Wurel House

Updated 13 April 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by an inspector.

Service and service type

This service is registered to provide care and support to people living in a 'supported living' setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; the premises were unoccupied. This service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats. This inspection looked at their personal care and support.

The provider of the service was also the manager of the service.

Notice of inspection

We gave the service 24 hours' notice of the inspection. This was because it is a small service and we needed to be sure the office was open, and staff were available to speak with us.

Inspection activity started on 10 February 2023 and ended on 24 February 2023. We visited the service on 10 and 17 February 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and sought feedback from partner agencies and professionals. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection,

We spoke with the manager and the operations director. We reviewed 5 people’s care records, risk assessments and daily records. We also looked at 7 staff files including their recruitment, supervision and training records. We reviewed records relating to the management of the service and a variety of policies and procedures implemented by the registered persons.

After the inspection we spoke with 3 relatives of people using the service and 2 care staff. We continued to seek clarification from the provider to validate evidence found. The provider supplied information relation to training, staff rotas and access to their electronic care records as requested during the inspection.

Updated 13 April 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, Right care, Right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Wurel House is a small four bedroom supported living service and domiciliary care service providing support to people living in their own houses and flats. At the time of our inspection, 5 people received domiciliary care in the community and no one was living within the supported living service. All 5 people received a domiciliary care package providing support with personal care. This is help with tasks related to personal hygiene and eating. We also considered any wider social care provided.

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

Right Support:

Staff supported people to complete personal care tasks and activities. Staff enabled people to access specialist equipment and health and social care support in the community. However, processes were not in place to ensure equipment used in people’s homes, such as lifting hoists and pressure relieving equipment, were safe to use or maintained. We did not identify that any equipment was not functioning correctly. We were unable to form a judgement about whether staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. This was because, other than the application of skin creams, the provider was not supporting anyone with management or administration of medicines. However, staff had received medicines training and had been competency checked.

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.

Right Care:

Enough staff were deployed; they were recruited safely and adequately checked to ensure they were suitable to work with people. However, individual risks were not always assessed and managed to keep people safe. Some care plans required further development to provide step by step guidance for staff to reflect specific considerations of some risk assessments. We found no evidence that people had been harmed, however, systems were not robust enough to demonstrate assessments of risk and care planning were always effectively managed.

Right Culture:

People and those important to them, were involved in care planning. Staff were able to communicate well with them. The provider had developed core values and behaviours for staff, which promoted a caring and enabling culture. People spoke positively about the service and the staff who supported them. However, the systems in place to audit the quality of the service were not always effective to alert the provider to the concerns and issues; audits had not picked up areas which were identified during this inspection.

People using the service told us the staff and manager were approachable and friendly; people felt safe when staff supported them and when they were in their home. Staff were introduced to people before they started to support them. People told us staff stayed for the full duration of the planned visit.

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 inadequate (published 29 June 2022) and there were breaches of regulation. These related to risk management, medicines management, infection control, recruitment staff deployment, safeguarding people from abuse, capacity and consent, staff training, assessment of care, records, complaints, reporting of notifiable events and effective systems to monitor and improve the service. We served the provider warning notices and asked them to meet the breached regulations by 31 May 2022.

We carried out a targeted inspection (published 24 November 2022) to check that action had been taken. We found that they had not been met and we took further enforcement action against the provider.

At this inspection we found areas of improvement but the provider remained in breach of some regulations.

This service has been in Special Measures since 29 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

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 see what action we have asked the provider to take at the end of this full 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.

Enforcement

We have identified breaches in relation to risk management, care planning and quality assurance process at this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well Led sections of this full report.

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.