Covenant Care - The Wheelhouse

Updated 20 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors visited the service.

Service and service type

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

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information we had received from the provider and others since the last inspection such as monthly reports, safeguarding concerns and feedback from local professionals. We used all of this information to plan our inspection.

During the inspection

We met the majority of the people who lived at the home. People were not able to fully express their views verbally, so we spent time talking with staff on duty and observing practices in communal areas.

We spoke with the registered manager, deputy manager and with four staff which included senior care staff and care staff. We also spoke with one of the directors who was visiting the service to undertake maintenance.

We looked at a staff file in relation to recruitment and at records of staff training and supervision. We looked at three people's care records and at medicine records. We reviewed quality monitoring records, such as checklists, audits, policies and procedures as well as servicing and maintenance records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We contacted health and social care professionals and an IMCA (independent mental capacity advocate) who regularly visited the service and received a response from three of them. We contacted relatives of people using the service and spoke with one of them. We requested information about infection control policies and procedures.

Updated 20 July 2021

About the service

The Wheelhouse is registered to provide care and support to a maximum of 10 people with a learning disability or who are living with autism, mental health difficulties, physical difficulties and/or sensory impairment. At the time of the inspection eight people were living at The Wheelhouse.

At the last inspection the service was also registered to provide personal care to people who live in their five supported living houses. In November 2020 the supported living side of the service had separated from The Wheelhouse and has registered as a new location.

In March 2019, we inspected the service where we identified three breaches of regulations in relation to safeguarding people from abuse, consent and good governance. Following this inspection, the Care Quality Commission (CQC) took enforcement action by imposing a condition on the provider’s registration. This required the provider to provide CQC with a monthly report outlining actions and progress towards making the required improvements. At this inspection we found improvements had been made and we have removed the imposed condition.

We made two recommendations at the March 2019 inspection, one in relation to infection control and one relating to following our publish guidance relating to submitting statutory notifications. At this inspection we found improvements had been made.

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

People were protected from harm. Safeguarding procedures were in place and were followed by the registered manager, this included informing the local authority. The registered manager was aware of their responsibility to notify the Care Quality Commission (CQC) of significant events in line with their legal responsibility.

There were significant improvements in leadership and quality monitoring systems, with evidence of improvement actions taken in response to training, safeguarding, restrictions, risks, supervisions and incidents and audits. The provider sent monthly reports to CQC, so we could monitor progress. Effective audits were in place to check the quality of the care provision and action was taken to address 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.

People were supported by staff who understood how to keep them safe. People’s risks were assessed, and staff understood how to manage risk.

People’s medicines were administered safely

Staff wore Personal Protective Equipment (PPE) in line with current guidance and promoted good Infection Prevention and Control (IPC) practice. We discussed with the registered manager about how they could improve how people maximised social distancing within the home and how people coming to the service for respite could be admitted safely. The registered manager said they would review these areas. Staff helped people keep in touch with their friends and relatives throughout the pandemic, which helped alleviate their worries. Visiting had resumed with the appropriate testing and safeguards in place to prevent cross infection.

People’s needs, and choices were assessed, and care was delivered in line with their care plans. People were supported by staff who had the required training and the skills to meet their needs. People were encouraged to maintain a balanced diet. Staff worked alongside health professionals to deliver effective care to people.

Staff knew people well and people’s care was more personalised. People were supported by kind and caring staff who respected them and promoted their dignity. People were supported by staff who promoted their independence.

People were supported by staff who understood their communication and sensory needs. People were encouraged to engage in activities of their choice. A complaints policy was in place and was followed.

People were supported by a new registered manager and staff team who were proactive in empowering people to achieve their desired goals. Staff felt supported by the registered manager and deputy manager.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care used at Covenant Care, fully maximised choice, control and independence for people with a learning disability. The National Institute for Health and Care Excellence recommends residential care ‘should usually be provided in small, local community-based units (of no more than six people)’. This service is registered for ten people with three of these people having separate accommodation with their own kitchenette and lounge area. The main shared communal area for the other seven registered beds was spacious which enabled people to move around in safety and have their own space.

Right care:

The care and support provided, met the needs of people with learning disabilities. Staff had received the training needed on how to meet the needs of people with learning disabilities and autism and had the skills they needed to provide appropriate support. A consistent staff team had been established after a period of staff turnover. This meant people received care from staff they knew and trusted.

People’s care was person centred, planned with people having choice and control over how their health and care needs were met. Care plans were focused on people’s strengths, abilities and individual goals.

Right culture:

The ethos, values, attitudes and behaviours of the registered manager, deputy manager and care staff ensured people with learning disabilities led confident, inclusive and empowered lives. Staff had the skills needed and the environment was suited to supporting needs of people with learning disabilities.

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 Requires Improvement (report published October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Covenant Care - The Wheelhouse on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.