The Care Quality Commission (CQC) has downgraded the rating of Cross House in Beeston, Nottingham from requires improvement to inadequate and placed the service into special measures to protect people following an inspection in May.

The service, run by Headzpace Therapeutic Care Limited, provides personal care and support to children and young adults in their own homes. Many of the individuals they support are autistic people, people with a learning disability or experience challenges with their mental health.

Although Cross House supported other people, CQC only looked at the support with personal care that the service provided, as this is the registered activity. At the time of this inspection, the service supported three people with personal care.

This inspection was carried out as CQC had received information of concern around poor management at Cross House. This was substantiated at inspection, and CQC identified a breach of regulation related to management and asked the service to submit an action plan highlighting how they will address these concerns.

The ratings for how safe and well-led the service is, have dropped from good to inadequate. This inspection didn’t look at how caring or responsive the service is so they maintain their current rating of requires improvement, or effective which remains good.

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CQC has placed the service into special measures which involves close monitoring to ensure people are safe while they make improvements.

Craig Howarth, CQC deputy director of operations in the Midlands, said:

“During the inspection of Cross House, our inspection team identified significant, widespread concerns about how the service was being run and how safe people were. We know from experience that services without strong leadership are less likely to meet people’s needs in the other areas we inspect, which is what we found here.

“Relatives had mixed feedback on the care their loved ones received. While some appreciated staff had built a good relationship with their relative and leaders provided consistency of carers, others expressed concern staff didn’t perform basic tasks well or consider their relative’s needs.

“Leaders lacked the necessary skills, knowledge and experience to perform their roles well. As a result, they didn’t understand the service or monitor the care staff provided. This meant they were unaware of issues and didn’t make improvements to enhance the care people received.

“Leaders failed to provide clear guidance for staff on how to support people with complex health conditions. Staff had restrained people, but without written guidance inspectors couldn’t determine whether they had restrained people safely in line with their care plan and risk assessment.

“Staff also didn’t understand the needs of the people they cared for because they didn’t keep care plans updated. This put people at risk of receiving ineffective care.

“We have told Cross House where they need to make urgent improvements to keep people safe. They must improve leadership and safety, and we will keep the service under close review while this happens.”

Inspectors found:

  • Leaders and staff failed to investigate incidents to identify learning opportunities and improve people’s experiences.
  • Staff didn’t keep the environment clean, safe or well-maintained. Inspectors found a dirty oven and cooker with a thick build-up of grease that posed fire safety and food contamination risks.
  • The service didn’t have effective processes when beginning support for a person. Staff didn’t have a reflective care plan in place on how to support one person three weeks after they had begun providing support.
  • Leaders didn’t work closely with other healthcare partners to keep people safe and provide consistent care.
  • Leaders didn’t ensure sufficient staff were available to fill rotas safely. Staff sometimes completed shifts of 48 hours or more, putting people at risk of receiving unsafe care from tired staff.
  • Leaders weren’t visible and didn’t provide adequate supervision for staff.
  • Staff didn’t always share safeguarding incidents with the local authority.

The report will be published on CQC’s website in the coming days.