Wings

About the service

Wings is a residential care home providing personal care to up to six people. The service provides support to adults with a learning disability, autistic people, mental health, physical disability and older people. At the time of our inspection there were six people using the service. Wings is a bungalow, all rooms are single, bathrooms are shared. There is a medium sized garden that is enclosed by a six-foot wooden fence. There is an office and a sleep-in room located in a separate building.

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

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

Right support: Wings is rural in location and to access the community would require access to transport. People were not consistently able to access planned day time pursuits because of a lack of staff who knew people well and could drive. This led to disappointment and sometimes anger for people.

Externally the care home fitted into the surroundings. However, the six-foot fence was not in keeping. Internally the environment had been improved since our last inspection with a newly fitted kitchen and décor throughout. The kitchen was accessible to everyone.

Right Care: People were not always encouraged or supported to become as independent as they could be or have choice and control over their support. One person had their liberty restricted by a locked gate and this led to others being restricted too. People did not receive planned and coordinated person-centred support that was appropriate and inclusive for them. An example being how medicines were managed. Everyone had medicines dispensed to them from one locked cabinet and people were asked to attend and wait their turn.

Right Culture: The values of the newly appointed registered manager are based upon empowerment and inclusivity. Therefore they will challenge the attitudes and behaviours of some of the embedded practices relating to choice and control to enable people to have their best lives whilst being appropriately supported.

People were not consistently supported to have maximum choice and control of their lives and staffing levels impacted upon the least restrictive way possible and peoples best interests; the systems in the service did not consistently support 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 and update

The last rating for this service was requires improvement. (Published 1 April 2020) 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

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

This inspection was prompted by a review of the information we held about this service. 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.

We have found evidence that the provider needs to make improvements. Please see safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Wings on our website at www.cqc.org.uk.

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 have identified breaches in relation to staffing levels, person centred care and the service being well led by the provider at this inspection.

Please see the action we have told the provider to take at the end of this report. 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.

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.

Wings is a residential care service providing personal care and support for up to six adults who have a learning disability and/or autism or a mental health support needs. At the time of our inspection five people were being supported at the service.

Wings had been built and registered before the Care Quality Commission (CQC) policy for providers of learning disability or autism services 'Registering the Right Support' (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

The service did not consistently apply 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.

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

The outcomes for people did not always reflect the principles and values of Registering the Right Support, because people received limited support to become more independent and develop new skills, were not supported by staff to always take part in activities and were not encouraged or

supported to become more involved in the community in accordance with their identified needs.

People did not always receive a service that provided them with safe, effective and high-quality care. The environment was not always well maintained, and repairs were not actioned in a timely manner.

The service was not always well led and there was a lack of quality assurance processes in place to identify the issues found during the inspection.

People were supported by staff who had a good understanding of how to recognise and report potential harm or abuse and were confident in local safeguarding procedures.

People were supported by staff who were kind and caring and who encouraged people to be as independent as possible within their home.

People were provided with a choice of meals which considered their likes and dislikes and were encouraged to eat a varied diet that took into account their nutritional needs. People were supported to access healthcare professionals when needed to maintain their health and wellbeing.

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 (published 11 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service is registered to provide care and support for up to six people with learning disabilities and conditions related to their mental health. At the time of our inspection six people were using the service.

There was a registered manager in post but they were on a period of extended leave, which they had previously notified us about, and the service was being managed by their deputy. 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.

Staff were trained in safeguarding people from the risk of abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns they may have. Appropriate action had been taken in response to safeguarding concerns.

Risks had been assessed and actions taken to try to reduce these risks.

Staffing levels matched the assessed safe levels. Recruitment procedures, designed to ensure that staff were suitable for this type of work, were robust and there was ongoing recruitment to fill current vacancies as a priority.

Medicines were administered safely and records related to medicines management were accurately completed.

Staff training was provided but some had not been appropriately updated, according to the provider’s own schedule. Some relevant training related to the management of acquired brain injury, epilepsy and mental health had not been provided to all staff.

Staff had received training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS), although some staff had not had this for several years. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. One application had been made to the local authority but locks and keycodes for the main doors meant that others were effectively being deprived of their liberty and the manager has since begun the process of assessing people’s capacity to consent to this to ensure it is lawful.

People were supported with their eating and drinking needs and staff helped people to maintain good health by supporting them with their day to day healthcare needs.

Staff were very caring and treated people with kindness, making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for.

People, and their relatives, were involved in planning and reviewing their care and were encouraged to provide feedback on the service. Some care plans required further updating were in to reflect people’s current needs.

People had opportunities to follow a range of outside interests and hobbies, although these were currently somewhat limited due to a lack of drivers for the service vehicle.

There was a complaints procedure in place but no formal complaints had been made. Informal concerns had been managed well.

Staff understood their roles and felt well supported by the acting manager.

Effective systems were in place to assess the quality and safety of the service and action had been taken to address any concerns. There was clear management oversight of the day to day running of the service. The manager had submitted all the required notifications regarding health and safety matters to CQC. Record keeping was acceptable, although some records needed further updating to reflect current needs.