Archived: Disabilities Trust - 25 Welby Close

Updated 15 November 2019

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.

Inspection team

This inspection was carried out by two inspectors on the first day of inspection and one inspector on the second day of inspection.

Service and service type

The Disabilities Trust, 25 Welby Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. However, at the time of inspection we were informed by the management team that the registered manager had left their post and they were in the process of deregistering them.

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.

During the inspection

We spoke with the regional manager and team leader. We will refer to them in this report as the management team. We spoke to three people about their experience of the care provided. We also observed staff members interacting with people. We looked at three people’s care records and their associated medicine records for those that were administered medication. We looked at records of accidents, incidents, and complaints received by the service. We looked at one recruitment records, staff supervision and appraisal records, staff training matrix and audits completed by the management team.

After the inspection

We requested additional information. This included some of the providers policies and procedures. We received feedback from one relative. We requested feedback from five care staff and three professionals but did not receive a reply.

Updated 15 November 2019

About the service

Disabilities Trust - 25 Welby Close is a care home without nursing. The service supported three people with learning disabilities or autism. The service is situated in a quiet residential area of Maidenhead, Berkshire. The house has two

floors.

The service was not always 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 did not always 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

There were not always clear safeguarding systems in place to protect people from risk of abuse.

It was evident where a safeguarding incident had occurred, the management team had not always followed their policies and procedures and informed the local authority.

Risks to people were not always managed safely. People’s risk assessments were not reviewed on a regular basis to ensure they were kept up to date and reflected any changing needs.

Risk assessments were not person centred. All care files contained risk assessments for people which were all initially scored as medium risk. There was no clear matrix or scoring tool to help staff determine what risk rating the assessment should be scored.

Required staff recruitment checks including criminal checks with the Disclosure and Barring Service were carried out. However, the management team could not always evidence they had taken a full employment history of staff. We could not be assured staff were been supported by people who had undergone the appropriate employment checks.

Medicines were not always managed safely by the service. For example, where people were prescribed 'as required' (PRN) medication, the service did not always have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

We recommended the provider consider current legislation related to the safe management of medicines and update their practice accordingly.

The management team used systems and processes to monitor quality and safety in the service. However, We identified some inconsistencies in record keeping that had not been identified from their quality assurance processes

Services registered with Care Quality Commission (CQC) are required to notify us of significant events, of other incidents that happen in the service, without delay. The management team had not consistently notified CQC of reportable events within a reasonable time frame. Three incidents had been identified as being unreported.

People had an autism profile in their care files that clearly highlighted their social, physical, communication and sensory needs to help guide staff when engaging with people.

People were involved in decisions about the decoration of their rooms. All bedrooms were personalised and set out in the way that people wanted. All people had their own bathroom facilities to use.

All people had communication profiles so that staff could clearly see how a person liked to be supported.

People’s individual care and support needs had been assessed, with assessments in place for areas such as mental capacity, medication, communication and interaction profile.

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.

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 28 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive, effective and well led sections of this full report.

Enforcement

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breach in regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment), regulation 16 (Receiving and acting on complaints), regulation 17 (Good governance) and regulation 19(Fit and proper persons employed). We found one breach of the Care Quality Commission (Registration) Regulations 2009. This was a breach regulation 18 (Notification of other incidents).