159 Wensley Road

159 Wensley Road is a small care home without nursing providing care and accommodation for up to four people with a learning disability. At the time of the inspection there were three people living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

People’s experience of using this service and what we found

Right Support

¿ The registered person did not use safe recruitment procedures to ensure people were supported by staff who were of good character, suitable for their role and had appropriate experience. There was a risk people could be supported by unsuitable staff putting them at higher risk of harm.

¿ Staff supported people with their medicines in a way that promoted their independence. However, other aspects of medicine management such as record keeping, medicine stock checks and training needed improvement.

¿ The service gave people care and support in a safe, clean, and well-furnished environment that met their sensory and physical needs. However, some aspect of premises safety such as maintenance checks, fire and legionella risk assessments and action plans needed improvement.

¿ People had a choice about their living environment and were able to personalise their rooms. People invited us to view their rooms and showed us how they sorted their rooms.

¿ The service and staff supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives.

¿ Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

¿ Staff supported people to achieve their aspirations and goals.

¿ Staff supported people to take part in activities and pursue their interests in their local area with people who had shared interests.

¿ Staff enabled people to access specialist health and social care support in the community.

¿ Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

¿ Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

¿ The service had enough staff to meet people’s needs and keep them safe. However, further evidence was not provided to show that staff were appropriately skilled to meet some people’s specific needs.

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff spoke to people politely giving them time to respond and express their wishes.

¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

¿ Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

¿ We found the registered person did not ensure we were notified of reportable events within a reasonable time frame.

¿ The registered person did not follow their quality assurance policy effectively so they could assess, monitor and mitigate any risks relating the health, safety and welfare of people using services, the service and others.

¿ The registered person did not follow and accurately record and keep a copy of all the actions taken as required in the duty of candour regulation when a notifiable safety incident occurred.

¿ Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

¿ Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

¿ Staff placed people’s wishes, needs and rights at the heart of everything they did.

¿ People and those important to them were involved in planning their care. Staff valued and acted upon people’s views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (report published on 16 December 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the second time in a row.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support right care right culture.

We carried out an unannounced comprehensive inspection of this service on 14 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 159 Wensley road on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, premises, recruitment, duty of candour, submitting notifications and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

159 Wensley Road is a small care home without nursing providing care and accommodation for up to four people with a learning disability. At the time of the inspection there were three people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The registered manager did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards were always effective in identifying when the fundamental standards were not met. The registered manager did not ensure effective recruitment processes were in place to ensure as far as possible, that people were protected from staff being employed who were not suitable. The management of medicines and premises was not always safe. The registered manager did not inform us about events such an injury to a person using a service in a timely manner.

We have made a recommendation about seeking guidance from a reputable source to ensure the principles of the Accessible Information Standard were met.

Most of the staff were up to date with their mandatory training. The manager had planned and booked training when necessary to ensure all staff had the appropriate knowledge to support people. Staff had not always received ongoing support via regular supervision and appraisals. However, they felt supported and maintained great team work.

The staff members felt staffing levels could be improved to ensure better management of people’s activities and staff time such as breaks. The registered manager appreciated staff’s contribution to ensure people received the best care and support. Staff felt the registered manager was supportive and open with them. However, communication and what was happening at the service could be improved. People and relatives felt they could approach the management and staff with any concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were happy living at the service. Relatives felt their family members were kept safe in the service. The registered manager and staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. There were contingency plans in place to respond to emergencies and the premises and equipment were kept clean.

People received effective care and support from staff who knew them well. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

People liked their staff and liked living in the service. The registered manager was working with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of their care.

The registered manager encouraged feedback from people and families. The staff team recognised and responded to changes in risks to people and ensured a timely response and appropriate action was taken. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 5 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to regulations 12, 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Staff recruitment was not always robust; medicine management and premises were not always managed safely; effective systems and governance overview were not always used to ensure the service met the required fundamental standards of care.

Please see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

People continued to receive safe care. There were sufficient numbers of staff to support people safely. Risk assessments were completed and reviewed regularly to enable people to receive support with the minimum of risk and were as least restrictive as possible. Medicines were managed safely by staff who had received relevant training. When appropriate, people were supported to manage their medicines independently. Staff were aware of and had practiced emergency procedures.

People continued to receive effective care. Staff were trained and supported to have the skills and knowledge they required to perform their role. People’s healthcare needs were monitored and they were supported to seek advice from healthcare professionals when necessary. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

The service remained caring. People had positive and trusting relationships with staff. They told us they got on well with staff and appreciated their support. Staff protected people’s privacy and dignity and treated them with respect. People made decisions about their care assisted by their key worker and other health and social care professionals. People were supported to be as independent as possible. They were enabled to acquire additional skills to enhance their independence.

The service remained responsive. Support plans were personalised and focussed on each individual. People had been involved in creating the plans which identified the preferences of each individual along with their lifestyle choices. People discussed their support plans regularly with their key worker and were encouraged to challenge and change them if they wished. People knew how to raise a complaint if they needed to and were confident in speaking to staff about any concerns they had.

The service was well-led. Improvements had been made following the previous inspection. A system was now in place to monitor and mitigate risks to people’s health, safety and well-being and action had been taken to resolve issues and concerns. Records relating to the management of the regulated activity were now stored securely in locked filing cabinets. The process of updating policies had been started, however, a duty of candour policy had not yet been created. The registered manager agreed to address this immediately. There was an open culture that promoted empowerment for people living at the service. The registered manager clearly wanted to work towards improving the service and engaged staff effectively in working toward this. People’s views were sought and the quality of the service was monitored.

Further information is in the detailed findings below.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure. The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place. Recruitment procedures were rigorous and thorough.

We saw that the home was clean but in need of decorating. Some furniture needed replacing as it was worn and damaged.

Procedures for dealing with emergencies were in place and staff were able to describe the action they would take to ensure the safety of the people who use the service. The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Manager was able to describe the circumstances when an application should be made and knew how to submit one. A policy with regard to this had been reviewed and rewritten in February 2014 in light of new guidance.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. This meant that people were sure that their individual care needs and wishes were known and planned for.

People had access to a range of health care professionals. For example: psychologist, neurologist and optician. People were escorted to healthcare appointments if needed.

Is the service caring?

People were supported by friendly and attentive staff who spoke politely to them. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with told us staff listened to them and took note of what they said. They told us they felt staff were easy to talk to and they could ask questions at any time.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, and discussions with people told us that individual wishes for care and support were taken into account and respected. This was confirmed by the records we looked at.

Is the service responsive?

People told us, that they were able to participate in a range of activities both in the home and in the local community. On the day of our visit two people were looking forward to going to visit their families for Easter and others were going out to do some shopping. The activities provided by the home included work placements, gardening projects, and attendance at day services as well as hobbies such as music and transport. The activities reflected the likes, dislikes and preferences of the people who use the service.

People told us they were involved in reviewing their plans of care when their needs changed. One person's care plan stated they wanted to self-medicate, we saw how a positive risk taking assessment had enabled this. The home had a system to assure the quality of service they provided. The way the service was run had been regularly reviewed and action taken when necessary to address any shortfalls. Trends in accidents and incidents had been monitored, advice sought and action taken appropriately to prevent reoccurrence. People's personal care records, and other records kept in the home, were accurate and complete.

Is the service well-led?

The service worked well with other agencies and professionals to make sure people received their care in a joined up way. The service has a quality assurance system and we saw that any identified shortfalls were addressed promptly. Staff had a good knowledge of their roles and responsibilities and could seek advice from senior staff and managers.

Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We reviewed two care plans and found these to be person centred and regularly reviewed. They were written by both the person and their key worker. This ensured the person was giving their consent and care workers knew how they wanted to be supported. Care plans recorded people had access to other services to support their health and social needs.

Medication was administered by suitably trained care workers who were knowledgeable about people's needs.

Care workers were supported by management and received regular supervision and had access to relevant training. Annual appraisals were also completed and care workers were encouraged to undertake further qualifications.

The manager had systems in place to assess and monitor the service being provided to people living at the home. The manager also sought the views of care workers and people living at the home so they had an understanding of the service and the support given to people.

We saw each person had their own room, which they had personalised to their preference. The bedroom doors had locks with keys held by the individual person and we were informed by people living at the home that no one entered their rooms without knocking. This ensured that people living at the home had privacy.

One person told us,'I like living here; I am able to sleep when I want. The people here are nice and this is my home'.

People were supported in promoting their independence and community involvement. We saw people had busy lives and weekly activity planners for each person were on view in the office. During our visit two people were out all day, while two others were seen to be supported leaving the house and going to the local shops. We saw the staff implemented behaviour management plans, which included a reward system to encourage appropriate behaviour.

We saw positive interactions between staff and the people living in the home.