Thomas Edward Mitton House

At our last inspection, the service was in breach of a legal regulation of the Health and Social Care Act (2014) in relation to good governance. At this inspection the service is still in breach of this legal regulation, and we also found new breaches of legal regulation in relation to safe care and treatment, safeguarding people from abuse, person centred care, safe staffing and good governance. The service rating has changed from requires improvement to inadequate at this inspection. Please see the full report for details.

People were not always safe as care plans and risk assessments were not detailed to ensure staff supported them safely. Staff did not always support people in line with their assessed support needs. People’s needs were not adequately assessed when they started using the service. Their rehabilitation journey whilst staying at the service was not adequately monitored to ensure they were being supported to achieve their goals. People were not always being supported to have positive outcomes at the service as a result. The provider was not always acting on known issues about the safety of the environment. Whilst staff had training to support people, it was not clear how they were being supported to understand or be competent after their training. People were not supported safely with all aspects of medicines administration as protocols for ‘as and when required’ (PRN) protocols were not in place.

People did not receive person centred care. Care plans were not personalised about how to support people in line with their preferences, likes and dislikes. People were not being supported to understand information in ways that made sense to them. People and their relatives were not being asked to feedback about their care and support. Staff were not consistently supporting people with dignity and respect or to be independent. Staff were not clear what goals and outcomes people wanted at the service and were not supporting them to consistently achieve these. Audits and governance measures were not effective in identifying where improvements may be needed. There had been several changes in senior management at the service which had impacted oversight of risk and the quality-of-care people received.

The service was clean and free from Infection Prevention and Control (IPC) risks for the most part. Staff told us they enjoyed working at the service. Some staff knew people well and wanted what was best for them. Some people had positive experiences at the service, including regaining skills and independence and successfully returning home. The covering service manager and wider senior management team reacted positively to our feedback during the inspection. They started implementing improvements based on our findings.

In instances where CQC has decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

This service has been placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.