Wey View

Wey View is a care home providing accommodation and personal care for up to 10 people with learning disabilities and/or autism spectrum condition. There were five people living at the home at the time of our inspection.

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

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.

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

Right support:

The number of staff on duty each day was sufficient to keep people safe, but did not reflect the number of commissioned staffing hours each day. This meant some people were not receiving personalised support to ensure they had opportunities to enjoy meaningful activities, participation in their community and a good quality of life. The provider was aware of concerns raised by relatives and staff about restricted opportunities for people to take part in activities or to access the community but had not effectively addressed these concerns.

The provider was aware of concerns raised by relatives and staff that people were not receiving their commissioned support hours. Some relatives felt their family members were not enjoying a good quality of life because they were not receiving support to access their community or to take part in meaningful activities. However, the provider had not acted to ensure people received the support they needed to live fulfilling and meaningful lives.

Right care:

Staff knew how to recognise and report abuse or poor practice. When safeguarding concerns had been raised, these had been reported and investigated. The provider’s recruitment procedures helped ensure only suitable staff were employed.

Medicines were managed safely. Risk assessments were in place to help keep people safe. Accidents and incidents were reviewed and action taken to help prevent similar events happening again. The home was clean and hygienic and staff understood how to minimise the risk of infection.

People who did not use speech were supported to express their needs and wishes through alternative methods of communication. 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 provider’s positive behaviour support (PBS) team had developed individual PBS plans for people, which contained guidance for staff about the potential triggers for emotional reactions and strategies for staff to employ when responding to the reactions.

Right culture:

There had been a number of management changes in the months prior to our inspection, which had affected the consistency of leadership and communication with relatives. Relatives told us communication with them had recently improved and we found the registered manager had improved several aspects of the service since taking up their post, including quality monitoring systems.

People who lived at the home, their relatives and staff had opportunities to give feedback about the service. The registered manager supported staff well and was available for advice and guidance. Team meetings took place regularly, to which staff were encouraged to contribute. The service had established effective working relationships with other professionals involved in people’s care.

Relatives knew how to complain and felt able to raise concerns if necessary. A complaint from two relatives about the support their family member was receiving was being managed in line with the provider’s complaints procedure at the time of our inspection.

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 the service was good, published on 22 October 2020.

Why we inspected

We received concerns in relation to staffing and opportunities for people to take part in activities or to access the community. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the responsive section of this report. You can see what action we have asked the provider to take at the end of this report.

Follow up

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

Wey View is a care home providing accommodation and personal care tor up to 10 people with autism and/or learning disabilities. There were three people living at the home at the time of our inspection. Eight people can be accommodated in the main building and two people lived in self-contained annexes. The home has a large, well-maintained garden.

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

People received safe and consistent care that was personalised to their individual needs. Any risks involved in people’s care were recorded and measures had been implemented to mitigate these.

The home was clean and hygienic. Additional infection control measures had been implemented to protect people and staff during the pandemic, including the use of appropriate personal protective equipment (PPE), more frequent cleaning of the home and ensuring staff were up-to-date with guidance about infection control.

Medicines were managed safely. Staff attended relevant training before administering medicines and followed good practice guidance in medicines management.

Staff received the training they needed to carry out their roles, including in techniques designed to manage behaviours safely and effectively. New staff had a comprehensive induction and all staff were supported through regular supervision.

People were supported to maintain good health and to access healthcare treatment if they needed it. Each person had a hospital passport, which contained information about their care in the event of a hospital admission.

The monitoring and management oversight of the service had improved since our last inspection. Regular checks and audits had been introduced and the registered manager carried out observations to ensure that staff provided safe and effective support. We heard positive feedback from people, relatives and staff about the improvements implemented by the registered manager since they took up their post.

People, relatives and staff were able to contribute to the development of the service. A relative told us communication with them had improved and that they were consulted about their family member’s care. Team meetings took place regularly and staff said they were able to make suggestions for improvements.

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.

Why we inspected

We carried out an unannounced inspection of this service on 31 January 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor the service action plan to understand what the provider will do to improve 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.

Wey View is a residential service that provides support to people with learning disabilities, autism and mental health conditions. They provide intensive support to people with complex needs. The service is registered to provide support to up to ten people, there were five people living at the service at the time of our visit.

People’s experience of using this service:

The outcomes for people using the service were not consistently reflecting the principles and values of Registering the Right Support as one person had had restrictions applied to them, limiting their choice, control and involvement without proper legal processes being followed.

Risks to people were not always managed safely. We identified instances where records relating to risk were not clear and measures to manage risk were not robust. We also identified the person's assessment did not gather enough information about their needs. The providers systems to monitor and audit care delivery had not proactively identified and addressed the breaches of the legal requirements found on this inspection.

People received a thorough assessment before coming to live at the service but we identified one example where this could have been more robust. People had detailed care plans and we saw evidence of systems to regularly involve people in their care. People’s healthcare needs were met and we saw records to show staff supported people to understand their health. People’s care plans had input from healthcare professionals and staff ensured people’s health was regularly checked. Staff were caring and committed to providing good care to the people they supported. People had individualised activity timetables which included leisure activities as well as activities to develop their skills and independence.

There were sufficient numbers of staff to meet people’s needs and staff had received training for their roles. Staff told us they felt supported by management and there was an open door policy. There was a new registered manager in post who was implementing improvements at the time of our visit and we saw evidence that they had started to implement improvements in response to our findings after the inspection.

Rating at last inspection: Good

Why we inspected: We were made aware of incidents at the service that showed there may be increased risk so we brought the inspection forward.

Follow up: We will request an action plan from the provider and continue to monitor the service closely. We will return to the service to re-inspect in line with our policy.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service Good.

Why the service is rated Good

People benefitted from a proactive approach to risk management and staff responded appropriately to incidents. Where there had been some recent concerns about staff culture, the provider had learned from these and identified plans to resolve them. People’s medicines were managed safely and the home was clean, reducing the risk of the spread of infection. There were enough staff working at the home to keep people safe and the provider carried out appropriate checks on new staff to ensure that they were suitable for their roles.

The food on offer matched people’s preferences and dietary needs. 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’s had access to healthcare professionals and the home environment was adapted to ensure it met people’s needs. Staff had received appropriate training and support for their roles.

People were supported by caring staff that they got on well with. Staff took time to involve people in their care and care was planned in a way that encouraged people to be independent. Staff were respectful of people’s privacy and dignity when providing support to them.

Care was planned in a person-centred way and staff knew what was important to people. People had access to a range of activities that were personalised to their needs and interests. Care plans were regularly reviewed and any changes were actioned by staff. There was a complaints procedure in place that was accessible to people and complaints were investigated and responded to appropriately.

People interacted well with the registered manager and staff had regular meetings to contribute to the running of the service. Regular checks and audits were carried out to identify improvements to people’s care. People were regularly involved in the running of the home through meetings and surveys. Where appropriate, the provider had notified CQC of significant events in line with their statutory duty to.

Further information is in the detailed findings below

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the key area of effective care as that was the area that required improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wey View on our website at www.cqc.org.uk.

Improvements to staff training had been implemented and staff had access to training that was tailored to people’s needs. Staff completed mandatory training as well as an induction so that they were effective in their roles. Staff received regular supervision and told us that they felt supported by management.

People’s rights were protected because staff worked in accordance with the Mental Capacity Act (2005). Where decisions were being made on people’s behalf, assessments were carried out. Best interest decisions involved relatives and healthcare professionals. Where people were deprived of their liberty, the correct legal process was followed.

People’s nutritional needs were met. People were prepared meals in line with their dietary requirements and preferences. People had access to healthcare professionals. Staff worked alongside healthcare professionals to meet people’s needs.

Wey View is a home providing support to up to 10 people living with learning disabilities, autism, complex needs and mental health problems. At the time of our inspection there were four people living at the home.

There was no registered manager in post, the current manager was in the process of being registered. 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 training was not always tailored to the individual needs of people who live at the home. In one instance staff did not feel equipped to deal with one person’s very complex behavioural needs. This meant that the person’s behaviour impacted on other people living at the home and meant that staff did not always feel confident in supporting this person.

The lack of additional training for staff supporting people with complex needs was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home environment was not homely due to the need to create a safe space for one person living at the home. This affected other people and created an atmosphere in the home that was not inclusive of all people who lived there. However this was due to a temporary situation that was being resolved.

Staff told us that they received a thorough induction. People and relatives told us that staff were effective in their roles.

Staff understood their role in safeguarding people. They had received training and demonstrated a good understanding of how they would protect people from abuse of potential harm. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence.

Policies and procedures were in place to keep people safe in the event of emergencies. People had individual plans to keep them safe in the event of an emergency. Staff were trained in how to respond in the event of a fire and contingency plans were in place to keep people safe.

The manager had a system in place to ensure appropriate numbers of staff were working to meet the needs of people. Checks were undertaken to ensure staff were suitable for their roles.

People were administered their prescribed medicines by staff who had received medicines training. Medicines records were up to date to ensure medicines were administered safely.

Staff provided care in line with the Mental Capacity Act (2005). Records demonstrated that people’s rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

People were supported to eat in line with their preferences and dietary requirements. People were involved in choosing meals and preparing food. Records contained details of people’s dietary requirements and preferences.

Staff treated people with dignity and respect. All caring interactions that we observed were positive and staff demonstrated a good understanding of how to respect people’s dignity.

Information in care plans reflected the needs and personalities of people. Staff had a good understanding of people’s needs and backgrounds as detailed in their care plans. People had choice about activities they wished to do and staff encouraged people to pursue new interests.

The manager had systems in place to monitor and ensure quality at the service.

Staff told us that they were well supported by management and had regular supervision.

People and relatives told us that they had a positive relationship with the manager.

During the inspection we found a breach 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.