The home was rated ‘Requires Improvement’ at our last full comprehensive inspection in December 2017. We visited again in June 2018 and rated the home ‘Inadequate’ and we placed the home in special measures. The overall rating from this inspection is 'Requires Improvement’, however it remains rated as ‘Inadequate’ in well led and the service therefore remains 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.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

About the service:

Cana Gardens is residential care home that was providing residential care for 8 people with a learning disability or autistic spectrum disorder. There are currently two people living in the home, neither of whom could comment on the quality of care and support. We spoke with the parents of both people to gain an insight about how they felt care and support was arranged. There is a management team made up of the registered manager, consultant manager and another manager. All three have specific management duties and oversight of the home.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control, limited independence and limited inclusion.

People’s experience of using this service:

The management team had completed audits to support quality checks, however for some areas, these had not identified where improvements needed to be made. This was linked to inconsistent safety practices. Because of this there were repeated breaches in Safe and Well Led.

Medicine administration had improved, and peoples care had some elements of safe practice.

Relatives of people living in the home gave mixed opinions if their relation was cared for safely, and if the home’s staff communicated with them.

The management and staff team did not fully comply with the MCA principles, or compliant with Deprivation of Liberty Standards (DoLS) authorisations or complied with positive conditions. That meant people were not supported to continue their transition to become more independent from staff assistance. Meaningful activities related to DoLS conditions were not well planned or regularly undertaken, which also detracted from people’s life experiences.

Staff training was variable, where care staff were trained but the management teams training was not being updated.

People were offered a healthy diet that met their cultural requirements but they did not always make healthy food choices.

Neither the people in the home or their relatives were supported to express their views about the care that the people living in the home preferred.

People experienced a positive relationship with staff and people’s relatives said their relations were well cared for and that staff were kind to them.

Auditing and governance continued to f

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This was a focused inspection which we carried out on 6 June 2018. The visit was unannounced.

Cana Gardens Residential Home provides care and accommodation for up to eight adults with learning disabilities. Cana Gardens is registered to provide care for up to 8 people. At the time of our inspection there were 4 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This unannounced inspection was undertaken to check that improvements to meet legal requirements by the provider following our inspection of 21 November 2017. We inspected the service against two of the five questions we ask about services: ‘Is the service Safe?’ and ‘Is the service Well Led?’ This is because the service was not meeting some legal requirements in these areas.

At our previous inspections of this service in October 2016 and December 2017 we found improvements were needed as the provider had not sent us notifications which involved the people living in the home. This was a continued breach of Regulation 18 (Registration) Regulations 2009, Notification of incidents.

We again found that the provider had not ensured they sent us notifications, around a medicine error and infestation in the home.

At our previous inspection of this service in December 2017 we found we found that we found the medicines system was not safe as staff had failed to ensure the correct medicines were given to a person.

There were issues around infection control, and an unsafe environment as some work was required to ensure the environment in the home and gardens were safe. We found the decoration of some parts of the home was poor and a carpet was dirty and stained.

These were all continued breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

We also found that the service had not ensured that people's health and welfare needs were protected and promoted as good governance systems were not comprehensively in place. This was a breach of Reg

The inspection took place on 1 and 15 December 2017, both days were unannounced.

Cana Gardens Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cana Gardens accommodates up to eight adults with learning disabilities in one adapted building. At the time of our inspection there were 5 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there was a lack of supervision by the provider to check quality monitoring had been carried out effectively. There was an absence of quality monitoring systems which covered people’s care plans and checks on medicines management.

There were no adequate infection control checks in place, staff were unsure which colour mops and buckets were used in each area of the home. Staff were also unsure what temperature soiled clothing was washed, these resulted in a heightened potential for cross infection and cross contamination of infection in the home. Improvements are required for the access to policies and procedures which would give staff the information to operate systems effectively and protect people in the home.

The systems in place were not reviewed by the registered manager to ensure people received a quality service. Incidents were recorded but information was not always sent to CQC. Improvements are required in assessing risk to people both in the home and in the enclosed garden.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. There was no system in place that allowed the registered manager to consistently supervise the staff to ensure people were safe in the home.

Health and safety checks were not regularly completed to ensure risks to people’s safety were minimised. We identified some health and safety issues to the consultant manager on the first day of our inspection visit where we had immediate concerns to people’s safety.

Care plans provided information for staff that identified people’s support needs and associated risks. There was enough staff on duty to respond to people’s health and social needs both in and out of the home. Staff recruitment procedures were adequate which ensured people were cared for by staff who had been assessed as safe to work with them.

The environment was in need of decoration, and doors were propped open which would have allowed fire to progress through the building. There was no plan of refurbishment of equipment or replacement of items or floor coverings. The main staircase carpet is in need of cleaning or replacement.

Staffing levels were adequate to ensure safe levels of care were maintained, people’s health and welfare were supported and people were assisted to conduct activities in and out of the home.

People were supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed and all five people had a DoLS in place for the restriction placed on them.

Staff knew how to keep people safe from the risk of harm. People told us, and the observations we made indicated people were safe living at Cana Gardens.

People were cared for by a caring and compassionate staff group who understood people’s needs, abilities, dietary and cultural requirements. Staff demonstrated their knowledge and training, however some staff training courses were out of date and we could not be assured staff were in receipt of the latest information.

Care

This inspection visit took place on 7 October 2016 and was unannounced. The service was last inspected in September 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Cana Gardens provides accommodation and care to people with a learning disability or autistic spectrum disorder. On the day of our inspection visit the service provided support to six people.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We refer to the registered manager as the manager in the body of this report.

The provider had not notified us about all incidents at the home which they were required to by law.

Quality assurance systems were not always in place to assess and monitor the quality of the service and focus on improvement. Although people felt safe using the service, there were inadequate processes and procedures in place to assess and monitor the risks associated with the environment, health and safety and infection control.

Staff understood how to protect people from the risk of abuse and keep people safe. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service. People's medicines were managed safely.

There were enough staff to deliver the care and support people required. People and their relatives told us staff were kind and knew how to support them.

Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us staff had the right skills to provide the care and support they required. People's care plans and individual risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff.

The managers and staff understood the principles of the Mental Capacity Act (MCA). Staff respected people’s decisions and gained people’s consent before they provided personal care.

Everyone felt the managers and staff were approachable. People's relatives told us they knew how to complain. The provider displayed information about making a complaint at the home following our inspection visit.

We found there was a breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and a breach of the (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection of Cana Gardens the people who used the service appeared settled and content. Staff got on well with them and were warm and friendly in their approach.

Please see our previous report published in June 2013.

When we visited there was one staff member and one person who used the service in the home. The latter showed us their room and pointed out some of the things they liked in there. Another person was at a local swimming pool with two staff members, and two other people were at day centres. They returned to the home later so we were able to meet them. All the people who used the service followed their own individual routines and appeared settled and content.

During our inspection a member of staff prepared the evening meal in the kitchen. One of the people who used the service sat with her and took an interest in the cooking process. The member of staff made vegetarian curry for three people and a gluten-free burger for a fourth who said they didn’t want the curry. Fresh produce was used and food hygiene principles followed.

Staff got on well with the people who used the service and relationships between them and the people they supported were warm and friendly. They told us they enjoyed working at Cana Gardens.

Care plans/risk assessments had not always been put in place/kept up to date following incidents of behaviour that challenges us. Two care plans/risk assessments for medication administration did not contain enough detail to help ensure people were safe. Some improvements to the premises were needed.

When we spoke with people during our previous inspection of Cana Gardens they told us they were satisfied with the care provided. They told us they could choose their meals, activities and daily routines, and got on well with the staff team.

For further details please see our previous report published in October 2012.

All the people who used the service were doing different things when we visited. One was out shopping, one at a day centre, and the others were in the home in their rooms or in one of the lounges watching television or listening to music.

One person told us they could choose their meals, activities and daily routines. Another person said they liked the layout of the home because there was a choice or communal areas and they could also spend time in their room if they wanted to.

Some care plans/risk assessments were out of date, non-existent, or unworkable. Consequently staff did not always have the information they needed to care for people effectively and keep them safe in the home.

People got on well with the staff team. One person told us, “The staff have all been lovely and they’re very helpful to me.” Staff worked with people in a warm and supportive way. They encouraged them to take part in the life of the home and go out into the community.

Two of the people who use the service told us they did not feel safe in the home because of recent challenging incidents. We asked the provider to take action to address this and provide support to those affected by the incidents.

The service appeared disorganised in parts with some policies and procedures not being followed, and some records not being kept properly. Action was needed to address this and other issues in the home.

When we inspected Cana Gardens in June 2011 we were told by someone who lived at the home that they had been on holiday and were involved in activities at a day centre they attended. We were unable to gather the views of people who were at the home when we visited in November 2011 as they were not able to communicate verbally.

One person told us “I’m going on a climbing holiday in South Wales with staff.” We asked them if they were happy living at Cana Gardens and they said “It’s somewhere to live and you have to be positive in life.” We asked them how they spent their time and they told us “I’ve been in hospital as I wasn’t well but I’m better now. I go to Mount sorrel day centre and I enjoy playing snooker.”

Staff we spoke with and records we viewed showed that people have access to a range of community activities, which included going to church, swimming, visiting public houses, eating out and going for walks.