a specialist service. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. At our previous inspection we identified breaches of the regulations in relation to; the Mental Capacity Act, management of risk, safeguarding, staff training and oversight of the service. The service had made improvements and is no longer in breach of regulations. The rating has improved from requires improvement to good. Systems to identify new risks and respond in a timely manner had improved. Risk assessments were completed and there was information to guide staff on how to protect people from harm. A safeguarding lead role had been developed. This had led to improved systems for recognising and responding to safeguarding incidents. Managers and staff now had a good understanding of the MCA. Capacity assessments were decision specific and evidenced how people had been supported to understand information. An in-house trainer monitored staff practice which enabled them to identify any gaps in training. Staff told us they were well supported and described a positive working environment. Care plans were person-centred and reflected people’s individual needs. However, goals associated with people’s personal development were not well documented. There were clear roles and responsibilities within the management team and these were known and understood by staff.
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Georgian House was downgraded from Good to Requires Improvement following a focused inspection that found breaches in safeguarding, safe care and treatment, staffing, consent (MCA), notifications and governance. While people felt safe and were cared for by kind staff, ineffective systems failed to identify shortfalls in risk management, medicines, induction training, commissioned support hours and CQC notifications.
Concerns (11)
criticalSafeguarding: “they had failed to report them to the local authority in accordance with procedures, for further investigation and follow up.”
criticalGovernance: “Systems to assess and improve the quality and safety of the service were ineffective. This was a breach of regulation 17 (Good Governance)”
criticalStaffing levels: “staffing rotas which demonstrated people did not receive their commissioned support hours.”
criticalStaff training: “there were significant gaps in the training some staff had undertaken and some staff had not completed an induction in line with the Care Certificate Standards.”
criticalConsent / capacity: “This lack of understanding had led to one person having restrictions placed upon them without legal authorisation.”
moderateMedication management: “Medication administration records (MAR) showed three gaps in one person's records where we could not tell if the medicines had been given.”
moderateCare planning: “information gathered as part of one person's pre assessment process did not form the basis of their risk assessments.”
moderateIncident learning: “this information was not being analysed or reviewed. This meant the provider could not be assured that lessons had been learnt”
moderateRecord keeping: “Some care records were not always accurate and had not always been updated to reflect changes in people's needs”
moderatePerson-centred care: “we observed some practice which did not always demonstrate a person-centred approach and was not in keeping with best practice guidance.”
moderateLeadership: “the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
Strengths
· Most people felt safe and well cared for by kind and caring staff
· Safe recruitment processes were followed in line with Schedule 3
· Detailed care plans and risk assessments in areas such as mobility, moving and handling and skin integrity
· Suitable arrangements for ordering, storage, recording and disposal of medicines
· Staff received training and competency checks for medicines administration
Quality-Statement breakdown (17)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and management; Using medicines safelyNot rated
safe: StaffingNot rated
safe: Learning lessons when things go wrongNot rated
safe: Preventing and controlling infectionNot rated
safe: RecruitmentNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; Supporting people to access healthcareNot rated
effective: Assessing people's needs and choicesNot rated
effective: Adapting service, design, decoration to meet people's needsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Continuous learning and improving careNot rated
well-led: Duty of candourNot rated
well-led: Engaging and involving people, the public and staff; Working in partnership with othersNot rated