Archived: Love Walk

Love Walk provides accommodation and personal care for up to 31 people with a range of physical disabilities. At the time of the inspection, there was 28 people living at this residential home. The service is supporting one person who has a learning disability. The provider is closing the home and rebuilding a new home on the current site. They are working with the local authority to find suitable alternative placements for people during the building works.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support: The model of care did not maximise people’s choice and independence and people were not always protected from the risk of harm.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The provider was unable to provide any evidence where decisions were made in people's best interests and where people may lack capacity.

Medicines were not always managed safely as the provider was not identifying potential risks. People told us they liked living at the home and they enjoyed spending time with each other and participating in activities.

Right Care: People were not always involved in making decisions about their care as night staff were waking people up and getting them dressed despite people’s care plans recording their preferences regarding being woken up. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care

Right Culture: Governance processes were not always effective as the registered manager did not always have clear procedures in place to monitor the home. This meant people did not always receive good care and support.

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 (published 20 August 2022) and there were 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 we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the key questions Safe and well-led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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.

Enforcement

We have identified breaches in relation to consent, staffing levels and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Love Walk provides accommodation and personal care for up to 31 people with a range of physical disabilities. At the time of the inspection, 27 people were living at the home and six people were on holidays.

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

Risks to people had not always been assessed and planned for. The provider had implemented a new monitoring system however this was not always effective as it had not identified the concerns with assessing and managing risks. The provider had processes for learning when things went wrong.

People told us they liked living in the home and they felt safe.

Staff demonstrated a good understanding of the provider's safeguarding policy. Medicines were safely managed. The provider was completing regular safety checks to ensure the building was safe. Staff were suitably trained, and they received regular supervision and appraisals.

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. We made a recommendation to the provider to considers people's preferences and needs as some people were unhappy with the food available.

The building was old and in need of modernisation. We made a recommendation to the provider to review their practices to ensure the building meets the needs of people living with dementia.

We saw some kind and caring interactions between staff and people living in the home. Care plans were detailed and person-centered and provided clear guidance to staff on how to care for people. Staff respected people's privacy and dignity. People were supported to be as independent as possible.

People knew how to make a complaint. The provider was not recording people’s end of life wishes.

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 (publishedgap13 April 2021) and there were breaches of regulation.

Why we inspected

We undertook the inspection to see if the provider had made improvements since the last inspection.

We looked at infection and prevention 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

At the previous inspection we identified breaches of regulation for 12 (safe care and treatment) 11 (consent) 17 (good governance) and regulation 18 (notification of other incidents) The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements, but the provider was still in breach of regulation 12 and 17.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Medicines were not always managed safely. Risk management plans were not always detailed and did not give staff clear guidance to help mitigate risks. Infection control measures needed to be updated and improved in line with current guidelines. This work was completed following the inspection.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had their daily fluid intake recorded but we could see no support given to people when they were not reaching their individual target.

The provider did not have effective quality assurance and monitoring systems in place to review and improve the care and support provided. The provider had not sent notifications of significant events to CQC within required timescales in line with legislation.

During the inspection we observed people having to wait for their care to be delivered. Following the inspection, the provider reviewed their staffing levels to ensure they had adequate staffing levels in place. Accidents and incidents were been analysed each month. People were happy with the care they received, and they felt staff were kind.

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 (03 January 2018)

Why we inspected

The inspection was prompted in part due to concerns received about a specific incident. Following which a person using the service died. The information CQC received about the incident indicated concerns about the management of choking. We undertook this inspection as we wanted to ensure people were receiving safe care.

As a result, we undertook a focused inspection to review the key questions of the safe, effective and well-led domains and this inspection examined those risks.

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 coronavirus and other infection outbreaks effectively.

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 monitor the service. 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 one breach in relation to notifiable incidents. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We identified breaches of regulations in relation to safe care and treatment, consent, good governance and notifiable incidents. 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 for 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.

People's accommodation is arranged over two floors and all bedrooms have en-suite facilities. People had access to communal areas and a well-maintained garden. The building was accessible by wheelchair and has a passenger lift that enabled people to access all parts of the accommodation.

At the last inspection on 10 September 2015, the service was rated ‘Good’. At this inspection, we found the service remained overall ‘Good’ with a rating of Outstanding in Responsive.

People benefitted immensely from taking part in a wide range of activities provided at the service. People using the service, their relatives and health and social care professionals spoke highly about the impact on people’s lives because of the stimulating activities and enabling environment provided at the home. They were consistent in their commendation about how people’s lives had vastly improved as a result of the support provided. In addition, this had enabled some people to move on to supported or independent living.

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. People consented to care and treatment. Staff understood and respected people’s rights in line with the requirements of the Mental Capacity Act 2005.

People were safe at the service. People were protected from abuse because staff were trained and able to identify and report safeguarding concerns about people’s health and well-being.

Appropriate risk assessments and management plans were in place to ensure people’s needs were met safely and without unlawfully restricting their independence and freedom.

People received their medicines safely when needed and in line with the support they required. Staff managed and administered people’s medicines appropriately by following the provider’s procedures.

The provider deployed a sufficient number of suitably skilled staff to meet people’s needs. New staff underwent appropriate recruitment procedures to ensure their suitability to deliver care.

People had an assessment of their needs before they started using the service. Support plans were reviewed regularly to ensure staff provided people with the care they needed.

People were treated as individuals and had their diversity and cultural differences respected. Staff knew people well and delivered care with kindness and compassion. Care plans were individualised and reflected the support each person required. Staff followed the guidance to deliver care in line with people’s support plans.

People were encouraged to develop daily living skills and to be independent when possible. Staff asked people about how they preferred to receive their care and support, and respected their choices.

People received the support they required to have meals that met their dietary needs. Staff supported people to access healthcare services to maintain their well-being.

People were supported to maintain relationships with people that mattered to them. People were confident their concerns or complaints would be investigated and resolved.

People benefitted from a culture that was centred on their individual needs and openness about how staff provided their care. Staff were valued at the service and committed to providing high standards of care.

People’s care and support was checked and audited and the registered managed used the findings to drive forward improvements. There were strong links with the local community and a close partnership with other agencies to improve the quality of care provided to people.

One person using the service told us, “I am happy living here.”

Peoples’ diversity, values and human rights were respected and people were treated as individuals. Staff demonstrated they understood peoples' care and mental health needs. People using the service had their needs assessed, monitored and reviewed through the care planning process and regular one to one meetings.

People using the service told us they felt safe and we found that staff were knowledgeable and competent.

We found that the provider responded appropriately to any complaints they raised.

People found that the provider responded appropriately to any complaints they raised. There was an effective system for maintenance and repairs of the premises and equipment in place. Not sure this is necessary as it is a regulation to have the premises in good order.

These views and comments were borne out by most of what we found in our inspection. However, action to address areas of the home identified as unfit for purpose and in need of repair at our previous inspection was still outstanding at our recent inspection. Consequently, we found that people may continue to be at risk because some areas of the home had not been maintained adequately. We were told though that the funding for repairs and refurbishment had now been approved and a schedule was in place to carry out the work required.