A watchdog has ruled a supported living service in Kinross took away too many freedoms from residents and risked creating a sense workers were “in charge”.
The Hillcrest facility, which houses four people with learning disabilities, has been ordered to review “restraint” measures in place after finding access to a communal kitchen was purposely shut off.
The unannounced inspection also found staff used bunches of keys to unlock doors and controlled telephone use, damaging the residents’ privacy as well as their “self-esteem and self-image”.
‘This was a form of restraint’
The Care Inspectorate has set out a series of changes needed to allow those living there to take “positive risks” to enhance their quality of life.
The report stated: “The kitchen was locked and staff told us this was to prevent one person eating raw food.
“This meant that other people living in the house could not access drinks or snacks independently.
“Water was available from a water cooler and staff offered people drinks on a regular basis.
“However, this was a form of restraint and there were no records of multi-disciplinary agreements or consents to the restraint.
‘People’s dignity and freedom at risk’
“This put people’s dignity and freedom of movement at risk.”
Officers also found staff knowledge and understanding of adults with incapacity legislation was “poor”.
This meant they did not know when guardians should be consulted to give consent for support and interventions.
People were supported to sign to withdraw cash from the bank when they had been assessed as not having the capacity to do so, putting them at risk of financial harm.
An autism care plan was also lacking, meaning people were at risk of emotional and psychological harm.
Concern over Covid-19 risks
The June 4 inspection was part of an overall review of services provided by the company in Fife and Kinross, which includes care at home.
Inspectors spoke to service users in Dunfermline, Cupar and Kinross, who reported to them they felt “well-supported” overall and enjoyed good relationships with staff.
However, further issues were identified, including concerns over Covid-19 infection control practices, which were branded weak.
The report said: “The standard of cleanliness in people’s houses was poor. The environment was cluttered and unkempt and décor was tired.
“Staff were not aware of the appropriate cleaning materials that should be used and cleaning records had significant gaps.
Bins were overfilled and did not have lids… staff did not follow hand hygiene guidance.
“Areas in the house were cluttered including kitchen worktops, laundry shelves and the staff sleepover room.
“Items were stored on the floor in the laundry and kitchen.
“Care equipment was dusty, scraped and chipped and this made it difficult to clean these areas effectively. We were concerned about the disposal of clinical and domestic waste.
“Clinical waste was not disposed of safely and bins were overfilled and did not have lids. Staff did not follow hand hygiene guidance.
“We observed staff opening bins with their hands without subsequently washing their hands. This put the health, safety and wellbeing of people at risk.”
‘Very challenging’ 18 months
The service is run by Hillcrest Futures, which is part of the non-profit Hillcrest group of companies.
Hillcrest provides housing, care, support, training, skills and employment services.
The organisation says it is already making improvements after the inspection.
A spokesperson said: “Our care at home service provides support to four individuals in Kinross to enable them to live the most fulfilling lives possible.
“As identified in the report, our staff have always developed and maintained good quality relationships with the people we support and put people at the centre of everything they do.
‘In the process of making improvements’
“During a very challenging 18 months where we had to adapt our ways of delivering care and support, we are very welcoming of the Care Inspectorate’s feedback to allow us to make improvements.”
The organisation says it is “open and transparent” and welcomes scrutiny.
The spokesperson added: “As a result of the recommendations made in this report, we are already in the process of making improvements.
“This includes further meetings to ensure that any risk assessments which identified measures such as locking of cupboards are fully discussed with our multi agency partners to ensure the best level of care for the people we support.”