Wendover Road

We found the following examples of good practice:

• Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

• Policies, procedures and risk assessments related to COVID-19 were up to date which enabled staff to keep people safe.

• All staff had received training and followed correct infection prevention control guidance and using PPE processes. The provider ensured a sufficient stock of appropriate PPE and there were designated notice boards available to remind staff about correct guidelines and handwashing techniques. There was a programme of training refreshers to ensure staff knowledge was kept up to date. Spot checks took place to ensure staff adhered to the training provided.

• The provider has assessed the impact of how PPE may cause fear and anxiety for people, particularly those who had limited mental capacity to understand the need for the staff to wear PPE. They mitigated these concerns using the COVID-19 risk management framework.

• The service was clean and fresh, staff carried out a number of additional tasks, such as cleaning of any regular touchpoint surfaces. Regular infection control audits took place and actions had been followed up when required.

• Staff had been trained and knew how to immediately instigate an enhanced infection control measures to care for people with symptoms to avoid the virus spreading to other residents and staff.

• The provider offered support to aid the wellbeing of the team, individual assessments had been carried out with staff to ensure any individual circumstances or health conditions were known and the support could be offered as needed.

• The registered manager reported good support from the local health professionals and the team at the provider's head office.

Wendover Road is a residential care home providing accommodation and personal care to four adults at the time of the inspection. The service can support up to a maximum of four people at any one time. There were nine staff employed by the service.

Wendover Road supports people living with a learning disability or autism. This includes both younger and older adults, and people with physical disabilities. The service is part of the Hightown Housing Association Limited group, who operate 14 registered locations in England.

The care home accommodated people within the single floor house, and each person had their own very large bedroom. There were communal shower, bath and toilet facilities. The entire premises were wheelchair accessible with wide doorways and corridors. There was a communal kitchen, lounge room and dining room. There was a large garden at the rear of the care home. The service had a minibus for transporting people from the care home into the community. There was also a dedicated staff office.

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.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were protected from abuse, neglect and discrimination. Risk assessments were carried out in a timely manner for people's personal care. The risk assessments were thorough and up-to-date and contained relevant information to ensure risks were mitigated as far as possible. Premises risks were assessed and managed. There were enough staff deployed. The house was clean and tidy. Medicines were safely managed.

People's likes, preferences and dislikes were considered and used in their everyday care. Staff had a good knowledge of people's needs. People received enough food and drinks to prevent malnutrition and dehydration. People's care was joined up with local and community-based health and social care professionals. The service was compliant with the Mental Capacity Act (and associated provisions) and people were legally deprived of their liberty. There was a pleasant refurbishment of the property and this was planned to continue. Staff had the necessary knowledge, skills and experience to support people who lived at Wendover Road.

The service was caring, and the staff are kind and compassionate. People's rights were respected, and their dignity and privacy was maintained. Where possible, people's independence was maintained and promoted. Parents/relatives were involved in people's care planning and reviews. There was positive feedback on file about the care provided.

Support plans were person-centred, detailed and contemporaneous. The daily notes were very good and contained information about people's daily behaviour and emotional status. The service ensured that information was provided in a way that people could understand it. There was a satisfactory complaints mechanism and no complaints had been received.

There was a good underlying set of principles about the care provided to people of Wendover Road. Staff were happy at the service and there was a positive workplace environment. There was an appropriate series of audits and other quality assurance processes to monitor and report on the quality and safety of care. Appropriate actions were taken when issues were identified. The registered manager and assistant manager were knowledgeable, skilled and experienced and able to lead the service well. There was good linked up working within the organisation and local community. Management and team meetings were used to share lessons learned, knowledge and updates within the organisation. We made a recommendation about the provider sharing feedback effectively with the location.

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.

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 24 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Wendover Road is a care home that is registered to provide residential care for up to four people with learning disabilities. At the time of our inspection four people lived in the home. They had complex disabilities which included learning, physical and behavioural needs.

During this inspection we spent time with staff who worked well together and who understood the needs of the people they were caring for. They were aware of the values of the service, and from our observations they aimed to implement them. Staff knew what people’s individual needs were, including their preferences. We observed positive interactions between people and staff and it was apparent, people enjoyed spending time with staff.

We found improvements had been made to the home, with redecoration in the parts that required it. Work had also been undertaken regarding the flooding of the car park, but this was ongoing.

Staff showed respect for people and preserved their dignity and privacy. People’s safety had been considered by the home, risk assessments related to care and the environment were in place. Care plans were in place that guided staff to provide appropriate care, these were reviewed on a regular basis. Care plans reflected people choice and the control they had over their lives and had improved since our last inspection. Staff were able to demonstrate their knowledge and received training in how to identify and report concerns related to abuse.

Staff understood the Mental Capacity Act 2005 (MCA) and how this applied to their role. Where restrictions on people’s liberty were required, staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been made to the local authority.

Medicines were safely administered and stored by trained staff. Records associated to the administration of medicines were up to date and accurate.

Staff were supported through regular supervision and appraisals. Training for staff was provided and kept up to date. New staff completed induction and training. Staff spoke positively about the registered manager and the support they received. Staff meetings also took place to encourage feedback from staff and to drive forward improvements to the service.

Staff were aware of people’s nutritional needs and how to support them. Staff understood the support needed by people to eat and drink and applied this to their practice. Staff were also aware of people’s dietary needs in relation to their culture and religion, and this was respected.

Appropriate activities were in place to ensure people remained stimulated and had a good quality of life. These were in line with people’s preferences.

The home practiced safe recruitment in relation to new staff. Employment checks were carried out and records kept. This minimised the risk of inappropriate staff working with people.

Checks were made on the safety of the home and the quality of the service provided. The registered manager had an overview of the home and was working towards continuous improvement. Both staff and a relative spoke positively about the registered manager and the assistant manager.

The home is a four bedroomed bungalow. There are shared areas such as a lounge, bathroom, kitchen and dining area. The registered manager was on long term leave at the time of the inspection. The service was being overseen by an interim manager, who planned to be present at the home for two days per week.

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.

Each person had a support plan and risk assessments in place to guide staff on how to provide care and minimise the risk of harm. One person’s plan and risk assessment gave insufficient clear guidelines for staff on how to support a person with behaviour that was challenging. We have made a recommendation about supporting staff with writing support plans. Another person had a support plan for exercise, which was written in such a way as to deprive them of choice or control over participating in the exercise. This was removed following the inspection.

Although the provider carried out the necessary checks when recruiting new staff, they failed to check gaps in some candidate’s employment histories. We have made a recommendation about the recruitment of staff.

People were appropriately supported with their food and fluid intake. Where specialist advice had been sought to ensure people could eat and drink safely this had been carried out by staff. Medicines were safely stored and administered. Records were up to date and showed people received their medicines at the time they needed them.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Where restraints had been put in place to keep people safe, authorisation had been applied for from the local authority.

Staff knew how to keep people safe and how to identify and report concerns of abuse. They also understood how to respond to complaints.

Staff received training in areas they needed to know to carry out their role safely. However records of staff training were not up to date or accurate. The interim manager did not have access to all the staff training records at the time of the inspection. This meant they could not assess the safety of the service in relation to the skills and knowledge of staff.

We found some areas of the home were in need of redecoration due to peeling and stained paint work, damaged wood work and structural defects within the parking area. Other parts of the house were well maintained and were well decorated such as people’s bedrooms and the lounge area.

People participated in activities both in the home and in the local community. People were assisted to maintain their health through regular contact with the relevant health professionals, for example, GP and dental practices.

Staff worked well as a team. We observed them to be caring and sensitive in their approach to supporting people in the home. They were focussed on supporting the people well and supporting each other. They knew how to preserve people’s dignity and privacy and communicated well with people.

Audits and checks were undertaken to ensure the safety of the service and drive forward improvements. We noted that the areas we found in relation to the writing of support plans had not been identified by senior staff during their audit. We have made a recommendation about the providers audit process.

Staff were positive about the skills and knowledge of the interim manager covering the registered manager’s position whilst they were on leave. The staff appeared to work well together and there was an honest and transparent approach. Staff felt confident to raise concerns and to seek support when needed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We sought evidence of how people who had used the service understood the care and treatment choices available. We saw arrangements for an individual 'link worker' for each person. We spoke with staff who told us 'Because [the people] can't communicate verbally the link worker is an important way of making sure they understand choices; we get to know people pretty well.'

We looked at how risk assessment was planned and delivered in a way that was intended to ensure safety and welfare. We saw how this confirmed compliance with a policy which stated that the service should adopt 'a positive approach to risk taking' and that 'people should not miss out on opportunities.'

It was clear from discussion that staff understood what might alert them to a Safeguarding concern or where they might be required to use the confidential reporting policy.

We saw evidence that had opportunities for further professional development, and to obtain further relevant qualifications.

It was clear that residents' meetings had been taken seriously and staff meetings had included discussion about a range of quality issues, where action to minimise the potential for any adverse re-occurrence had been considered.

We found that people were treated with respect. People's health and social care needs were met. The environment was suitable, well maintained and had been adapted to meet people's needs where required. Staff were provided with the training required to support people. Complaints were considered and action taken where required.